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Objectives: To quantify the rate of cardiac implantable electronic device (CIED)‐related infections and to identify risk factors for such infections. Design: Retrospective cohort study; analysis of linked hospital admissions and mortality data. Setting, participants: All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals). Main outcome measures: Proportions of patients hospitalised with CIED‐related infections (identified by hospital record diagnosis codes); risk of CIED‐related infection by patient, device, and procedural factors. Results: Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED‐related infections (median follow‐up, 24.9 months; interquartile range, 11.2–40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT‐D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45–0.54) per 1000 person‐months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89–6.42] per 1000 person‐months). The risk of CIED‐related infection was greater for people under 65 years of age than for those aged 65–74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32–2.23), for people with CRT‐D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02–2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02–2.25) or had CIED‐related infections (aHR, 11.4; 95% CI, 8.34–15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10–2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11–1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27–1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10–1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25–2.05). Conclusions: Knowledge of risk factors for CIED‐related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. METHODS: The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score–matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. RESULTS: Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score–matched patients (propensity score–matched BVP, 707; propensity score–matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29–0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26–0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16–0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). CONCLUSIONS: LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP. [ABSTRACT FROM AUTHOR]

Abstract Background It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL.

Background: It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation: A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions: Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL. [ABSTRACT FROM AUTHOR]

This article discusses a case of catheter-related superior vena cava syndrome (SVCS) in a 16-year-old female patient with cystic fibrosis. The patient had a central venous access device (TIVAD) for frequent antibiotic treatments. The TIVAD became occluded, leading to SVCS symptoms such as pleural effusions and prominent chest wall veins. The patient underwent a procedure to remove the catheter, stent graft the occluded veins, and insert a new central venous access device. The symptoms resolved, and the patient remains well over a year later. The article emphasizes the importance of careful catheter positioning and using the smallest catheter possible to reduce the risk of central venous stenosis. Endovascular stenting is recommended as the first-line treatment for SVCS, with covered stents offering longer patency and potentially avoiding the need for long-term anticoagulation. [Extracted from the article]

A recent study conducted in New South Wales, Australia, examined the rate of infections following cardiac pacemaker and defibrillator implantation procedures. The study found that 1.1% of patients required re-hospitalization due to infections within twelve months of the procedure. Factors that increased the risk of infection included age, device type, previous procedures or infections, concomitant cardiac surgery, and certain medical conditions. The overall infection rate was consistent with international standards, and the identified risk factors were similar to those found in other studies. The study highlights the importance of adhering to aseptic techniques, using antibiotic prophylaxis, and having detailed discussions with patients about the risks associated with these procedures. [Extracted from the article]

Congenital complete heart block is a potentially fatal complication that can occur in neonates whose mothers have autoimmune disorders; it has rarely been reported in the presence of Sjögren syndrome. Pacemaker implantation is recommended to treat rhythm abnormalities in these neonates. We report the case of a late-preterm infant with Sjögren-syndrome-antibody–induced complete heart block who underwent temporary bipolar epicardial pacing as a bridge to permanent pacemaker implantation. Soon after the pacemaker was implanted, takotsubo cardiomyopathy developed. To our knowledge, this is the first report of reversible cardiomyopathy after pacemaker implantation in an infant. [ABSTRACT FROM AUTHOR]

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Introduction: Heart failure (HF) is a clinical syndrome that is secondary to an abnormality of cardiac structure or function. These clinical practice guidelines focus on the diagnosis and management of HF with recommendations that have been graded on the strength of evidence and the likely absolute benefit versus harm. Additional considerations are presented as practice points. Main recommendations: Blood pressure and lipid lowering decrease the risk of developing HF. Sodium-glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease. An echocardiogram is recommended if HF is suspected or newly diagnosed. If an echocardiogram cannot be arranged in a timely fashion, measurement of plasma B-type natriuretic peptides improves diagnostic accuracy. Angiotensin-converting enzyme inhibitors, β-blockers and mineralocorticoid receptor antagonists improve outcomes in patients with HF associated with a reduced left ventricular ejection fraction. Additional treatment options in selected patients with persistent HF associated with reduced left ventricular ejection fraction include switching the angiotensin-converting enzyme inhibitor to an angiotensin receptor neprilysin inhibitor; ivabradine; implantable cardioverter defibrillators; cardiac resynchronisation therapy; and atrial fibrillation ablation. Multidisciplinary HF disease management facilitates the implementation of evidence-based HF therapies. Clinicians should also consider models of care that optimise medication titration (eg, nurse-led titration). Changes in management as a result of the guideline: These guidelines have been designed to facilitate the systematic integration of recommendations into HF care. This should include ongoing audit and feedback systems integrated into work practices in order to improve the quality of care and outcomes of patients with HF. [ABSTRACT FROM AUTHOR]

