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Background: Cardiac tamponade caused by temporary right ventricular (RV) pacemaker perforation is a rare but serious complication in transcatheter aortic valve replacement (TAVR)., Aims: To study the incidence of temporary pacemaker related cardiac tamponade in TAVR, and the relation to the type of pacemaker lead used in periprocedural temporary transvenous pacing., Methods: A single center registry of transfemoral TAVRs in 2014-2020. Main inclusion criterion was peri-operative use of a temporary RV pacing lead. Main exclusion criteria were a preoperatively implanted permanent pacemaker or the exclusive use of left ventricular guidewire pacing. Incident cardiac tamponade was classified as pacemaker lead related, or other. Patients were grouped according to type of temporary RV pacing wire., Results: 810 patients were included (age 80.5 ± 7.3 [mean ± standard deviation], female 319, 39.4%). Of these, 566 (69.9%) received a standard RV temporary pacing wire (RV-TPW), and 244 (30.1%) received temporary RV pacing through a permanent, passive pacemaker lead (RV-TPPL). In total, 18 (2.2%) events of cardiac tamponade occurred, 12 (67%) were pacemaker lead related. All pacemaker lead-related cardiac tamponades occurred in the group who received a standard RV-TPW and none in the group who received RV-TPPL (n = 12 [2.1%] vs. n = 0 [0%], p = 0.022). No difference in cardiac tamponade due to other causes was seen between the groups (p = 0.82)., Conclusions: The use of soft-tip RV-TPPL was associated with a lower risk of pacemaker related cardiac tamponade in TAVR. When perioperative pacing is indicated, temporary RV-TPPL may contribute to a significant reduction of cardiac tamponade in TAVR., Competing Interests: Declaration of Competing Interest Dr. Feldt has received consulting/speaker fees from Abbott Vascular, Astra Zeneca, Anteris Technologies and Alleviant Medical. Dr. Dalén, Dr. Kastengren, Dr. Hörnsten, and Dr. Omar report no relationships that could be construed as a conflict of interest. Dr. Rück has served as a proctor for Boston Scientific and has received consulting fees from Medtronic and Edwards. Dr. Meduri has received consulting fees from Boston Scientific, Abbott Vascular, Cardiovalve, Vdyne, Alleviant and Anteris Technologies. Dr. Saleh and Dr. Linder report no relationships that could be construed as a conflict of interest. Dr. Settergren has served as a proctor for Boston Scientific, Abbott Vascular and has received consulting fees from Medtronic, Anteris Technologies, Holistic Medical, Cardiomech and Teleflex., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The aim of the study was to examine the treatment outcome for patients with cardiovascular implantable electronic device (CIED) infections after extraction., Methods: Patients who underwent CIED extractions due to an infection at Karolinska University Hospital 2006-2015 were analyzed., Results: In total, 165 patients were reviewed, 104 (63%) with pocket infection and 61 (37%) with systemic infection. Of the patients with systemic infection, 34 and 25 patients fulfilled the criteria for definite and possible endocarditis, respectively. Complications after extraction occurred only in one patient. Reimplantation was made after a mean of 9.5 days and performed in 81% of those with pocket infection and 44.3% in systemic infection. Infection with the new device occurred in 4.6%. The mean length of hospital stay for patients with pocket infection was 5.7 days, compared to 38.6 days in systemic infection. One-year mortality was 7.7% and 22.2% in pocket infection and systemic infection, respectively. Patients with Staphylococcus aureus infection had a higher mortality., Conclusions: In this study, the majority of the patients had a pocket CIED infection, with a short hospital stay. Patients with a systemic infection, and S. aureus etiology, had a prolonged hospital stay and a higher mortality.

The method of auditory evoked brainstem responses (AEBR) was applied on an animal model with two types of well defined middle ear effusions--serous otitis media (SOM) and purulent otitis media (POM). The animals with SOM exhibited fairly normal interpeak latencies but a considerably increased auditory threshold. In contrast, POM mainly affected the latencies of the brainstem evoked potential but also caused a slight increase of the auditory threshold. The results indicate that SOM chiefly causes a conductive hearing loss, while POM also affects the neural circuit.

Maximum torques, total work and mean power of isokinetic plantar flexions were measured with simultaneous registrations. The integrated electromyograms (iEMG) were obtained by surface electrodes from all three heads of the m. triceps surae. The method applied offers possibilities for adequate description of dynamic muscular work which in the case of plantar flexion in trained man declines as a negative exponential function of angular motion velocity. The decline is parallel to that of maximum torques. The summed triceps surae iEMG was inversely proportional to the velocity and direct proportional to time suggesting that structural rather than neural factors determine the relationships between velocity of angular motion and maximum torque/total work of single Mmaneuvers. Moreover, the fact that maximum mean power as well as maximum electrical efficiency were reached at the functional velocity of toe-off during gait suggests an influence of pragmatic demands on plantar flexion mechanical output.