Assuntos
Circulação Assistida/métodos , Cateterismo Cardíaco/métodos , Cardioversão Elétrica/métodos , Balão Intra-Aórtico/métodos , Marca-Passo Artificial/métodos , Biópsia por Agulha/métodos , Cardioversão Elétrica/efeitos adversos , Hemodinâmica , Humanos , Monitorização Fisiológica/métodos , Pericárdio/cirurgiaRESUMO
Prophylactic pacemakers should be recommended for all preoperative patients with second- and third-degree heart block, regardless of whether the block is in the AV node or the trifascicular conduction system. Symptomatic patients with potential for trifascicular block should also have a transvenous pacemaker. Those without symptoms should be monitored during anesthesia and the postoperative recovery period.
Assuntos
Arritmias Cardíacas/diagnóstico , Sistema de Condução Cardíaco/fisiopatologia , Cuidados Pré-Operatórios/métodos , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Bloqueio Cardíaco/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Marca-Passo Artificial/métodos , Síndrome do Nó Sinusal/fisiopatologiaRESUMO
The records of 1,235 consecutive patients treated with long-term pacing by the endocardial route between 1964 and 1977 were analyzed to determine the incidence, mechanism, course and treatment of septicemia. Septicemia developed in 12 patients (1 percent), and Staphylococcus aureus was isolated from the blood culture in 10. All patients were treated with the usual prolonged course of bactericidal drugs. Treatment was successful in only two of the seven patients whose endocardial pacing system was left in place; in three of the seven the septicemia recurred, necessitating removal of the endocardial system, and two of these patients died. In the remaining four patients the endocardial wire was promptly withdrawn, with use of a thoracotomy when necessary, and an epicardial system inserted; all of these patients survived. This is the treatment of choice.
Assuntos
Marca-Passo Artificial/efeitos adversos , Sepse/etiologia , Infecções Estafilocócicas/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Endocardite Bacteriana/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/métodos , Sepse/epidemiologia , Sepse/terapia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/terapiaRESUMO
In a patient with syncope and sinus bradycardia the left superior vena cava drained into the right atrium via the coronary sinus. He underwent permanent transvenous pacemaker implantation via the tortuous left superior vena-caval route, and has continued to show normal pacing over an 18-month follow-up period. The problem of pre-operative recognition and the optimum means of permanent and temporary pacing in this condition are discussed.
Assuntos
Eletrodos Implantados , Marca-Passo Artificial/métodos , Veia Cava Superior/anormalidades , Idoso , Bradicardia/terapia , Humanos , MasculinoRESUMO
The electrotonic interactions of a parasystolic pacemaker with ventricular responses to the normal pacemaker across an area of depressed excitability were simulated in a model consisting of strands of canine Purkinje fibers mounted in a sucrose gap preparation. Experiments were conducted to study the patterns of ectopic activity that result from entrainment of the "ectopic" pacemaker (EP) on one side of the sucrose gap by evoked responses (sn) on the other side of the gap. When one-way conduction ("entrance block") was established, manipulations of the SN frequency and of the impedance between the two outer chambers resulted in periods of silence, concealed or manifest bigeminy, trigeminy and quadrigeminy, and periods of more complex patterns of group beating as the entrainment ratios changed. The results confirm the predictions of the previously described mathematical model that these patterns depend on the magnitude of the electrotonic influence of SN on the EP cycle length and also on the ratio of the intrinsic frequencies. These studies should help to distinguish between reentrant and parasystolic mechanisms in clinical arrhythmias.
Assuntos
Modelos Biológicos , Marca-Passo Artificial/métodos , Animais , Cães , Ramos Subendocárdicos/fisiologiaRESUMO
One hundred and three patients undergoing pacing procedures have been studied, the majority requiring the insertion of an epicardial system under general anaesthesia. The main findings were of an elderly group of patients with a high incidence of associated disease, who suffered predominantly from pulmonary and renal complications. Methods of reducing these complications, particularly in relation to general anaesthesia are discussed.
Assuntos
Anestesia Geral/efeitos adversos , Marca-Passo Artificial/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , RiscoRESUMO
We report here on two female patients who had permanent pacemakers implanted in their chests and who developed carcinoma of the breast subsequently. An association is suspected between the breast cancer and the pacemaker, which is implanted in an area which borders with the mammary gland or is even right within it. This suspicion led us lately to change in female patients the site of the subcutaneous pocket for the implantation of the pacemaker to a position higher in the chest than before. Moreover, we advocate frequent breast examinations in all female patients with implanted pacemakers.
Assuntos
Adenocarcinoma/etiologia , Neoplasias da Mama/etiologia , Carcinoma Intraductal não Infiltrante/etiologia , Marca-Passo Artificial/efeitos adversos , Idoso , Mama/lesões , Feminino , Humanos , Marca-Passo Artificial/métodos , Doença de Paget Mamária/etiologia , Ferimentos e Lesões/complicaçõesRESUMO
Complications from the use of permanent cardiac pacemakers are frequent and manifold. The most common complications associated with pacemaker electrodes, both endocardial and myocardial, as well as their prevention and treatment are discussed. Also described is a new technique of inserting a myocardial electrode without formal thoracotomy.
Assuntos
Marca-Passo Artificial/efeitos adversos , Eletrodos Implantados , Traumatismos Cardíacos/etiologia , Humanos , Marca-Passo Artificial/instrumentação , Marca-Passo Artificial/métodos , Tromboflebite/etiologia , Veias/lesõesRESUMO
A patient with an R-wave inhibited permanent pacemaker required electroconvulsive therapy (ECT). Possible interference by this therapy with pacer functioning through external interference or internal interference by inhibitory myopotentials was eliminated by temporary conversion to fixed rate pacing before ECT.
Assuntos
Depressão/terapia , Eletroconvulsoterapia , Marca-Passo Artificial/instrumentação , Idoso , Feminino , Bloqueio Cardíaco/terapia , Humanos , Marca-Passo Artificial/métodos , RiscoRESUMO
A method of achieving permanent pacing by the use of a single bipolar transvenous lead is described, the atrial and ventricular electrodes being located on the same lead 14--17 cm apart. The new leads have been implanted successfully in two patients.
Assuntos
Bloqueio Cardíaco/terapia , Marca-Passo Artificial/métodos , Eletrocardiografia , Eletrodos Implantados , Átrios do Coração/fisiopatologia , Bloqueio Cardíaco/fisiopatologia , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Cava SuperiorRESUMO
A method is presented for cannulating the external jugular vein and implanting a pacemaker through one incision. No increase in morbidity over the conventional methods has been demonstrated. This technique is an attractive alternative to the standard emthods in use.