Systemic lupus erythematosus mimics heart failure.
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Biomedical subjects
R Karaoğuz
Publications and source records attributed to R Karaoğuz.
Left atrial appendage function in patients with different pacing modes.
Many studies suggest that patients who receive a ventricular pacemaker have a higher incidence of systemic thromboembolism compared to patients receiving a physiological pacemaker. However, the exact mechanism regarding the etiology of thromboembolism remains unclear. We evaluated the left atrial appendage (LAA) functions, using multiplane transesophageal echocardiography (TEE), in patients with different pacing modes. In order to evaluate the ejection fraction (EF), peak emptying (V(E)) and filling (V(F)) flow velocities of the LAA by TEE, we studied 31 patients (mean age 63+/-18.5 years) who had been paced for 5.0+/-2.9 years. Patients with atrial fibrillation, left ventricular dysfunction and mitral valve disease were excluded. The pacing indications were complete atrioventricular block (AVB) in 19 patients (9 VVI, 10 VDD or DDD) and sick sinus syndrome (SSS) in 12 patients (5 VVI, 7 DDD). Mean EF, V(E) and V(F) of the LAA were significantly lower in all patients with ventricular pacing (25.5+/-15.6%, 30.4+/-15.6 cm/s and 29. 1+/-19.2 cm/s, respectively) compared to those with physiologic pacing (48.5+/-16.9%, 59.6+/-16.3 cm/s, 57.9+/-18.5 cm/s, respectively) (P<0.01 in all). When patients were further classified with respect to underlying heart disease whether they had SSS or AVB, all measurements of the LAA (EF, V(E) and V(F)) in both subgroup of patients with SSS and AVB were found significantly lower in those with ventricular pacing than in those with physiologic pacing (Tables 3 and 4). This decrease, especially in LAA flow, was much greater in those with SSS (Mean V(E) and V(F) <20 cm/s). In a patient paced with VVI for SSS, a thrombus was detected within the LAA cavity. In conclusion, these results suggest that the pacing modality appeared to influence the LAA functions in paced patients. Patients with asynchronous ventricular pacing modes had a significantly higher incidence of depressed LAA functions than did patients with physiological pacing, especially more marked in patients with sick sinus syndrome. This may be a factor responsible for increased risk of thrombus formation and thromboembolic events in this patient population.
Adult↗
Atrial sensing performance of a single-lead VDD pacing system during physical activities.
This study was undertaken to evaluate the atrial sensing performance of a single-lead atrial synchronous-ventricular pacing system during various physical activities on late follow-up. Fourteen patients (mean age 55 +/- 17 years) with a third-degree or high-degree atrioventricular block and normal sinus node function were treated with the single-lead Thera VDD (Medtronic, Inc, Minneapolis, MN) pacemaker system. Mean P-wave amplitude at implantation was 3.2 +/- 1.3 mV. To assess the VDD system performance, P-wave amplitudes during various physical maneuvers (supine, sitting, deep breathing, standing, and exercise; respectively) were measured and atrial sensing was evaluated at a mean follow-up of 11 +/- 4 months. During deep breathing, minimum and maximum P-wave amplitudes (0.8 +/- 0.7, 1.2 +/- 1.0 mV, respectively) were found to be significantly lower than the standing position (minimum, 1.1 +/- 0.9, maximum, 1.4 +/- 1.1 mV P = .02 in both). No significant difference was found during other physical maneuvers. During the testing maneuvers, atrial undersensing was observed in 8 patients (57%) at the nominal atrial sensitivity of 0.5 mV. After increasing the atrial sensitivity (0.25 mV), no sensing failure was observed in these patients. It has been concluded that Medtronic Thera VDD system is a safe and reliable device with an easy implantation technique providing effective atrioventricular synchronization. The sensing problems, which may occur on late follow-up, can be corrected successfully by reprogramming. To achieve an optimal atrial sensing function in patients with a single-lead VDD pacing, we recommend that the atrial sensing capability should be examined in various physical maneuvers.
Adult↗
Undersensing of the tiny QRS complexes that emerged after the isolation of the right ventricle in a patient with ventricular tachycardia.
This article describes a patient who underwent right ventricular disconnection for medically refractory ventricular tachycardia associated with arrhythmogenic right ventricular dysplasia. After the operation there was no ventricular tachycardia recurrence. Two years after the operation, he received a permanent VVI pacemaker for the symptomatic second-degree AV block. Sensing function of the pacemaker was normal for the normal QRS complexes, but the tiny QRS complexes that appeared after the arrhythmia surgery were not sensed by the pacemaker and therefore caused no problem.
Adult↗
Severe vascular toxicity associated with cisplatin-based chemotherapy.
A 19-year-old man with a germ cell tumor who experienced hypertension, acute myocardial infarction, and cerebrovascular accident (CVA) associated with hypomagnesemia as late complications of cisplatin-based chemotherapy is presented, and previously reported cases in the literature are reviewed. Different physiopathologic mechanisms are hypothesized for early and late vascular complications of cisplatin.
Adult↗