Pacing and clinical electrophysiology : PACE
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Effects of direct radiation on implantable cardiac devices have been well studied. However, the effects of scatter radiation are not as clear. Recommendations on management of patients with implantable cardiac devices undergoing radiotherapy are based on limited studies mostly involving pacemakers. We sought to elucidate the effects of scatter radiation on implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT)-ICDs. ⋯ Device reset or malfunction associated with scatter radiation likely represents an unpredictable, rare occurrence. While we see no clear contraindication to radiotherapy in patients with ICDs or CRT-ICDs, precautions should be taken to avoid direct radiation exposure and to closely evaluate patient outcomes before and after the radiation course.
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Pacing Clin Electrophysiol · Jun 2008
Case ReportsPrecipitation of ventricular fibrillation by intravenous diltiazem and metoprolol in a young patient with occult Wolff-Parkinson-White syndrome.
We report the case of a young man who presented with a rapid, narrow-complex atrial fibrillation. A few hours after being administered intravenous metoprolol and diltiazem for rate control, he developed intermittent ventricular preexcitation on the electrocardiogram (ECG) and experienced ventricular fibrillation, from which he was successfully defibrillated. ⋯ A left lateral accessory pathway was successfully ablated. Wolff-Parkinson-White syndrome should be included in the differential diagnosis when a young patient presents with atrial fibrillation, even if the ventricular complexes on the ECG are not preexcited.
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Pacing Clin Electrophysiol · May 2008
Case ReportsLeft innominate vein aneurysm finding during pacemaker lead insertion.
Thoracic vein aneurysms are very rare vascular lesions, usually detected as incidental findings. We describe the case of a patient with an advanced atrioventricular block who underwent definitive pacemaker implantation. In order to explain the difficult advancement of a pacemaker lead, vein angiography was performed during the procedure and a large innominate vein aneurysm was observed. Successful lead placement was then performed without further complications.
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Pacing Clin Electrophysiol · May 2008
Deactivating implanted cardiac devices in terminally ill patients: practices and attitudes.
Clinicians may receive requests to deactivate pacemakers and implantable cardioverter-defibrillators (ICDs) in terminally ill patients. ⋯ Deactivation of implanted cardiac devices in terminally ill patients is common. Practices and attitudes associated with pacemaker deactivation differ significantly from those associated with ICD deactivation. Professional groups should develop guidelines for managing requests for implanted cardiac device deactivation and should clarify the role of device industry representatives in these deactivations.