Pacing and clinical electrophysiology : PACE
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In recent years several trials demonstrated the efficacy of implantable cardioverter-defibrillation (ICD) therapy in reducing cardiac and total mortality in patients affected by rapid ventricular tachycardia (VT) and/or ventricular fibrillation. Nevertheless, ICD do not prevent arrhythmia recurrences, thus being a palliative and not a curative treatment modality. The tolerance to ICD therapy varies greatly, and within individuals, this leading to a nonuniform acceptance of this form of therapy. ⋯ In experienced centers, RFCA is now performed, regardless of whether the VT rate is rapid and/or is hemodynamically unstable. Newer mapping and ablation techniques are now available, enhancing the acute success rate of the procedure. In this review the most recent application of VT catheter ablation and the use of advanced mapping and ablation techniques will be discussed.
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Pacing Clin Electrophysiol · Dec 2006
Comparative StudyConvective cooling effect on cooled-tip catheter compared to large-tip catheter radiofrequency ablation.
Both actively cooled-tip and large-tip catheters are currently available clinically to create large endomyocardial lesions during application of radiofrequency (RF) energy. The purpose of this study was to compare the effect of convective cooling at physiologic flow rates on RF lesion size using both actively cooled and large-tip catheters. ⋯ During RF ablation, blood flow rate significantly affects lesion size for large-tip but not cooled-tip catheters. At low flow rates (0-1 L/min) cooled-tip catheters create larger lesions, while at high flow rates (3 L/min) large-tip catheters create larger lesions.
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Pacing Clin Electrophysiol · Nov 2006
Review Case ReportsPacemaker contact dermatitis: The effective use of a polytetrafluoroethylene sheet.
A 52-year-old man with Down's syndrome was implanted with a DDDR pacemaker for advanced atrioventricular block. He was admitted with development of skin eczema and partial exposure of the generator 1 year after reimplantation. ⋯ These findings indicated pacemaker contact dermatitis. After the patient was reimplanted with a pacemaker wrapped with a polytetrafluoroethylene sheet, there has been no recurrence of the contact dermatitis during a follow-up period of 3 years.
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Pacing Clin Electrophysiol · Nov 2006
Controlled Clinical TrialTransesophageal echocardiography in the diagnosis of thrombosis associated with permanent transvenous pacemaker electrodes.
We sought to assess the value of transesophageal echocardiography (TEE) in the diagnosis of PM-lead-associated central venous thrombi. ⋯ TEE is an excellent method to visualize electrodes within the RA and proximal SVC. Electrode-associated RA thrombi appear to be relatively common after PM implantation, and they may remain undetectable by venography or TTE. Although these thrombi are mostly asymptomatic, they can give rise to pulmonary embolism and should also be kept in mind in the differential diagnosis of endocarditis. TEE is the method of choice for the diagnosis of these lesions.
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Pacing Clin Electrophysiol · Oct 2006
Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor.
This study tested the feasibility of automatically detecting advanced sleep disordered breathing (SDB) from a pacemaker trans-thoracic impedance sensor. ⋯ It is feasible to automatically measure SDB severity using a pacemaker trans-thoracic impedance sensor. Advanced SDB was frequently undiagnosed in this cohort of pacemaker patients.