Background: Pacing remains the method of choice for treatment of cardiac electrical conduction disorders.This study examined the interrelationship between the site of the right ventricular lead tip and patient prognosis in association with other cardiovascular risk factors over a 4‑year follow-up period.Patients and methods: The study comprised 450 consecutive patients (223 women; aged 69.16 ± 9.63 years) who had their first SSI or DDD pacemaker implanted for typical indications.Results: During follow-up, 91 (20.2%) patients died. The positive prognostic factors were: female sex (hazard ratio [HR] = 0.426), DDD pacemaker (HR = 0.526), oral anticoagulant use (HR = 0.330; all groups), sodium concentration (HR = 0.926), oral anticoagulant (HR = 0.115) and statin (HR = 0.260) use (female group), and non-apical location of the right ventricular lead tip (HR = 0.549; male group). Risk factors for death were: age (HR = 1.063), diabetes requiring insulin (HR = 2.832), creatinine concentration (HR = 1.005; all groups), age (HR = 1.11; female group), and elevated creatinine level (HR = 1.012; male group). In all patients, the non-apical location of the right ventricular lead tip was associated with an 18.92% reduced mortality rate during the 4‑year follow-up, which was statistically significant for the male group.Conclusion: The non-apical location of the right ventricular lead tip was a positive prognostic factor and was statistically significant in the male subgroup. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence and clinical significance of single and dual- chamber pacing on central aortic pressure (CAP) and augmentation index (AI) in non-smoking individuals. Methods Totally, 83 non-smokers with pacemaker-implanted were consecutively enrolled in this study, and they were divided into three groups: dual-chamber pacemaker group (DDD, n=35), single-chamber pacemaker group (VVI, n=33) and control group (n=15). Heart rate (HR), CAP, AI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in three groups of patients. Finally, DDD pacing mode was turned into VVI pacing mode in patients of DDD group and the indexes were measured again. All of the indexes were recorded and analyzed. Results There were no significant changes in baseline characteristics and laboratory data between three groups (P＞0.05). Left atrial diameters were significantly higher in VVI group than those of control group (P＜0.05). Values of CAP were significantly higher in DDD group than those of control group and VVI group (P＜0.05). Values of AI, corrected AI (AIc) and brachial BP were significantly higher in DDD group than those of VVI group (P＜0.05). Values of CAP and brachial BP were significantly lower in VVI group than those of control group (P＜0.05), while no significant changes were found in AI and AIC between VVI group and control group (P＞0.05). All of these indexes (CAP, AI and brachial BP) were significantly reduced after the pacing mode was changed (P＜0.05). Conclusion In nonsmokers, dual-chamber pacing mode can increase CAP and AI. [ABSTRACT FROM AUTHOR]

FUNDAMENTO: A estimulação de ventrículo direito pode ser deletéria em pacientes com disfunção ventricular, entretanto há poucas evidências sobre o impacto dessa estimulação em pacientes com função normal. OBJETIVO: Avaliar a evolução clínica e laboratorial de pacientes com função ventricular normal submetidos a implante de marcapasso cardíaco artificial. MÉTODOS: Foram estudados de forma prospectiva 16 pacientes com os seguintes critérios de inclusão: função ventricular normal definida pelo ecocardiograma e presença de estimulação ventricular superior 90% (avaliação por telemetria do gerador). Parâmetros analisados: classe funcional (CF), teste de caminhada, dosagem de BNP, ecocardiograma (convencional e parâmetros de dessincronia intraventricular e teste de qualidade de vida (SF36). Essas medidas fora feitas com 10 dias(d) (t1), 120d(t2) e 240 d(t3). Os dados foram comparados ao longo do tempo segundo método ANOVA. Comparações múltiplas de médias foram efetuadas utilizando-se o método de Tukey. RESULTADOS: Dos dados avaliados os seguintes não apresentaram variação estatística significante (p>0,05): classe funcional, dosagem de BNP, parâmetros ecocardiográficos convencionais, dessincronia intraventricular (Doppler tecidual). Apresentaram piora (pFUNDAMENTO: La estimulación del ventrículo derecho puede ser dañosa a pacientes con disfunción ventricular. Sin embargo, hay pocas evidencias sobre el impacto de esa estimulación en pacientes con función normal. OBJETIVO: Evaluar la evolución clínica y laboratorial de pacientes con función ventricular normal sometidos a implante de marcapaso cardíaco artificial. MÉTODOS: Se estudiaron de forma prospectiva a 16 pacientes con los siguientes criterios de inclusión: función ventricular normal definida por el ecocardiograma y presencia de estimulación ventricular superior a 90% (evaluación por telemetría del generador). Parámetros analizados: clase funcional (CF), test de marcha, dosificación de BNP, ecocardiograma (convencional y parámetros de desincronía intraventricular y prueba de calidad de vida (SF36). Esas mediciones se hicieron con 10 días(d) (t1), 120d(t2) y 240 d(t3). Los datos se compararon a lo largo del tiempo según el método ANOVA. Comparaciones múltiples de promedios se efectuaron utilizándose el método de Tukey. RESULTADOS: Desde los datos evaluados, los siguientes no presentaron variación estadística significante (p>0,05): clase funcional, dosificación de BNP, parámetros ecocardiográficos convencionales, desincronía intraventricular (Doppler tisular). Presentaron empeoramiento (pBACKGROUND: The stimulation of the right ventricle (RV) may be deleterious in patients with ventricular dysfunction; however there is little evidence about the impact of this stimulation in patients with normal ventricular function. OBJECTIVES: To assess the clinical and laboratory evolution of patients with normal ventricular function submitted to implant of artificial cardiac pacemaker (PM). METHODS: 16 patients enrolled according to the following inclusion criteria: normal ventricular function defined by echocardiogram and presence of upper ventricular stimulation > 90% (generator telemetry assessment) submitted to a PM implant were prospectively studied. The following parameters were assessed: Functional Class (FC), walk test, BNP levels, echocardiography evaluation (conventional and intraventricular dyssynchrony) and quality of life test (SF36). The patients were assessed after 10 (t1), 120 (t2) and 240 days (t3). Data was compared throughout time according to ANOVA. Multiple comparisons of means were performed through Tukey's test. RESULTS: Among the assessed data, the following did not present significant statistic variation (p> 0.05): functional class, BNP levels, conventional echocardiographic parameters, intraventricular dyssynchrony (tissue Doppler). The walk test (between t2 and t3) and the time between septal contraction and LV posterior wall showed worsening (p

