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Choe JK, Kim S, Lee AY, Choi C, Cho JH, Jo W, Song MH, Cha C, Kim J. Flexible, Biodegradable, and Wireless Magnetoelectric Paper for Simple In Situ Personalization of Bioelectric Implants. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2311154. [PMID: 38174953 DOI: 10.1002/adma.202311154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Indexed: 01/05/2024]
Abstract
Bioelectronic implants delivering electrical stimulation offer an attractive alternative to traditional pharmaceuticals in electrotherapy. However, achieving simple, rapid, and cost-effective personalization of these implants for customized treatment in unique clinical and physical scenarios presents a substantial challenge. This challenge is further compounded by the need to ensure safety and minimal invasiveness, requiring essential attributes such as flexibility, biocompatibility, lightness, biodegradability, and wireless stimulation capability. Here, a flexible, biodegradable bioelectronic paper with homogeneously distributed wireless stimulation functionality for simple personalization of bioelectronic implants is introduced. The bioelectronic paper synergistically combines i) lead-free magnetoelectric nanoparticles (MENs) that facilitate electrical stimulation in response to external magnetic field and ii) flexible and biodegradable nanofibers (NFs) that enable localization of MENs for high-selectivity stimulation, oxygen/nutrient permeation, cell orientation modulation, and biodegradation rate control. The effectiveness of wireless electrical stimulation in vitro through enhanced neuronal differentiation of neuron-like PC12 cells and the controllability of their microstructural orientation are shown. Also, scalability, design flexibility, and rapid customizability of the bioelectronic paper are shown by creating various 3D macrostructures using simple paper crafting techniques such as cutting and folding. This platform holds promise for simple and rapid personalization of temporary bioelectronic implants for minimally invasive wireless stimulation therapies.
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Affiliation(s)
- Jun Kyu Choe
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Suntae Kim
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Ah-Young Lee
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Cholong Choi
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Jae-Hyeon Cho
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Wook Jo
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Myoung Hoon Song
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Chaenyung Cha
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Jiyun Kim
- Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
- Center for Multidimensional Programmable Matter, Ulsan National Institute of Science and Technology, Ulsan, 44919, Republic of Korea
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2
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Chen Z, Lin Z, Obaid SN, Rytkin E, George SA, Bach C, Madrid M, Liu M, LaPiano J, Fehr A, Shi X, Quirion N, Russo B, Knight H, Aduwari A, Efimov IR, Lu L. Soft, bioresorbable, transparent microelectrode arrays for multimodal spatiotemporal mapping and modulation of cardiac physiology. SCIENCE ADVANCES 2023; 9:eadi0757. [PMID: 37406128 DOI: 10.1126/sciadv.adi0757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
Transparent microelectrode arrays (MEAs) that allow multimodal investigation of the spatiotemporal cardiac characteristics are important in studying and treating heart disease. Existing implantable devices, however, are designed to support chronic operational lifetimes and require surgical extraction when they malfunction or are no longer needed. Meanwhile, bioresorbable systems that can self-eliminate after performing temporary functions are increasingly attractive because they avoid the costs/risks of surgical extraction. We report the design, fabrication, characterization, and validation of a soft, fully bioresorbable, and transparent MEA platform for bidirectional cardiac interfacing over a clinically relevant period. The MEA provides multiparametric electrical/optical mapping of cardiac dynamics and on-demand site-specific pacing to investigate and treat cardiac dysfunctions in rat and human heart models. The bioresorption dynamics and biocompatibility are investigated. The device designs serve as the basis for bioresorbable cardiac technologies for potential postsurgical monitoring and treating temporary patient pathological conditions in certain clinical scenarios, such as myocardial infarction, ischemia, and transcatheter aortic valve replacement.
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Affiliation(s)
- Zhiyuan Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Zexu Lin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Sofian N Obaid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Eric Rytkin
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Sharon A George
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Christopher Bach
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Micah Madrid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Miya Liu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Jessica LaPiano
- MedStar Georgetown University Hospital, Washington, DC 20037, USA
| | - Amy Fehr
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Xinyu Shi
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Nathaniel Quirion
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Benjamin Russo
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Helen Knight
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Anthony Aduwari
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL 60611, USA
| | - Luyao Lu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
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3
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Choi YS, Yin RT, Pfenniger A, Koo J, Avila R, Benjamin Lee K, Chen SW, Lee G, Li G, Qiao Y, Murillo-Berlioz A, Kiss A, Han S, Lee SM, Li C, Xie Z, Chen YY, Burrell A, Geist B, Jeong H, Kim J, Yoon HJ, Banks A, Kang SK, Zhang ZJ, Haney CR, Sahakian AV, Johnson D, Efimova T, Huang Y, Trachiotis GD, Knight BP, Arora RK, Efimov IR, Rogers JA. Fully implantable and bioresorbable cardiac pacemakers without leads or batteries. Nat Biotechnol 2021; 39:1228-1238. [PMID: 34183859 PMCID: PMC9270064 DOI: 10.1038/s41587-021-00948-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 05/06/2021] [Indexed: 12/22/2022]
Abstract
Temporary cardiac pacemakers used in periods of need during surgical recovery involve percutaneous leads and externalized hardware that carry risks of infection, constrain patient mobility and may damage the heart during lead removal. Here we report a leadless, battery-free, fully implantable cardiac pacemaker for postoperative control of cardiac rate and rhythm that undergoes complete dissolution and clearance by natural biological processes after a defined operating timeframe. We show that these devices provide effective pacing of hearts of various sizes in mouse, rat, rabbit, canine and human cardiac models, with tailored geometries and operation timescales, powered by wireless energy transfer. This approach overcomes key disadvantages of traditional temporary pacing devices and may serve as the basis for the next generation of postoperative temporary pacing technology.
