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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 4 (1991), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Placement of a pacing lead into a branch of the coronary sinus for biventricular pacing sometimes is difficult or impossible. Surgical completion typically has included immediate or subsequent thoracotomy lead placement with hookup to the device at the time of chest surgery. We describe an alternative procedure of complete device-lead hookup and permanent pocket closure in the electrophysiology laboratory. The left ventricular lead is an epicardial type. The lead is tunneled to a position where the surgeon subsequently can recover it using the thoracotomy incision and implant the lead on the epicardium using device-based testing.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Opinions vary regarding the need to perform defibrillation testing prior to hospital discharge in recipients of state-of-the-art cardioverter defibrillators (ICDs). Our protocol is to perform predischarge ICD testing 1 day after implant. This report includes 682 consecutive implants. Adverse observations at testing were grouped into (1) risk of defibrillation failure, (2) surgical complications, (3) sensing/pacing issues or narrow defibrillation margin warranting closer follow-up, or (4) findings correctable by device reprogramming. Among the 682 patients, 63% had single-chamber and 37% dual-chamber or biventricular ICDs. In 48 patients (7%) there were 69 concerns and/or interventions, with overlaps among the four categories, including one failure to defibrillate (0.15%), and six other patients at risk. Surgical complications included 11 hematomas (1.6%), and six lead dysfunctions. Closer follow-up was indicated in 19 patients (2.7%), for high pacing thresholds in seven, sensing issues in seven, and 〈10 J defibrillation margin in five. Device reprogramming was needed in 31 patients (4.5%), for tachycardia detection and therapy settings in 12, and for pacing/sensing functions in 22 patients. In eight patients ventricular fibrillation could not be induced. There was no morbidity or mortality due to testing. The state-of-the-art ICDs delivering biphasic shocks are remarkably reliable. The routine pre-hospital discharge defibrillation testing of such ICDs may be optional and left to the physicians’ discretion.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: VIJAYARAMAN, P., et al.: Runaway Pulse Generator Malfunction Resulting from Undetected Battery Depletion. Runaway pacemaker is an uncommon, potentially lethal circuit malfunction characterized by sudden onset of erratic pacing at rapid nonphysiological rates. Two patients with a single chamber pacemaker (Medtronic ST 8331 and 8419) presented with episodic dizziness. ECG revealed recurrent decrescendo amplitude episodes of runaway stimuli at 2,400 and 2,600 ppm, approximately 3 seconds in duration, separated by pacing at 62.5 and 65 ppm, respectively. Fortunately the runaway stimuli were subthreshold and did not result in capture of the ventricle. Emergency pulse generator replacement was uneventful. Both leads were normal and both pulse generators had low battery voltages at 1.488 and 1.78 V, respectively.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices. It is uncertain whether this tradeoff for smaller size is desired by patients. We surveyed 156 patients to determine whether patients prefer a larger, longer-lasting device, or a smaller device that is less noticeable but requires more frequent surgery. The effects of subgroups were evaluated; these included body habitus, age, gender, and patients seen at time of pulse generator replacement (PGR), initial implant, or follow-up. Among 156 patients surveyed, 151 expressed a preference. Of these, 90.1% preferred the larger device and 9.9% the smaller device (P 〈 0.0001). Among thin patients, 79.5% preferred a larger device. Ninety percent of males and 89.2% of females selected the larger device. Among younger patients (≤72 years), 89.6% preferred the larger device, as did 90.5% of older patients (〉72 years). Of patients undergoing PGR or initial implants, 95% favored the larger device, as did 86% of patients presenting for follow-up. The vast majority of patients prefer a larger device to reduce the number of potential replacement operations. This preference crosses the spectrum of those with a previously implanted device, those undergoing initial implants, those returning for routine follow-up, and patients of various ages, gender, and habitus.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: PALMA, E.C., et al.: Sinus Node Recovery After 25 Years of Atrial Flutter. This case report demonstrates that the sinus node can recover relatively quickly even after being suppressed by atrial flutter for 25 years, and that a permanent pacemaker may not always be necessary in all patients with sinus arrest after a successful atrial flutter ablation.