Search

Pacemaker (PM) and implantable cardiac defibrillator (ICD) malfunction is a serious and frequent finding in clinical setting. Depending on baseline rhythm and the type of malfunction, symptoms with different severity can occur, from no symptoms to syncope and sudden death due to asystole or ventricular fibrillation. Unfortunately, symptoms, such as asthenia, dizziness, dyspnea, and palpitations, are often vague, and this can lead to a dangerous delay in cardiac implantable electronic device (CIED) malfunction detection. An ECG recording and careful device and lead evaluation by means of telemetry are necessary for the diagnosis. A great help to early detection of CIED malfunctions is coming from remote control, allowing therapeutic interventions within 24 h since the malfunction occurs in most cases.

To evaluate the prevalence of severe right atrial conduction delay in patients with sinus node dysfunction (SND) and atrial fibrillation (AF) and the effects of pacing in the right atrial appendage (RAA) and in the inter-atrial septum (IAS).Forty-two patients (15 male, 72 +/- 7 years) underwent electrophysiologic study to measure the difference between the conduction time from RAA to coronary sinus ostium during stimulation at 600 ms and after extrastimulus (DeltaCTos). Patients were classified as group A if DeltaCTos60 ms and group B if60 ms. Each Group was randomized to RAA/IAS pacing and algorithms ON/OFF.Fifteen patients (36%, group A) had DeltaCTos = 76 +/- 11 ms and 27 patients (64%, group B) had DeltaCTos = 36 +/- 20 ms. Twenty-two patients were paced at the RAA and 20 at the IAS. During the study, no AF recurrences were reported in 11 of 42 (26%) patients, independently of RAA or IAS pacing. Patients from group A and RAA pacing had 0.79 +/- 0.81 episodes of AF/day during DDD, which increased to 1.52 +/- 1.41 episodes of AF/day during DDDR + Alg (P = 0.046). Those with IAS pacing had 0.5 +/- 0.24 episodes of AF/day during DDD, which decreased to 0.06 +/- 0.08 episodes of AF/day during DDDR + Alg (P = 0.06). In group B, no differences were reported between pacing sites and pacing modes.Severe right atrial conduction delay is present in one-third of patients with SND and AF: continuous pacing at the IAS is superior to RAA for AF recurrences. In patients without severe conduction delay, no differences between pacing site or mode were observed.

From January 2003 to February 2005, 30 consecutive patients (mean age 54±8.7 years, 27 male, 3 female) waiting for a catheter ablation of atrial fibrillation underwent gadolinium-enhanced magnetic resonance imaging (MRI) before the procedure. Variant pulmonary vein anatomy was observed in 12 (40%) of patients. The most frequent was a common left trunk (5 patients). Right middle pulmonary vein was observed in 4 cases, two right middle pulmonary veins in 2 cases and a common right trunk in 2 cases. One patient showed a common right trunk together with a common left trunk. Our study demonstrates the high frequency of variant pulmonary vein anatomy in the general population and demonstrates the value of MRI in facilitating catheter ablation of atrial fibrillation. Potentials benefits of obtaining preprocedural MRI include the ability to quantitatively evaluate the number, size, and shape of the pulmonary veins and the eventual choice of alternative mapping or ablation tools.

A 71-year-old male patient with end-stage heart failure, atrial fibrillation, congestive and low output symptoms, underwent biventricular pacing and atrioventricular junction ablation while anuric and hypotensive. Following atrioventricular junction ablation blood pressure increased by 20 mmHg during biventricular but not during right ventricular apical pacing. A rapid clinical improvement was observed and the patient was discharged from the hospital in NYHA functional class III.