OBJETIVOS: Avaliar a utilidade da varfarina na prevenção dessas complicações nos pacientes de alto risco. MÉTODOS: Estudo clínico prospectivo, randomizado, cego, em pacientes submetidos ao primeiro implante transvenoso de DCEI, com FEVEOBJECTIVES: To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis. METHODS: Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF

OBJETIVO: Avaliar os efeitos da estimulação atrial direita temporária na prevenção da fibrilação atrial no pósoperatório de revascularização do miocárdio com circulação extracorpórea e identificar os fatores de risco para o aparecimento dessa arritmia. MÉTODO: Estudamos 160 pacientes que, ao término da cirurgia de revascularização miocárdica, submeteram-se ao implante de eletrodos epicárdicos na parede lateral do átrio direito e foram randomizados em grupos não-estimulado (NE) e grupo com estímulo atrial direito (AD). O ritmo cardíaco foi monitorizado durante as 72 horas seguintes ao término da operação e as variáveis estudadas foram: a incidência de fibrilação atrial, os fatores de risco pré, intra e pós-operatórios para o seu aparecimento e eventos pósoperatórios. Resultados: Foram detectados 21 (13,1%) episódios de fibrilação atrial, sendo 20 no grupo NE e um no grupo submetido à estimulação do átrio direito (AD). O risco relativo para o desenvolvimento de fibrilação atrial foi de 0,18 (IC 95%= 0,05-0,60) para o grupo AD quando comparado ao grupo NE. A regressão logística identificou que as variáveis idade mais jovem, uso de beta-bloqueador no pré-operatório e presença da estimulação atrial direita estiveram associadas a uma menor razão de chances (odds ratio) para o surgimento de fibrilação atrial no pós-operatório. CONCLUSÕES: A estimulação atrial direita temporária reduziu a incidência de fibrilação atrial pós-operatória. A idade avançada e a não estimulação atrial foram fatores preditivos independentes para a ocorrência dessa arritmia.OBJECTIVE: To evaluated the effects of temporary atrial pacing to prevent the atrial fibrillation after coronary artery bypass graft surgery and the risk factors to the occurrence of this arrhytmia. METHODS: We have studied 160 patients who, at the end of coronary artery bypass graft surgery, were submitted to epicardial electrode implantation in the right atrium lateral wall. They were randomized into two groups: non-pacing (NP) group and right atrial (RA) pacing group. The cardiac rhythm was monitorized over 72 hours following to the end of surgery and the variables studied were as follow: incidence of atrial fibrillation; the risk factors pre-, intra-, and postoperative for its occurrence, and postoperative events. RESULTS: There were 21 (13.1%) episodes of atrial fibrillation, 20 in NP group and one in RA group. The relative risk (RR) for development of atrial fibrillation was 0.18 (95% CI; 0.05-0.60) for the RA group when compared to the NP group. The logistic regression identified that the study variables, such as younger age; use of beta-blockers in the preoperative, and the presence of right atrial pacing had been associated to a lower Odds ratios (ORs) for the occurrence of atrial fibrillation in the postoperative. CONCLUSIONS: The temporary atrial pacing reduced the incidence of atrial fibrillation after the CABG surgery. Older age and a non-atrial pacing were the independent predictive factors of the occurrence of this arrhythmia.

OBJETIVO: Realizar uma análise da estimulação biventricular convencional (BV), da estimulação bifocal (BF) de ventrículo direito (VD) e uma análise comparativa das duas técnicas, em relação aos parâmetros clínicos, funcionais e ecocardiográficos, em uma população sem os critérios de exclusão dos trabalhos clássicos. MÉTODOS: Foram analisados de forma prospectiva, não randomizada, 36 pacientes submetidos a cirurgia para implantes de marcapassos multissítos devido a QRS > 130 ms, disfunção ventricular esquerda grave e insuficiência cardíaca congestiva classe funcional III ou IV. RESULTADOS: Os resultados favoráveis da ressincronização foram obtidos com as duas técnicas, sem diferenças significativas na comparação dos dois grupos, exceto por maior estreitamento do QRS e tendência a menor número de internações no grupo dos BV. Quando os grupos foram analisados individualmente e comparados, antes e após os procedimentos, observamos que as melhoras foram bem mais expressivas no grupo dos biventriculares, assim como os índices de relevância estatística maiores. CONCLUSÃO: A terapia de ressincronização cardíaca mostrou ser terapia eficaz nos 2 grupos analisados, entretanto com resultados mais expressivos no grupo dos biventriculares.OBJECTIVE:To analyze the conventional biventricular pacing (BV) and the bifocal (BF) right ventricular (RV) pacing, and to perform a comparative analysis of these two techniques in relation to clinical, functional and echocardiographic parameters in a population without the exclusion criteria of the major studies. METHODS:A prospective non-randomized analysis of 36 patients undergoing surgery for multisite pacemaker implantation due to QRS > 130 ms, severe left ventricular dysfunction, and NYHA functional class III or ambulatory class IV congestive heart failure was performed. RESULTS: Favorable results of resynchronization were obtained with both techniques, with no significant differences in the comparison of the two groups, except for a higher QRS narrowing in the BV group, and a trend of a lower number or hospital admissions in the BV group. When the groups were analyzed separately and compared before and after the procedures, we observed that improvement was much more significant in the biventricular group, as were the more statistically relevant rates. CONCLUSION: Cardiac resynchronization therapy proved to be an efficient therapy in both groups analyzed, although with more significant outcomes in the biventricular group.