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: It is occasionally difficult to disconnect leads from headers at the time of pulse generator replacement without injuring the fragile leads. Over a 2.5-year period we encountered this problem in six cases (1.7% of pulse generator replacements). The posterior portion of the header was clipped off using an orthopedic bone cutter in four cases. The cut was aligned with the deep end of the lead socket in the header. A metal rod was then used to push the lead out of the socket. Bench testing of alternative methods was done on previously explanted pulse generators that were firmly held in a vice. Motorized microtools were used to drill holes from the end of the header to the deep end of the socket; or with a rotary saw attachment to slice off the back of the header, allowing a retained lead to be pushed out. The latter was also done with a hand held razor saw, and attempts were made with a scalpel. Lead removal in the clinical cases was accomplished quickly in the four cases using the bone-cutter, without trauma to the lead. Bench testing results varied. The bone cutter was the most efficient method for most brands, but was ineffective on one. The motorized tool was difficult to position, produced sprays of plastic particles, and would have been risky in a clinical setting. The razor saw was difficult to use safely, or efficiently, except in some headers that resisted the bone cutter. The scalpel failed except in one “soft header” pacemaker. An orthopedic bone cutter is a useful tool for removing a retained lead from a pulse generator header. Different header designs and materials necessitate knowledge of several lead detachment methods.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: FISHER, J.D., et al.: Simplified Tilt Table Test Protocol with Continuous Upright Position During Medication Administration and No Hydration. Recommendations for head-up tilt testing (HUT) often include the prolonged abstaining from food and water consumption (nothing by mouth [NPO]) and intravenous fluids administration before HUT. After the baseline test, supine equilibration periods are recommended before and between each dose of medication. The aim of this study was to determine if similar results are obtainable with a simpler protocol. After 2–3 hours NPO, 1,540 HUTs were performed at 70 degrees for 30 minutes unless predetermined endpoints were reached. Then, with the patient remaining in the tilted position, isoproterenol (ISO) (1 μg/min), titrated every 3 minutes to a maximum of 5 μg/min ( n = 803 patients), sublingual nitroglycerin (NTG) (300–400 μg) ( n = 143 patients), or edrophonium (EDP) (5 mg) repeated once after 3 minutes (n = 46 patients) were administered. No aspiration or other adverse effects attributable to the abbreviated fasting period were observed. ISO was well tolerated as doses were increased. Vasovagal manifestations developed in 31% of ISO tests, in 11% with EDP, and in 50% with NTG ( P 〈 0.001 ). Time consumed with rehydration before and postural changes during HUTs may be avoided when ISO is administered. With NTG the response may be excessive. (PACE 2003; 26[Pt. II]:451–452)
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: FISHER, J.D., et al.: Broad Applicability of Ultrarapid Train Stimulation as an Efficient Alternative to Conventional Programmed Electrical Stimulation. Background and study objective:Conventional programmed electrical stimulation (PES) is useful for establishing inducibility or noninducibility of clinical ventricular arrhythmias (VA), but is complex and time-consuming. This study compared a standard PES protocol with ultrarapid train stimulation (UTS) in a broad range of patients with and without a history of ventricular arrhythmias or structural heart disease. Methods: Patients prospectively underwent electrophysiologic testing with both UTS and conventional PES protocols in a randomized, crossover design. Results: The results were concordant in 79% of 150 matched pairs of comparisons in 104 patients (NS). There were no differences related to underlying heart disease or arrhythmia, or antiarrhythmic treatment. Induction of nonclinical arrhythmias with the two methods was similar (P = 0.524) . Inhibition phenomena were minor except in some patients receiving amiodarone. Fewer drive-extrastimuli sequences and less time were needed to complete the trains protocol (P 〈 0.0001) . Conclusions: In cases where the main intent is to induce ventricular arrhythmias, UTS yields results that are similar to those of conventional PES protocols in a shorter length of time. (PACE 2003; 26[Pt. II]:518–523)
    Type of Medium: Electronic Resource
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