Patient exposure data and operator dose in coronary interventional procedures: Impact of body-mass index and procedure complexity.

PURPOSE: The aim of this study was to assess patient exposure data and operator dose in coronary interventional procedures, when considering patient body-mass index and procedure complexity. METHODS: Total air kerma area product (PKA), Air-Kerma (AK), Fluoroscopy time (FT), operator dose and patient body-mass index (BMI) from 97 patients' procedures (62 coronary angiography (CA) and 35 Percutaneous Coronary Intervention (PCI) were collected for one year. For PCI procedures, also the complexity index-CI was collected. Continuous variables for each of the 2 groups procedures (CA and PCI) were compared as medians with interquartile range and using Mann-Whitney U test. Multiple group data were compared using Kruskal-Wallis test (significance: p < 0.05). RESULTS: Median PKA was 63 and 125 Gy cm2 for CA and PCI respectively (p < 0.001); FT was 3 and 14 min, respectively (p < 0.001). PKA and FT significantly increased (p < 0.05) with BMI class for CA procedures. PKA and FT also increased in function of CI class for PCI, thought significantly only for FT (p < 0.001), possibly because of the low number of PCI procedures included; cine mode contributed most to PKA. Significant dose variability was observed among cardiologists for CA procedures (p < 0.001). CONCLUSIONS: Dose references levels for PKA and FT in interventional cardiology should be defined - on a sufficient number of procedures- in function of CI and BMI classes. These could provide an additional tool for refining a facility's quality assurance and optimization processes. Dose variability associated with cardiologists underlines the importance of continuous training.

An unusual way to diagnose asymptomatic right ventricular perforation by a temporary endocardial pacing electrode.

Right ventricular perforation by a temporary endocardial pacing electrode can be fatal and needs to be detected promptly. This usually symptomatic situation is diagnosed by X-ray or echocardiographic findings. We present the case of a patient with an asymptomatic right ventricular perforation, in whom serial electrocardiograms enabled us to detect the displacement of the right ventricular lead.

Role of pacing mode and algorithms for effective prevention of atrial fibrillation after coronary artery bypass surgery.

Atrial fibrillation after coronary artery bypass surgery occurs in 30 to 40% of patients. Prophylactic therapy with drugs is not always possible and not always efficient. Atrial pacing may play a role in the prevention of atrial fibrillation. Biatrial pacing with fixed high rate or overdrive and right atrial pacing with overdrive has been demonstrated to reduce the incidence of atrial fibrillation after coronary artery bypass surgery. Avoidance of undersensing and loss of capture with atrial epicardial wires is a technical challenge. Individually tailored and combined approaches are promising future directions for prophylactic therapy.

Loss of left ventricular epicardial lead capture due to pneumothorax.

Pneumothorax is a rare complication of pacemaker lead insertion by subclavian way. We report a case of temporary ineffective biventricular pacing due to pneumothorax. This complication has to be ruled out before electing to reposition or to replace the lead.