OBJETIVOS: Avaliar a ativação elétrica cardíaca usando Mapeamento Eletrocardiográfico de Superfície (MES), em pacientes com ICC e bloqueio de ramo esquerdo [BRE] submetidos a terapia de ressincronização cardíaca (CRT) com implante de marca-passo átrio-biventricular (MP-BIV). MÉTODOS: Foram analisados os tempos médios de ativação elétrica cardíaca no ventrículo direito (tempo médio de ativação do VD [mVD]), área ântero-septal (mAS), e ventrículo esquerdo (mVE), de 28 pacientes (idade média 61,2±9,5 anos, ICC classe III-IV NYHA, fração de ejeção OBJECTIVES: To assess cardiac electrical activation by using body surface potential mapping (BSPM), in patients with congestive heart failure (CHF) and left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT) with biventricular pacemaker (BIV-PM) implantation. METHODS: Mean cardiac electrical activation times were analyzed in the right ventricle (RV) (mean RV activation time = mRV), anteroseptal area (mAS), and left ventricle (mLV) of 28 patients (mean age 61.2 ± 9.5 years; NYHA class III-IV CHF; ejection fraction

The article projects the future of cardiovascular (CV) biomedicine in terms of cardiac arrhythmias and electrophysiology in the U.S. Topics discussed include an overview of cardiac arrhythmias, its diagnostic strategies, its lead technology and implantable devices, its ablation strategies, its pharmacological and genomic therapies, and its trends.

OBJETIVO: A estimulação cardíaca permanente melhora a sobrevida de crianças com bradicardia congênita ou adquirida, embora a mortalidade após o implante de marcapasso permaneça relativamente alta. O objetivo deste estudo foi avaliar os resultados em longo prazo de crianças submetidas a implante de marcapasso endocárdico pela veia femoral, incluindo a identificação de fatores de risco associados à mortalidade. MÉTODO: De 1981 a 2000, 99 pacientes variando em idade de um dia a 13 anos (4,1 ± 3,6 com mediana = 3 anos) foram submetidos a implante de marcapasso permanente pela via femoral devido a bradicardia de origem congênita (39,4%), pós-cirúrgica (54,5%) ou adquirida não cirurgicamente (6,1%). RESULTADOS: Ao final de 7,1 ± 5,3 anos (708,3 pacientes-anos) de seguimento, 18 (18,2%) pacientes haviam morrido. A sobrevida atuarial foi de 85%, 79,5%, e 74,2%, aos cinco, 10, e 15 anos, respectivamente. Os fatores independentes de mortalidade identificados pela análise proporcional de Cox foram: menor idade ao implante (p = 0,028), presença de anomalias cardíacas não corrigidas ou presença de próteses intracardíacas (p = 0,0001) e evidências radiográficas de cardiomegalia (p = 0,035). CONCLUSÕES: A estimulação cardíaca endocárdica permanente pela via femoral apresenta expectativa de sobrevida comparável a outras técnicas, com baixas taxas de complicações devidas ao implante de marcapasso. A sobrevida em longo prazo foi limitada pela menor idade e dilatação cardíaca no momento do implante, assim como pela presença de defeitos cardíacos sem correção ou de próteses valvares.OBJECTIVE: Permanent cardiac pacing improves survival of children with congenital or acquired bradycardia, although mortality after pacing remains relatively high. The aim of this study was to evaluate the long-term outcomes of children who undergo permanent endocardial cardiac pacing via the femoral vein, including the identification of associated risk factors for mortality. METHOD: From 1981 to 2000, 99 patients ranging in ages from one day to 13 years (4.1 ± 3.6 and median = 3 years) underwent permanent transfemoral pacemaker implantation due to congenital (39.4%), postsurgical (54.5%), or non-surgically acquired bradycardia (6.1%). RESULTS: By the end of 7.1 ± 5.3 years (708.3 patient-years) of prospective follow-up, 18 (18.2%) patients had died. The actuarial survival rates were 85%, 79.5%, and 74.2%, at 5, 10, and 15 years, respectively. Independent predictors of mortality identified by Cox proportional hazards analysis were younger age at implantation (p = 0.028), the presence of untreated cardiac anomalies or intracardiac prostheses (p = 0.0001), and radiographic evidence of cardiomegaly (p = 0.035). CONCLUSIONS: Permanent endocardial pacing via the femoral vein presented survival expectance comparable to other techniques with a low rate of pacing complications. Long-term survival was limited by lower ages and cardiac dilatation at the time of implantation as well as by the presence of untreated cardiac defects or valve prostheses.

