A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to cut the temporary epicardial pacing wires (TEPWs) flush with the patient's skin surface prior to discharge. Altogether 105 relevant papers were identified of which 13 case reports represented the best evidence to answer the question. The author, journal, date, country of publication, complications, the culprit TEPW and relevant outcomes are tabulated. All case reports demonstrated a wide spectrum of complications.
Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
AIMS: Several case reports have demonstrated negative interactions between various physiotherapy modalities and cardiac rhythm devices (CRD). Fear of these potential interactions may lead to suboptimal utilization of physiotherapy treatments in CRD patients. No prior review of available guidelines, or management strategies, on the interaction between physiotherapy modalities and CRD patients has been reported. To review existing guidelines regarding the use of physiotherapy modalities in patients with pacemakers and/or implantable cardioverter-defibrillators (ICDs).
Health care ethics USA: a publication of the Center for Health Care Ethics
Ethics committees are use [sic] to questions concerning the withdrawal of life-support. Such questions become increasingly complex when that life-support is implantable, like a pacemaker. This essay seeks to address the question of under what, if any, circumstances it would be permissible to discontinue the use of such implantable devices.
Heart Rhythm: The Official Journal of the Heart Rhythm Society
BACKGROUND: Heartbeat International is a little-known 501(c)(3) charitable organization, which for the past 25 years has been responsible for the implantation and follow-up of cardiac implantable electronic devices in over 9000 indigent recipients in predominantly developing countries. Although the concept was founded in Guatemala over 30 years ago, it took the vision and drive of Dr. Henry D. McIntosh, M.D., M.A.C.C, to create Heartbeat International in 1984.
Failure of the pacemaker is a common complication of pacemaker therapy. Identification of the disorder responsible for the failure to pace is often difficult. An increase in myocardial threshold can result in nonconduction of the artificial impulse, particularly near the end of the life of the battery, when the output of current has started to decline. This report demonstrates such an increase in myocardial resistance which was apparent only upon massage of the carotid sinus.
We investigated 76 patients with carotid sinus syndrome followed over a time period of 12-40 months (mean 24 months). In 27 patients long-term ECG were recorded over 24 hours continuously. Carotid Doppler sonography was performed in all patients. 14 patients were studied electrophysiologically. The long-term ECG examinations in patients with carotid sinus syndrome showed a significant tendency to nocturnal bradycardia, and normal heart frequency during the day. In 41% of patients extracranial obstruction of internal carotid arteries could be demonstrated.
Because syncope may occur intermittently in patients with carotid sinus hypersensitivity, a knowledge of its natural history is needed as a basis for interpreting the usefulness of therapy. Fifty-six consecutive patients are described (47 men and 9 women; mean age 61 years) with carotid sinus hypersensitivity and syncope in whom 24 hour ambulatory monitoring and intracardiac electrophysiologic study revealed no other cause for the syncope. The mean duration of symptoms was 44 months (range 1 to 480) and the mean number of episodes was 4.0 (range 1 to 20).
The authors report their experience of permanent exclusive atrial pacing in the treatment of sinus node dysfunction in a series of 65 cases with a follow up of 1 to 5 years (average 37.6 months; 2406 patients months), 41 women and 24 men aged 74 +/- 3 years. Sixty one patients were symptomatic. The diagnosis was made from surface ECG recordings in 54 cases (83 p. 100) and after electrophysiological investigation in 11 cases (16 p. 100).
The aim of this study was to evaluate the importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. In 23 patients (21 m, two f; mean age 69 +/- 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: (1) Research of ventriculo-atrial conduction, orthostatic hypotension and pacemaker effect; and (2) Carotid sinus massage in the standing position during VVI and DVI temporary pacing.