Pacing and clinical electrophysiology : PACE
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Twiddler's syndrome is classically described as withdrawal of pacing or defibrillator leads from their position in the heart as a result of arm motion or manipulation of the pulse generator site. Reverse Twiddler's syndrome is now reported as advancement of the leads into the heart by a similar repetitive motion but opposite in direction.
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Pacing Clin Electrophysiol · Dec 2008
Case ReportsDelayed cardiac perforation by defibrillator lead placed in the right ventricular outflow tract resulting in massive pericardial effusion.
A 76-year-old man received a dual-chamber implantable cardioverter defibrillator (ICD), with the defibrillator lead positioned within the right ventricular outflow tract. The lead parameters at the time of implantation were satisfactory and the post-procedure chest X-ray showed the leads were in place. The patient was cardioverted from atrial fibrillation during defibrillation threshold testing and commenced on anticoagulation immediately. ⋯ Pericardiocentesis was performed and the defibrillator lead replaced with a different model positioned at the right ventricular apex. The patient made an uneventful recovery. The management and avoidance of delayed cardiac perforation by transvenous leads were discussed.
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Pacing Clin Electrophysiol · Aug 2008
Case ReportsCardiac conduction disturbances and ventricular tachycardia after prolonged propofol infusion in an infant.
We report an infant who, after prolonged intravenous propofol infusion for treatment of status epilepticus, developed dramatic cardiac conduction disturbances and tachyarrhythmias in the setting of only mild metabolic acidosis and good ventricular function. Certain electrocardiographic findings were similar to those observed in the Brugada syndrome as well as in adult patients with propofol toxicity who suffered fatal ventricular arrhythmias. This case illustrates that serious arrhythmias can occur during prolonged high-dose propofol infusion in young patients, probably through a direct electrophysiologic membrane effect.