OBJETIVO: Avaliar os efeitos da mudança de modo de estimulação ventricular para atrioventricular sobre a qualidade de vida em pacientes com cardiopatia chagásica e bloqueio atrioventricular, na troca eletiva do gerador de pulsos. MÉTODO: No período de 8 de setembro de 2001 a 18 de março de 2004, no Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo e no Hospital de Beneficência Portuguesa de Ribeirão Preto, foram estudados comparativamente sob estimulação ventricular e atrioventricular 27 pacientes com cardiopatia chagásica e bloqueio atrioventricular, com indicação de troca eletiva do gerador de pulsos. Os pacientes foram analisados na inclusão do estudo e alternadamente no modo ventricular e atrioventricular em duas fases com duração de 90 dias, considerando-se o comportamento clínico, avaliado pela qualidade de vida. A análise estatística foi realizada na condição basal, modo VVI e modo DDD, utilizando-se o teste de variância para medidas repetidas, considerando-se nível de significância de 0,05. RESULTADOS: Não foram detectadas diferenças de comportamento na qualidade de vida, avaliada pela capacidade funcional pelo estado geral e pela vitalidade, entre os dois modos de estimulação cardíaca estudados. Ocorreram três casos de complicações relacionadas à mudança de modo de estimulação: dois casos de taquiarritmias atriais conduzidas pelo marcapasso e um caso de deslocamento de eletrodo atrial. CONCLUSÕES: A análise comparativa da estimulação ventricular com a atrioventricular, na troca eletiva do gerador, demonstrou que não houve diferença de comportamento clínico sobre a qualidade de vida.OBJECTIVE: Health-related quality of life in patients with Chagas' cardiomyopathy and complete atrioventricular block at elective pulse generator replacement: effects of pacing mode upgraded from VVI to DDD. METHOD: From September 8, 2001 to March 18, 2004, at the Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo and Hospital de Beneficência Portuguesa de Ribeirão Preto, a total of 27 patients with chronic Chagas' cardiopathy, complete atrioventricular block and implanted ventricular pacemaker were upgraded to a dual-chamber pacing mode. At the beginning of the study and after 90-days periods under each pacing modes, the patients' quality of life was evaluated. Statistical analysis was made at basal, VVI and DDD conditions using the analysis of repetitive measures. RESULTS: No significant differences in the health-related quality of life, across the three studied variables (physical function, vitality and general health), were detected after the change of pacing mode from VVI to DDD. There were three cases of complications related to pacing mode upgrade: two cases of atrial tachycardia triggered to ventricles through DDD pacemaker and one atrial lead displacement. CONCLUSIONS: No benefits no quality of life were detected after the change of pacing mode VVI to DDD during elective replacement of pulse generator, in patients with Chagas' cardiomyopathy and complete AV block

OBJETIVO: Estudar os pacientes portadores de marcapasso cardíaco artificial permanente, comparando as características clínicas e epidemiológicas dos portadores da doença de Chagas com a dos portadores de doenças degenerativas do sistema de condução. MÉTODO: Foram analisados 57.632 procedimentos cadastrados no Registro Brasileiro de Marcapassos, realizados no período de 1995 a 2003, sendo: 25.648 pacientes portadores da doença de Chagas e 31.984, de doenças degenerativas. A comparação das características dessas populações foi feita pelos testes do Qui-quadrado e t-Student com nível de significância de 5%. RESULTADOS: Houve predomínio da doença de Chagas na região Centro-Oeste, nos implantes iniciais. Nas reoperações, a população chagásica representou maioria também no Sudeste. A idade dos pacientes chagásicos foi 58,6 ± 15,3 e 59,3 ± 14,8 anos, respectivamente para implantes iniciais e reoperações, e, nos não chagásicos, 73,5 ± 12,6 e 73,7 ± 13,5. Não foi notada diferença na distribuição entre os dois sexos. Houve maior ocorrência de síncopes, pré-síncopes e bloqueio atrioventricular com QRS largo nos pacientes chagásicos e de tonturas, insuficiência cardíaca e QRS estreito nos não chagásicos. O modo de estimulação ventricular foi utilizado em 60% e 63% nos implantes iniciais e em 77% e 76% das reoperações, respectivamente para os pacientes chagásicos e não chagásicos. A depleção da bateria por desgaste normal foi o principal motivo para reoperação dos pacientes, tendo ocorrido em 76,1% e 79,6% das reoperações, respectivamente para chagásicos e não chagásicos. CONCLUSÕES: Os dados analisados demonstraram diferenças significativas nas características clínicas e demográficas das populações estudadas.OBJECTIVE: To study patients with permanent cardiac pacemakers, comparing the clinical and epidemiological characteristics of patients with Chagas' disease versus the ones with degenerative or ischemic diseases. METHOD: 57,632 procedures performed from 1995 to 2003, registered in the Brazilian Pacemaker Register were analyzed: 25,648 patients with Chagas' disease and 31,984 with degenerative or ischemic bradiarrythmias. The comparison of the characteristics of these two populations included Chi-square and t-Student tests, with a 5% level of significance. RESULTS: There was a predominance of the Chagas' disease in the Centar-west region, in the initial implantations. In re-operations, the population with Chagas' disease represented majority in the Southeast, too. Mean age was 59.3 ± 15.3 and 58.6 ± 14.8, respectively for initial implantations and re-operations in Chagas' disease patients and 73.5 ± 12.6 and 73.7 ± 13.5, in non Chagas'disease patients. There was no difference in respect to both genders and etiology. Syncope episodes and 3rd degree AV block with wide QRS were more frequent in patients with Chagas' disease, and dizziness, heart failure and 3rd degree AV block with in the other patients. Ventricular pacing systems were used in 60% and 63% in the initial implants and 77% and 76% of the reoperations, respectively for Chagas' and non-Chagas' disease patients. The need to change the batteries was the main reason for reoperations in 76.1% and 79.6% of these procedures, respectively for patients with Chagas' disease and the other causes of bradicardia. CONCLUSIONS: The analysis of data of these two populations demonstrated significant differences in the clinical and demographic characteristics.

The article offers information about implementing ventricular tachycardia (VT) ablation in patients with heart disease and with implantable cardioverter defibrillators. It reports that such life-saving therapies do not prevent arrhythmia recurrences and presents randomized trials which demonstrated the efficacy of both sotalol and amiodarone in reducing VT recurrences.

