Safety and Effectiveness of Transvenous Lead Extraction in Octogenarians

Transvenous Lead Extraction . Introduction: As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Western countries. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians. Methods and Results: From January 2005 to January 2011, we reviewed data from consecutive patients ≥ 80 years referred to our institutions for transvenous lead extraction because of cardiac device infection or lead malfunction. Clinical characteristics, procedural features, and periprocedural major and minor complications were compared between octogenarians and younger patients. Out of 849 patients undergoing lead extraction in the participating institutions during the study period, 150 (18%) patients were octogenarians (mean age 84 years; range 80–96; 64% males). A significantly higher percentage of octogenarians presented with chronic renal failure (55% vs 26%; P < 0.001), history of malignancy (22% vs 6%; P < 0.001), and chronic obstructive pulmonary disease (46% vs 19%; P < 0.001). Complete lead extraction rates were similar in the 2 age groups (97% in octogenarians vs 96% in patients <80 years; P = 0.39). Periprocedural death occurred in 2 (1.3%) patients ≥80 years and in 5 (0.72%) patients <80 years (P = 0.45 for comparison). No differences in terms of other periprocedural major and minor complications were found between the 2 age groups. Conclusion: Despite presenting with a significantly higher rate of comorbidities, transvenous lead extraction can be performed safely and successfully in octogenarians. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1103‐1108, October 2012)     

Radiofrequency Catheter Ablation of Ventricular Tachycardia Guided by Nonsurgical Epicardial Mapping in Chronic Chagasic Heart Disease

We report a case of a 63-year-old women with Chagas'disease and recurrent, syncopal VT treated by RF catheter ablation in whom endocardial application of RF energy was guided by nonsurgical epicardial mapping. The procedure was undertaken in the electrophysiology laboratory under deep anesthesia. VT was interrupted after 2.4 seconds of application and rendered noninducible afterwards. Two weeks after the procedure, a distinct morphology VT was induced by programmed ventricular stimulation, and the patient was started on amiodarone, remaining asymptomatic 12 months after the procedure.     

Hormonal and metabolic characteristics of geneticall obese Zucker and dietar obese Sprague-Dawle rats

Abstract. The endocrine-metabolic plasma pattern and the capacit of isolated perfused livers to produce triglcerides and ketone bodies have been studied in geneticall and diet-acquired obese rats (Zucker and Sprague-Dawle obese rats), and in control groups of the same strains.
An increased plasma insulin/glucagon molar ratio with hperinsulinaemia and hpoglucagonaemia was associated with hpertriglceridaemia, normal ketonaemia, elevated free fatt acids and normal or slight hperglcaemia in obese rats.
During oleate perfusion, the livers of Zucker and Sprague-Dawle obese rats showed an increase in triglceride output and liver triglceride content. The ketone bod output as well as the mitochondrial carnitine palmitol transferase activit were normal or slightl decreased.
In our rat population, a positive correlation between the insulin/glucagon molar ratio and triglceride output has been found.     

Interventional Catheterization after Total Cavopulmonary Connection: Experience in 68 Patients

Background: Total cavopulmonary connection (TCPC) is performed in patients having a single ventricle to allow the passive flow of systemic venous blood to the lungs. Interventional catheterization is needed to treat residual defects or complications. Aims: We discuss our results concerning 68 patients who had had TCPC from January 1995 to December 2010. Methods: Initial and follow‐up catheterization data were reviewed retrospectively. Mid ‐ term results were evaluated by means of angiography and/or CT scan. Results: Mean age at TCPC was 5 years (2.5–18); mean interval between TCPC and catheterization was 5.6 years (1.5–15). Sixty‐nine catheterizations were performed in 53 patients. Eleven patients (21%) had low venous pressure, did not display a right‐to‐left shunt, and did not need any intervention. Fifteen patients (28%) had low venous pressure and only needed the closure of the fenestration. The remaining 27 patients (51%) needed the following interventions: embolization of venous vessels prompting right‐to‐left shunt (n = 15), stenting or reconnection of pulmonary arteries (n = 5), stenting or recanalization of systemic veins (n = 11), other procedures (n = 5). In 3 patients the fenestration could not be closed due to high venous pressure. After the interventions oxygen saturation increased from 90.5%± 4.8% to 94.7%± 3.6% (P = 0.002). Conclusions: Our data show that 49% of patients with TCPC are in good condition late after surgery. However, half of these patients continue to need interventions generally aimed at suppressing stenoses at various levels of TCPC or at occluding vessels prompting right‐to‐left shunt. This population should enter a multicenter program aimed at identifying patients at risk. (J Interven Cardiol 2012;25:622–627)     

Anaesthesia for emergency caesarean section

Summary. The Report on Confidential Enquiries into Maternal Deaths in England and Wales 1982–84 (Department of Health 1989) recommends early involvement of the anaesthetist in women having emergency caesarean sections and the use of epidural anaesthesia in preference to general anaesthesia. In an observational prospective study the need for emergency abdominal delivery could be anticipated in 87% of 360 consecutive emergency caesarean sections. Early establishment of epidural analgesia allowed extension, to an appropriate level for the surgery, in 70%. The duty anaesthetist accompanying the obstetric team on three wardrounds a day could be forewarned of anticipated problems in most women who are eventually delivered abdominally.     

Catheter Induced Distal Intra-Hisian Right Bundle Branch Block in a Patient with Persistent Proximal Intra-Hisian Complete A-V Block

We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.     

Echocardiographic and Doppler Findings in Primary Sarcoma of the Pulmonary Artery

Primary sarcoma of the pulmonary artery is a rare heart tumor. In the reported case, the clinical findings were nonspecific, and were characterized by progressive dyspnea, fever, and a systolic murmur in the pulmonary area. Echocardiographic examination showed an echogenic mass partially obstructing the pulmonary artery trunk, dilation of the right cardiac chambers, and a pressure overload pattern. Doppler and color Doppler demonstrated a high-velocity systolic flow jet in the pulmonary artery due to obstruction of the vessel by the tumor, as well as severe high-velocity tricuspid regurgitation. The patient died suddenly soon thereafter. The autopsy confirmed almost total occlusion of the pulmonary artery by a neoplastic mass. Histopathological diagnosis was primary vascular leiomyosarcoma of the pulmonary artery. In addition, a large tumor embolus had occluded the right pulmonary artery. Doppler echocardiography proved useful in noninvasively recognizing the sarcoma of the pulmonary artery, and explaining the clinical picture and hemodynamic derangements produced by this tumor. This could, in other patients, allow an early diagnosis and timely surgical intervention.     

Transcoronary Chemical Ablation of Incessant Atrial Tachycardia

Transcoronary Ablation of Incessant Atrial Tachycardia. Incessant atrial tachycardia, of at least 10 years duration and not controllable by antiarrhythmic drugs, was ablated by means of transcoronary administration of ethanol in a 24–year-old female. The arrhythmia was suppressed completely without recurrences during 8 months of follow-up. (J Cardiovasc Electrophysiol, Vol. 1, pp. 116–120, 1990)