Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Feb 2003
Case ReportsUse of a modified, commercially available temporary pacemaker for R wave synchronized atrial pacing in postoperative junctional ectopic tachycardia.
Junctional ectopic tachycardia (JET) is a life-threatening arrhythmia frequently seen after surgical correction of congenital heart defects. This study evaluates the use of a modified, commercially available temporary dual chamber pacemaker used to reestablish AV synchrony by R wave synchronized atrial pacing, a technique not routinely applied because of a lack of appropriate equipment. Ten consecutive children with postoperative JET (median maximum heart rate 185, range 130-240 beats/min) age 0.3-45 (median 5.2) months were studied. ⋯ In conclusion, R wave synchronized atrial pacing could be easily performed using a modified, commercially available temporary dual chamber pacemaker. Significant hemodynamic benefit was achieved due to optimal AV resynchronization at intrinsic heart rate and spontaneous ventricular activation sequence. R wave synchronized atrial pacing should be included in the standard management protocol of postoperative JET.
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Pacing Clin Electrophysiol · Feb 2003
Postoperative ventricular arrhythmias after cardiac surgery: immediate- and long-term significance.
AF is frequent after cardiac surgery. However, ventricular arrhythmias are less known. The purpose of the study was to evaluate the causes and the prognostic significance of severe ventricular arrhythmias occurring after cardiac surgery. ⋯ The reduction of indexes reflecting sympathetic and parasympathetic tone could facilitate the occurrence of atrial arrhythmias (and then VT) in patients without ventricular arrhythmogenic substrate or the development of VT/VF in patients with a latent previous ventricular arrhythmogenic substrate. In patients without inducible VT, the prognosis is excellent and an ICD is not recommended in these patients. In those with inducible VT, there is a high incidence of responders to antiarrhythmic drugs with a favorable prognosis.