Introdução/Objetivo: O implante de marcapasso cardíaco definitivo é um procedimento caracterizado por um baixo índice de complicações. No entanto, a infecção, principalmente a de loja de fonte geradora, caracteriza-se como uma das complicações mais comuns, com incidências variando entre 1-5% na maioria dos centros. Diversas abordagens terapêuticas para o tratamento desta afecção vêm sendo descritas com resultados controversos. Observa-se, entretanto, uma tendência a melhores resultados, com menores índices de falência de tratamento ou reinfecção, nas abordagens mais agressivas, estas sempre relacionadas à alta morbidade e a altos custos finais. Com base nos princípios já bem descritos do poder bactericida dos flaps musculocutâneos associados à antibioticoterapia na esterilização de áreas pouco vascularizadas infectadas, foi desenvolvida e avaliada neste estudo inicial a técnica de implante subpeitoral para o tratamento dos casos de infecção restrita de loja de fonte geradora, objetivando-se menores morbidades e custos com, bons resultados. Casuística e Método: Foi considerado no presente estudo o período de janeiro de 1996 a março de 2000 onde foram realizados 574 procedimentos, entre implantes e trocas de fontes geradoras, na Santa Casa de São Paulo, com um índice de infecção de 1,11% (6 casos) e 2 casos de extrusão de fonte geradora sem infecção aparente. Quatro casos tratavam-se de infecção exclusiva de loja de fonte e em 2 casos houve comprometimento sistêmico com sepse. Os germes infectantes foram S.aureus, S.epidermidis e Pseudomonas. Foi utilizada como abordagem terapêutica para todos os casos sem comprometimento sistêmico a técnica de implante subpeitoral da mesma fonte geradora associada à antibioticoterapia específica. Resultados: Não houve óbitos, casos de reinfecção ou falência de tratamento nos pacientes submetidos à técnica. O tempo médio de internação foi 7,3 dias. O tempo médio de antibioticoterapia foi de 7 dias. Não houve distúrbios do marcapasso que exigissem reabordagem. O seguimento é de 5 meses a 4 anos. Conclusão: A técnica avaliada mostra-se, a princípio, como uma alternativa viável no tratamento da infecção de loja de marcapasso, com baixa morbidade e grande eficácia.Introduction: Permanent pacing implantation is a very low risk procedure. However, infectious complications, specially in the pacemaker generator pocket, are the most common one with incidences (1 to 5%). These patients have been treated by many different therapeutic proceduros with controversial results. It has been well demonstrated that eradication of the infection is extremely difficult and the best results are reached through radical surgery consisting of removal of the pacemaker generator and electrode associated to antibiotic therapy. These procedures are related to high morbidity and expense. Muscle flaps are thought to have the ability to survive a bacterial inoculation and control infection. It also brings a rich network of blood supply to an infected and poorly vascularized area. Based in these facts we developed a new technique for the treatment of the generator pocket infection that is the subpectoral pacemaker implantationn. Material and Methods: Between January 1996 and March 2000, a total of 574 pacemakers were implanted or reimplanted at Santa Casa de São Paulo. Infection at the site of implantation developed in 6 instances (incidence of 1.11%) and two extrusions of generator without apparent infection. Four patients had infection involving only the pacemaker pocket and two patients had sepsis. The organisms cultured were Staphylococcus aureus, Streptococcus epidermis and Pseudomonas. At pacemaker pocket infection instances and in the pacemaker extrusion the patients were treated by this new approach associated to antibiotic therapy. Results: There were no deaths, reinfection or failure of treatment. The mean hospital stay was 7.3 days and antibiotic therapy 7 days. The follow up is five months to four years. Conclusions: The subpectoral pacemaker implantation technique is a good alternative for cases of pocket generator infection with low morbidity and good finals results.

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La estimulación multisitio constituye una alternativa terapéutica para pacientes con disfunción ventricular severa. Esta técnica fue utilizada en 6 pacientes con insuficiencia cardíaca refractaria, clase funcional III-IV y bloqueo de rama izquierda, para evaluar su eficacia. Se programaron intervalos PR variables para estimulación: Biventricular: entre el seno coronario o el ventrículo izquierdo y la punta del ventrículo derecho; y Bifocal: entre el tracto de salida y la punta del ventrículo derecho. Se realizó una ventriculografía nuclear en estado basal, a los 7 días y a los 6 meses posimplantación, para medir las fracciones de eyección, el sincronismo ventricular y el índice de regurgitación mitral. Durante el seguimiento, 2 pacientes hicieron insuficiencia cardíaca refractaria y uno de ellos falleció (estimulación bifocal). La mejoría de la fracción de eyección y de la capacidad funcional fueron evidentes con la estimulación biventricular. Esta técnica resultó eficaz en el tratamiento de la disfunción ventricular severa.The multisite pacing is a therapeutic alternative for patients with severe ventricular dysfunction. This technique was used in 6 patients with functional class III-IV refractory heart failure and left bundle branch block to evaluate its efficiency. Variable PR intervals were programmed for biventricular pacing between the output tract and the apex of the right ventricle. A nuclear ventriculography in basal state was performed on the 7th day and on the 6th month after the implantation to measure the ejection fractions, the ventricular synchronism and the mitral regurgitation index. During the follow-up, 2 patients had refractory heart failure and one of them died (bifocal pacing). The improvement of the ejection fraction and of the functional capacity were evident with the biventricular pacing. This technique proved to be efficient in the treatment of severe ventricular dysfunction.

