Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Jul 1998
Case ReportsTreatment of malignant neurocardiogenic vasovagal syncope with a rate drop algorithm in dual chamber cardiac pacing.
A 29-year-old man with malignant vasovagal syncope presented with episodes of abrupt loss of consciousness associated with an aura, totaling more than 10 episodes over 3 months. Holter monitoring showed cardiac arrest with a duration of 15 seconds. Oral propranolol and disopyramide therapy failed to prevent the syncope. ⋯ There may be multifactors involved in the mechanism of this syndrome. The patient has returned to a normal active life. This rate drop algorithm is an effective therapy for the prevention of syncope in malignant vasovagal syncope.
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Pacing Clin Electrophysiol · May 1998
Comparative StudyHeart rate variability in passive tilt test: comparative evaluation of autoregressive and FFT spectral analyses.
The dynamic response of the autonomic nervous system during tilting is assessed by changes in the low (LF) and high frequency (HF) components of the RR series power spectral density (PSD). Although results of many studies are consistent, some doubts related to different methodologies remain. Specifically, the respective relevance of autoregressive (AR) and fast Fourier transform (FFT) methods is often questioned. ⋯ In conclusion, significant differences between AR and FFT spectral analyses do exist, particularly in supine position. Nevertheless, dynamic trends provided by the two approaches are consistent. Normalization is necessary to evidence the LF increase during tilt.
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Pacing Clin Electrophysiol · May 1998
Long-term performance of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead.
Bipolar epicardial leads are not yet widely available for atrial use. Since September 1986, we have used a bipolar active fixation endocardial lead (Cardiac Pacemakers model number's 4266, 4268, and 4269) as a bipolar epicardial atrial lead by attaching the corkscrew tip to the atrial surface and imbricating atrial tissue around the more proximal electrode. A total of 77 bipolar epicardial atrial leads have been implanted using this approach in 72 patients with congenital heart disease (ages 3 months to 38.7 years; mean 8.9 +/- 8.8 years). ⋯ Two leads failed (high capture thresholds at 5 days [n = 1], lead fracture at 42 months [n = 1]; one of which was replaced. Four additional leads were replaced electively (marginal thresholds [n = 1], intermittent phrenic nerve stimulation [n = 1], damaged during subsequent surgery [n = 1], clinically irrelevant insulation break [n = 1]) concomitant with additional cardiac surgery. Until a commercially available lead is developed and released, improvisation with a bipolar active fixation endocardial lead as a bipolar epicardial atrial lead is a reasonable approach to providing bipolar atrial sensing and pacing in patients for whom endocardial pacing is contraindicated.
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Pacing Clin Electrophysiol · Mar 1998
Case ReportsCerebral embolism due to a retained pacemaker lead: a case report.
There are only a few reported cases of a pacemaker lead migrating inadvertently into the left atrium or ventricle. An unusual complication of unremoved, unwanted pacemaker lead is presented. The free tip of the lead caused cerebral embolism after perforating the interatrial septum.