Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Jun 2007
Electromagnetic Interference (EMI) and arrhythmic events in ICD patients undergoing gastrointestinal procedures.
The objective was to determine the effect of electromagnetic interference (EMI) in patients undergoing gastrointestinal endoscopy. The implantable cardioverter-defibrillator (ICD) is the primary therapeutic modality for patients at risk for sudden cardiac death. One potential problem with ICDs is interactions with electrical devices and medical procedures causing EMI or triggering arrhythmic events. Endoscopy frequently employs electrocautery (EC) for diagnosis and treatment of gastrointestinal diseases. Current guidelines advise inactivating ICDs before any surgical procedure. There is limited information on management of ICDs during endoscopy with or without EC. We prospectively evaluated patients with ICDs undergoing endoscopic procedures at our institution. ⋯ Our study shows no EMI or arrhythmic events triggered during endoscopic procedures in patients with pectorally implanted transvenous ICDs. Routine practice of programming ICDs off for gastrointestinal procedures may not be necessary. However, larger studies are needed before change in current recommendations.
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Electrical cardioversion (ECV) usually requires the assistance of the anesthesiology team. To avoid this dependence, previous studies have considered the use of sedation with benzodiazepines administered by cardiologists. We describe our experience with intravenous Midazolam during cardioversion. ⋯ Sedation with Midazolam for ECV is effective and well tolerated, with some cautions discussed. A loading dose of Midazolam is well tolerated and further reduces the procedural time.
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Pacing Clin Electrophysiol · Apr 2007
Radiofrequency ablation of the ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy using non-contact mapping.
Intracardiac non-contact mapping provides a rapid and accurate isopotential mapping that facilitates catheter ablation of the ventricular tachyarrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). ⋯ The rapid ventricular tachyarrhythmias in ARVC patients can be abolished or improved significantly by regional RF catheter ablation under the guidance of non-contact mapping. There was no sudden cardiac arrest or death in those patients without ICD implantation. Delayed efficacy may occur in some patients after ablation.
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Pacing Clin Electrophysiol · Feb 2007
Case ReportsReinitiation of ventricular macroreentry within the His-Purkinje system by back-up ventricular pacing - a mechanism of ventricular tachycardia storm.
We describe immediate reinitiation of macroreentry ventricular tachycardia (VT) involving the His-Purkinje system by ventricular pacing from the electrode of an implantable cardioverter defibrillator (ICD) as a mechanism of VT storm refractory to ICD therapy. ⋯ Repetitive reinitiation of BBRT and interfascicular tachycardia by ventricular pacing from the ICD electrode should be considered as a mechanism of VT storm refractory to ICD therapy in patients with a pre-existing conduction delay within the His-Purkinje system.
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Pacing Clin Electrophysiol · Feb 2007
Clinical TrialIneffectiveness of precordial thump for cardioversion of malignant ventricular tachyarrhythmias.
The Precordial Thump (PT) is commonly used for cardiopulmonary resuscitations both in and out of hospitals. However, the support for its efficiency relies mainly on sporadic cases. In this current prospective large study, we tested the effectiveness and safety of PT in a wide range of malignant ventricular tachyarrhythmias. ⋯ PT is not effective in terminating malignant ventricular tachyarrhythmia and should be reserved to a situation in which a defibrillator is not available.