Background--The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. Methods and Results--The study consisted of 11 patients who had BS and CRBBB. B S was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=l) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V2 or V3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class Ic drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age- and sex-matched controls: 170±13 versus 145±15 milliseconds in V1 and 144±19 versus 128±7 milliseconds in V5 (both P<0.0001). The amplitude of R in V1 was larger in the BS patients than in the control subjects (P=0.0323), but that of R' was similar (P=0.0560). Conclusions--BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined. [ABSTRACT FROM AUTHOR]

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The article describes the case of an 83-year-old woman who was referred for lead extraction due to pacemaker pocket infection. The patient has a history of atrial fibrillation and complete heart block following an atrioventricular (AV) node ablation. It is noted that the case reflects the challenges encountered in managing patients with cardiac implantable electronic device (CIED) infections.

Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure. [ABSTRACT FROM AUTHOR]

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A 45-year-old man with nonischemic cardiomyopathy and end-stage renal disease had lived uneventfully with a cardiac resynchronization therapy defibrillator (CRT-D) for 5 years. Less than a month before presenting at our institution, he had undergone stenting of his partially occluded subclavian vein, to relieve stenosis of the ipsilateral arteriovenous fistula that was used for his hemodialysis. The CRT-D subsequently discharged. Device interrogation revealed that electrical noise originating from leads damaged by the stent had caused the inappropriate shock and intermittent electrical discharges thereafter. The patient was highly traumatized by these events and insisted upon device removal, which deprived him of a potentially life-saving intervention. He later had a cardiac arrest that resulted in sustained profound hypoxic ischemic encephalopathy with minimal neurologic recovery: his family placed him in a long-term care facility on ventilator support, with a tracheostomy and feeding tube. This situation might have been avoided through collaboration between the interventional radiologist and the electrophysiologist. To our knowledge, this is the first report of a patient with nonischemic cardiomyopathy and end-stage renal disease who presented with inappropriate defibrillator discharge caused by lead damage secondary to stenting across the leads. [ABSTRACT FROM AUTHOR]

The authors discuss guidelines and updates on implantable cardioverter-defibrillators (ICDs) as treatment for ventricular arrhythmias. Topics mentioned include other factors that indicate which patients may benefit from ICD therapy, the Multicenter Unsustained Tachycardia Trial or MUSTT, and the role of cardiac imaging in stratifying the risks of sudden death.

Isolated atrial flutter is an extremely rare form of supraventricular tachycardia in the neonatal period. It may be initiated by central venous catheterization.Case report. – A male infant was born at 35 weeks by cesarean section for placenta praevia. He was eutrophic. Apgar score was 10 at 1 and 5 minutes. He secondary developed a respiratory distress syndrome. He was then ventilated by nasal CPAP. Immediately after an umbilical venous catheterization, a tachycardia appeared without preexistent cardiac dysfunction. An intravenous dose of adenosine (Striadyne®) showed a characteristic sawtooth pattern of P waves on inferior leads. The cardiac-US examination was normal. This atrial flutter was converted to normal sinus rhythm by transoesophageal pacing, without adjonction of antiarythmic drugs. The newborn was weaned from mechanical ventilation 48 hours later and discharged from hospital at seven days post natal age. His development and clinical examination were normal two months later.Conclusion. – The isolated atrial flutter is rare in the neonate. It may be triggered by a venous catheterization. Transoesophageal atrial pacing is safe and effective for conversion. [Copyright &y& Elsevier]

The anti-CD20 monoclonal antibody rituximab is an effective treatment for small lymphocytic lymphoma; however, it has been associated with infusion reactions, including cardiac arrhythmias. Severe cardiac arrhythmia is an adverse reaction that is related to rituximab chemotherapy, and more investigation is warranted into the adverse reactions of rituximab that involve cardiac conduction abnormalities. Herein, we report what we believe to be the 1st case of symptomatic polymorphic ventricular tachycardia to have occurred during an initial infusion of rituximab. [ABSTRACT FROM AUTHOR]

Atrioventricular nodal re-entry tachycardia is the most common form of regular paroxysmal tachycardia in the adult population. This tachycardia is a re-entrant rhythm that uses the anatomic location of the atrioventricular node and its surrounding perinodal atrial tissue. The simplest concept regarding the atrioventricular nodal physiology that allows re-entry is founded upon the postulated existence of 2 atrioventricular nodal pathways with different conduction velocities and refractory periods. Herein, we present the case of a 64-year-old man who had a history of paroxysmal atrial fibrillation; he had a permanent pacemaker for sick-sinus syndrome. He developed a tachycardia-induced cardiomyopathy with a perpetual dual response to the pacemaker stimulus. The tachycardia displayed characteristic dual atrioventricular-nodal physiology that was suppressed by amiodarone therapy, leading to a reversal of the cardiomyopathy. We discuss the mechanisms that surround such phenomena. [ABSTRACT FROM AUTHOR]

