Tag Archives: pacemaker

Background Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), arises from Virchow’s triad: venous stasis, endothelial injury, and hypercoagulability. Upper extremity DVT (UEDVT) represents ~10% of all DVTs, with an annual incidence of 0.4–1.0 per 10,000 people.1 Symptomatic disease is rarer. Causes are primary or, more commonly (~60%), secondary to central venous catheters, pacemaker leads, malignancy, or other prothrombotic states.2,3 Pacemaker leads substantially increase UEDVT risk. A 2021 meta-analysis (Duijzer et al.) reported a >10-fold higher incidence after transvenous lead insertio

Introduction Atrioventricular (AV) block is an uncommon complication of myocarditis, which is most often observed in combination with underlying conditions such as that caused by cardiac sarcoidosis (CS), giant cell myocarditis (GCM) and acute lymphocytic myocarditis. Myocarditis is a broad term that describes inflammation of the myocardium, which can range from mild and self-limiting to fulminant variants that require cardiac transplantation. Patients with proven GCM and CS may benefit from immunosuppression, and it is important to investigate for underlying infiltrative disease in cases of myocarditis and AV block as specific treatments ma

Introduction Dr Selwyn Brendon Goldthorpe Indications for the use of pacemakers and implantable cardioverter-defibrillators (ICDs) have become more defined over time, resulting in many more patients receiving these devices.1 Cardiac implantable electronic device (CIED) procedure is the term used to encompass pacemaker and ICD implant surgery. As of 2016, it was estimated that there were about 1.14 million pacemakers globally. By the year 2023, that number is expected to increase to 1.43 million units.2 Many nations are now keeping records of the implant complication rate for pacemakers and ICDs.3-6 As in any surgical procedure, a complication

Introduction Severe aortic stenosis (AS) is the most common degenerative heart valve disease (HVD).1 There are growing numbers of patients with AS who are waiting for transcatheter aortic valve implantation (TAVI), as rates of degenerative HVD rise. Around 1.5 million people in the UK currently have moderate-to-severe HVD, and numbers are expected to rise to 2.7 million by 2040.2 Figure 1 shows the level of undiagnosed patients across all age groups with severe symptomatic AS.3 A significant proportion of patients who are receiving TAVI are aged 75 to 90 years, an increasing demographic in the National Health Service (NHS) as the population a

Background One of the consequences of cardiovascular disease may be a limitation of physical activity, as a result of pain (e.g. in patients with angina) or inadequate cardiac output (e.g. in patients with heart failure). While the benefits of regular physical activity for secondary prevention in cardiovascular disease are well recognised,1 declines in physical activity may indicate a change in clinical status of a patient, whether this is in relation to cardiovascular diseases, such as heart failure,2 or the more general wellbeing of the patient. Thus, one measure of disease severity is to assess the objective exercise capability of patient

Introduction There has been a significant increase in the use of computed tomography (CT) imaging over the last 20 years, both in terms of the number of patients being imaged and the number of imaging studies per patient. Between 1997 and 2006 the incidence of CT scanning in the US has more than doubled.1 A consequence of increased use is the detection, in increasing numbers, of incidental findings and artefacts.2 An artefact is defined as any discrepancy between what is identified on the CT image and the true appearance of the object.3 Detection of incidental findings and artefacts are particularly prevalent in patients with metallic foreign

Dr Paul Foley Introduction 2018 marks the 60-year anniversary of the first patient to receive an implantable battery-powered pacemaker.1 In fact, the earliest recorded description of pacing was in 1882, and now countless lives have been saved by pacemaker technology. Subsequent important developments include the development of the implantable cardioverter defibrillator (ICD) in 1980 and then, more recently, one of the most effective cardiac treatments, cardiac resynchronisation therapy, which was first described in 1984. Exciting and disruptive developments in pacing technology may, potentially, herald a sea change in practice, while historic

Definitions Lead extraction is defined as a procedure in which a cardiovascular implantable electronic device (CIED) lead is removed with the assistance of equipment not routinely used during implantation, or after it has been in situ for more than one year. Lead explant is the removal of a lead that has been implanted for less than one year using only standard implantation stylets. Indications The indications for CIED lead extraction from contemporary international guidelines are summarised in table 1. Table 1. Adapted indications for lead extractions and their class of recommendation1 Epidemiology The number of lead extraction procedures be

Dr Paul R Roberts Introduction Since the first implantation of a pacemaker 60 years ago, the medical world has seen an incredible evolution of these devices. The first pacemaker had limited capability. With time, we have seen changes to lead design that have meant that they are smaller, more robust and last longer. The greatest changes have occurred with the electrical aspects of the devices. There are enhanced algorithms in the devices that make them more physiological, and magnetic resonance imaging (MRI) safe devices are now considered the standard of care. This journey has not been without some challenges, and this therapy continues to be

A new portable monitoring device (CardioMessenger Smart, Biotronik) has been launched in the USA. Roughly the size of a smartphone, the device keeps pacemaker, implantable cardioverter defibrillator, and insertable cardiac monitor patients connected to their physician remotely. The device automatically transmits daily reports of cardiac activity via worldwide cellular networks to physicians without intervention from the patient. It also provides fully customisable alerts that can be programmed to the physician’s specifications. Studies have found that home monitoring can significantly reduce hospitalisation, stroke and mortality. The manuf