RESUMEN
Modern implantable cardioverter defibrillators (ICD) employ dynamic sensing algorithms in order to protect against fine ventricular fibrillation without oversensing intrinsic activity. We present a patient with a Medtronic ICD who had inhibition of pacing and not inappropriate shocks due to T wave oversensing (TWOS) in both true bipolar (TB) and integrated bipolar (IB) sensing configurations. Rather than alternatives such as lead revision or programming to an unacceptably insensitive value, this was solved by exchanging for a Boston Scientific ICD. Although the literature suggests lead sensing configuration impacts TWOS, this case demonstrates ICD sensitivity algorithm may be a key determinant.
Asunto(s)
Algoritmos , Fibrilación Atrial/terapia , Desfibriladores Implantables , Electrocardiografía , Fibrilación Ventricular/diagnóstico , Adulto , Nodo Atrioventricular/cirugía , Ablación por Catéter , Desfibriladores Implantables/efectos adversos , Remoción de Dispositivos , Errores Diagnósticos , Diseño de Equipo , Falla de Equipo , Femenino , Humanos , Recall de Suministro Médico , Cardiopatía Reumática/complicaciones , Sensibilidad y EspecificidadRESUMEN
The management of alveolar clefts has changed through the years as medical knowledge has improved. An alveolar cleft is the result of abnormal primary palate formation during weeks 4 to 12 of gestation. The rationale for its closure includes 1) stabilizing the maxillary arch, 2) permitting support for tooth eruption, 3) eliminating oronasal fistulae, and 4) providing improved esthetic results. Methods for closure of the alveolar cleft have been solidified during the last century with the use of bone grafting. Secondary bone grafting is now the preferred method of treatment, because early grafting has proven detrimental to midfacial growth. Various materials for bone grafting have been proposed, including iliac crest, cranium, tibia, rib, and mandibular symphysis. Regardless of the timing and materials used, the main principles in approaching alveolar clefts have been well described. They include 1) appropriate flap design, 2) wide exposure, 3) nasal floor reconstruction, 4) closure of oronasal fistula, 5) packing bony defect with cancellous bone, and 6) coverage of bone graft with gingival mucoperiosteal flaps. Certain alveolar clefts are difficult to manage by grafting alone, and orthodontic preparation may be required. Complications of alveolar bone grafts include donor site morbidity as well as graft exposure and loss.