The ability to preoperatively identify patients who may require permanent pacemaker implantation is rather poorly understood. The aim of this study is to determine the current incidence of permanent pacing after valve surgery and to determine which factors place the heart valve patient at risk of requiring permanent pacemaker implantation. We audited the records of 2,392 consecutive adult patients who underwent cardiac valve surgical procedures by the same surgical team from 25 April 1998 through 31 March 2003. Of these, 118 patients (group A) required the postoperative implantation of permanent pacemakers during the same hospitalization; they were compared with 1,959 heart valve patients (group B) who did not require pacemaker placement. Multivariate logistic regression analysis showed that reoperations (odds ratio [OR], 8.23; P <0.001), longer cumulative cross-clamp times (OR, 5.9; P <0.001), multiple-valve surgical procedures (OR, 3.46; P <0.05), and absence of preoperative sinus rhythm (OR 2.52; P <0.001) were independent predictors of the need for permanent pacemaker implantation after valve surgery. These results suggest that patients who display these risk factors for arrhythmias that require permanent pacemaker implantation receive closer observation and advance counseling about the likelihood of such implantation. [ABSTRACT FROM AUTHOR]

Hypothesis: The level of cervical spinal cord injury (CSCI) can be used to predict the need for a cardiovascular intervention. Design: Retrospective review. Data included level of spinal cord injury, Injury Severity Score, lowest heart rate, and systolic blood pressure in the first 24 hours and intensive care unit course. The level of CSCI was divided into high (cord level C1-C5) or low (cord level C6-C7). Neurogenic shock was defined as bradycardia with hypotension. Statistical analysis was performed with the t test and the χ[sup 2] test. Setting: Level I trauma center. Patients: The patients studied were those with quadriplegia who experienced a CSCI and were admitted to the hospital between December 1, 1993, and October 31, 2001. Interventions: Pressors, chronotropic agents, and pacemakers. Main Outcome Measure: Use of a cardiovascular intervention in the presence of neurogenic shock. Results: Eighty-three patients met the criteria for CSCI and quadriplegia, 62 in the high (C1-C5) and 21 in the low (C6-C7) level. There was no significant difference between the 2 groups in mean ± SD age (38.2 ± 17.8 vs 34.7 ± 15.6 years; P = .43), mean ± SD Injury Severity Score (35.7 ± 17.5 vs 32.5 ± 11.2; P = .44), mean ± SD admission base deficit (-0.7 ± 3.6 vs 0.7 ± 2.7; P = .06), or mortality (12 [19%] of 62 patients vs 2 [10%] of 21 patients; P = .29). Neurogenic shock was present in 19 (31%) of the 62 patients with high CSCI and in 5 (24%) of the 21 patients with low CSCI (P = .56). There was a marked difference in the use of a cardiovascular intervention between those with a high and those with a low CSCI: 15 (24%) of 62 patients vs 1 (5%) of 21 patients (P = .02). Two patients with C1 through C5 spinal cord injuries required cardiac pacemakers. Conclusions: There was no significant difference in the frequency of neurogenic shock by injury level. Patients with a high CSCI (C1-C5) had a significantly greater requirement for a cardiovascular intervention compared with patients with lower injuries (C6-C7). [ABSTRACT FROM AUTHOR]

The article presents the case study of a 55-year-old woman with syncope which was preceded by sudden onset neck pain while driving her car at low speed.

Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. In patients with heart failure (HF), however, this definition is unsuitable because metabolic demands are unmatched to cardiac output in both conditions. Moreover, HR dynamics in patients with HF differ from those in healthy subjects and may be affected by β-blocking medication. Nevertheless, it has been demonstrated that CI in HF is associated with reduced functional capacity and poor survival. During exercise, the normal heart increases both stroke volume and HR, whereas in the failing heart, contractility reserve is lost, thus rendering increases in cardiac output primarily dependent on cardioacceleration. Consequently, insufficient cardioacceleration because of CI may be considered a major limiting factor in the exercise capacity of patients with HF. Despite the profound effects of CI in this specific population, the issue has drawn limited attention during the past years and is often overlooked in clinical practice. This might partly be caused by a lack of standardized approach to diagnose the disease, further complicated by changes in HR dynamics in the HF population, which render reference values derived from a normal population invalid. Cardiac implantable electronic devices (implantable cardioverter defibrillator; cardiac resynchronization therapy) now offer a unique opportunity to study HR dynamics and provide treatment options for CI by rate-adaptive pacing using an incorporated sensor that measures physical activity. This review provides an overview of disease mechanisms, diagnostic strategies, clinical consequences, and state-of-the-art device therapy for CI in HF. [ABSTRACT FROM AUTHOR]

Background: Permanent cardiac pacemakers require invasive procedures with complications often related to long pacemaker leads. We are developing a percutaneous pacemaker for implantation of an entire pacing system into the pericardial space.Methods: Percutaneous micropacemaker implantations were performed in 6 pigs (27.4-34.1 kg) using subxyphoid access to the pericardial space. Modifications in the implantation methods and hardware were made after each experiment as the insertion method was optimized. In the first 5 animals, nonfunctional pacemaker devices were studied. In the final animal, a functional pacemaker was implanted.Results: Successful placement of the entire nonfunctional pacing system into the pericardial space was demonstrated in 2 of the first 5 animals, and successful implantation and capture was achieved using a functional system in the last animal. A sheath was developed that allows retractable features to secure positioning within the pericardial space. In addition, a miniaturized camera with fiberoptic illumination allowed visualization of the implantation site before electrode insertion into myocardium. All animals studied during follow-up survived without symptoms after the initial postoperative period.Conclusions: A novel micropacemaker system allows cardiac pacing without entering the vascular space or surgical exposure of the heart. This pericardial pacemaker system may be an option for a large number of patients currently requiring transvenous pacemakers but is particularly relevant for patients with restricted vascular access, young children, or those with congenital heart disease who require epicardial access. [ABSTRACT FROM AUTHOR]

Abstract Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias. Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Methods: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. Results: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). Conclusion: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH.