Orally administered levofloxacin as prophylaxis against pacemaker infection.

OBJECTIVES: Despite paying careful attention to surgical details and sterile procedures, infection often occurs after pacemaker implantation. The prophylactic use of intravenously or orally administered antibiotics should therefore be considered. The present study aimed to evaluate the efficacy of orally administered levofloxacin (LVFX) as prophylaxis against pacemaker infection. METHODS: Thirty-nine patients who underwent permanent pacemaker implantation or pacemaker generator replacement due to battery depletion were included in the present study. Patients were divided into two groups (groups 1 and 2) and administered different antibiotics accordingly. Group 1 included 19 patients (75.7+/-9.3 years of age; 10 men and nine women) who were intravenously administered 2 g of cefazolin daily for five days postoperatively. Group 2 included 20 patients (73.7+/-14.4 years of age; 10 men and 10 women) who were orally administered 200 mg of LVFX 2 h before surgery and then 400 mg daily for five days thereafter. RESULTS: In group 1, the mean white blood cell concentrations before, and one, four and seven days after surgery were 4979+/-1330/mm(3), 6453+/-1200/mm(3), 5463+/-1303/mm(3) and 5632+/-1154/mm(3), respectively, and in group 2, they were 5931+/-1316/mm(3), 7062+/-1774/mm(3), 5708+/-1402/mm(3) and 5345+/-1506/mm(3), respectively. In group 1, the mean blood C-reactive protein concentrations before, and one, four and seven days after surgery were 0.27+/-0.34 mg/dL, 0.48+/-0.48 mg/dL, 1.04+/-0.99 mg/dL and 0.52+/-0.48 mg/dL, respectively, and in group 2, they were 0.43+/-0.54 mg/dL, 0.52+/-0.27 mg/dL, 0.61+/-0.42 mg/dL and 0.56+/-0.63 mg/dL, respectively. The inflammatory parameters showed similar responses in both groups. CONCLUSIONS: Orally administered LVFX following permanent pacemaker implantation can prevent pacemaker infection as successfully as intravenously administered cefazolin.

Successful catheter ablation of ventricular tachycardia originating from the idiopathic saccular apical left ventricular aneurysm.

Left ventricular (LV) aneurysm has been recognized to frequently become a substrate of ventricular tachyarrhythmias. We report a case of a 66-year-old woman with symptomatic sustained monomorphic ventricular tachycardia (SMVT) originating from saccular apical LV aneurysm without definite underlying diseases. We performed catheter ablation using electroanatomical and conventional bipolar potential mapping. During SMVT, we found an area of fragmented potential -40 ms preceding the earliest wide QRS complex in the area of the apical LV aneurysm. Radiofrequency applications were delivered to this area. Since then, SMVT was no longer inducible by programmed electrical stimulation. The patient has remained free of VT recurrences during a subsequent 12-month follow-up period.

Atrial septal defect in apical hypertrophic cardiomyopathy associated with coronary spasm.

Apical hypertrophic cardiomyopathy (HCM) is a well-known myocardial disease, but the additional coexistence of an atrial septal defect (ASD) and coronary spasm is quite rare. We report here on a 62-year-old man suffering from congestive heart failure due to apical HCM complicated by coronary spasm and secundum-type ASD. The transthoracic, transesophageal echocardiography and cardiac catheterization were useful for diagnosing and evaluating of the patient's status. A calcium channel blocker was given to prevent coronary spasm, and a surgical patch closure operation was successfully performed. Afterwards, his symptoms were alleviated.