ABSTRACT
Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutter rhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery
ABSTRACT
To evaluate the admission electrocardiogram [ECG] patterns as prognostic factors and compare the Q wave with other criteria such as time, for choosing the best treatment in acute myocardial infarction [AMI] Prospective case-control study Cardiac Emergency Departments of Imam Reza and Qaem Hospitals, Mashhad, Iran A total of 143 consecutive patients between year 2010 and 2012, diagnosed with AMI who were candidates for reperfusion therapy were enrolled. The admission and control post-thrombolytic therapy ECGs were taken for all subjects. Then admission ECG patterns, time to therapy and their relation with the reperfusion rate were analyzed. 60.1% [n = 86] of patients achieved 50% or more ST recovery [good response group] and 39.8% [n = 57] of patients had lower than 50% ST recovery [poor response group]. The mean response rate was significantly lower in patients presenting with Q wave [p 0.023]. In patients with initial Q wave, there was no significant difference in response rate whether they were treated within three hours from the onset of symptoms or not [p = 0.75]. In contrast, patients without Q wave who received thrombolytic therapy within first three hours had significantly higher reperfusion rates in comparison with those treated after three hours [p = 0.004]. It is suggested that, time from the onset of symptoms along with initial Q wave is better for decision making in AMI management, than the time alone
ABSTRACT
Atrial fibrillation [AF] is the most common postoperative arrhythmic complication after coronary artery bypass graft surgery [CABG]. The aim of the present study was to compare AF prevalence after off-pump versus on-pump CABG. In this prospective study, performed between September 2008 and September 2009, 128 consecutive patients in our local cardiovascular surgery ward were allocated into two groups of off-pump [95 patients] and on-pump CABG [33 cases]. We compared preoperative risk factors such as left ventricular ejection fraction [LVEF]<%40, hypertension [HTN], and Cr>2mg/dl, site of grafting such as the left coronary descending artery [LAD], right coronary artery [RCA], and left circumflex artery [LCX] in the two groups of surgery techniques [on-pump versus off-pump CABG] with/without postoperative AF after 24 hours of surgery in the Intensive Care Unit, Statistical power of the study was 80%, and a P-value less than 0.05 was considered significant. The prevalence of AF was 15 [15.8%] in the off-pump group versus 7 [21.2%] in the on-pump group [p=0.67] 24 hours after CABG. In the on-pump group, there was no difference between age categories [p=0.11]. In the on-pump group, as opposed to the off-pump CABG group, there was no relationship between the surgery techniques with or without AF, LVEF <%40, and HTN. There was a significant relation with Cr more than 2 mg/dl in the on-pump CABG group [p=0.001] versus the off-pump CABG group [p=0.057]. There was no statistical relation between the type of vascular graft [LAD, RCA, and LCX] between the on-pump and off-pump CABG patients attributed to with or without AF. There was no reduction in the AF rate in the off and on-pump CABG versus off-pump CABG. It seems that there was another predictive factor for AF in the off and on-pump CABG groups, so further prospective trials with larger sample sizes are recommended