Pacemakers, implantable cardioverter/defibrillators, and extracorporeal shockwave lithotripsy: evidence-based guidelines for the modern era.

Early work examining interactions between extracorporeal shockwave lithotripsy (SWL) and implantable pacemakers or implantable cardioverter/defibrillators suggested that shockwave oversensing may result in inappropriate suppression of pacing, delivery of antitachycardia pacing therapy, delivery of inappropriate shock therapy, or outright damage to such devices. In the absence of national guidelines, those provided by manufacturers are nonuniform and practice patterns vary between centers. Improvements in SWL energy delivery as well as in device shielding and discrimination technologies have demonstrated improved safety data in recent years. We review these advances in both technologies as well as the most recent data to construct practice guidelines for the modern era.

Tumour on the tricuspid valve: metastatic osteosarcoma and the heart.

The antemortem diagnosis of cardiac metastases in osteogenic sarcoma has been documented in only 25 cases over the past 50 years, whereas a prevalence as high as 20% is seen at autopsy, suggesting that cardiac involvement is a late stage complication. As the survival times for primary osteosarcoma continue to improve, previously rare, late stage complications will undoubtedly become more prevalent. In addition to presenting a new case of cardiac metastasis with prolonged survival, the present case report reviews the 25 cases from the literature to illustrate the distinguishing characteristics and clinical presentation, as well as to draw conclusions regarding investigation and management. The demographic differences include female sex, advanced age at the time of diagnosis and longer interval to onset of secondary disease. The clinical characteristics involve hemodynamic compromise or precordial abnormality, with magnetic resonance imaging emerging as the gold standard for diagnosis. Cardiac involvement is a strong predictor of disease elsewhere and mandates careful surveillance, with surgical management likely providing the best outcome.