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Affiliation(s)
- Yeon Sik Choi
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Rose T Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Anna Pfenniger
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA
| | - Jahyun Koo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - K Benjamin Lee
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Sheena W Chen
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Geumbee Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Gang Li
- Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO, USA
| | - Yun Qiao
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | | | - Alexi Kiss
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- The George Washington Cancer Center, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shuling Han
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Seung Min Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Chenhang Li
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, International Research Center for Computational Mechanics, Dalian University of Technology, Dalian, China
| | - Yu-Yu Chen
- Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Amy Burrell
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA
| | - Beth Geist
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA
| | - Hyoyoung Jeong
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
| | - Joohee Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
| | - Hong-Joon Yoon
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Anthony Banks
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA
| | - Seung-Kyun Kang
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Zheng Jenny Zhang
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chad R Haney
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, USA
| | - Alan Varteres Sahakian
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - David Johnson
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA
| | - Tatiana Efimova
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- The George Washington Cancer Center, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Gregory D Trachiotis
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC, USA
| | - Bradley P Knight
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA
| | - Rishi K Arora
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL, USA.
| | - Igor R Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA.
| | - John A Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA.
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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4
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Pekarsky V, Gimrikh E, Karpov R, Popov S, Chekhov A, Savenkov G, Pekarskaya M. Prevention of recurrent life-threatening ventricular arrhythmias by temporary cardiac pacing. ACTA MEDICA SCANDINAVICA 2009; 217:95-9. [PMID: 3976438 DOI: 10.1111/j.0954-6820.1985.tb01641.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Overdrive pacing has been applied in 26 patients to prevent frequent recurrent ventricular fibrillation (VF) and ventricular tachycardia (VT) occurring in the setting of ventricular extrasystole of 2-5 degrees graded by Lown. These patients had 3-47 recurrent attacks of VF and VT (11.4 +/- 2.4) which were not prevented with antiarrhythmic agents. Overdrive pacing was continued for 2-236 hours (21.3 +/- 3.7) and appeared to be effective in 23 (88.4%) of the 26 patients including those with prolonged QT intervals. Atrial pacing was more effective than ventricular overdriving and required stimulation at a slower rate. Antiarrhythmic therapy and overdrive pacing in combination were more effective than both used independently. Suppression of ventricular extrasystole and prevention of life-threatening arrhythmias were achieved by increasing the heart rate by 23.2 +/- 4.5 beats/min.
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5
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Temporary Cardiac Pacing. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Deprez F, Blommaert D, De Roy L. An unusual way to diagnose asymptomatic right ventricular perforation by a temporary endocardial pacing electrode. Eur J Emerg Med 2003; 10:250-1. [PMID: 12972908 DOI: 10.1097/00063110-200309000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Right ventricular perforation by a temporary endocardial pacing electrode can be fatal and needs to be detected promptly. This usually symptomatic situation is diagnosed by X-ray or echocardiographic findings. We present the case of a patient with an asymptomatic right ventricular perforation, in whom serial electrocardiograms enabled us to detect the displacement of the right ventricular lead.
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Affiliation(s)
- Frédéric Deprez
- Department of Cardiology, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium
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7
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Temporary Cardiac Pacing in the Intensive Care Unit. J Intensive Care Med 1996. [DOI: 10.1177/088506669601100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Indications for temporary cardiac pacing have increased substantially in the last several years. Although most temporary cardiac pacing is still carried out to treat symptomatic bradycardia due to atrioventricular conduction system disease or atrial bradycardia (i.e., sinus node dysfunction), temporary pacing is currently used to induce and to terminate some supraventricular tachyarrhythmias, prevent pause-dependent ventricular tachycardia (usually torsades de pointes), and vagally mediated atrial fibrillation, to allow the maintenance of hemodynamic competence in postoperative cardiac patients and to evaluate selected patients with hypertrophic and dilated cardiomyopathies who might benefit hemodynamically from cardiac pacing. The roles of transcutaneous and esophageal pacing have also expanded; transcutaneous pacing is now commonly used in patients at high risk for the development of atrioventricular block, such as those with acute myocardial infarction and bifascicular block. We review available types of temporary pacing leads and pulse generators, the methods by which temporary pacing is accomplished, complications of pacing system insertion, and current indications for this therapy. Guidelines for troubleshooting normal and abnormal pacemaker function in the intensive care unit setting are provided.
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8
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Shandling AH, Crump R, Nolasco M, Lorenz LM, Li CK. The effect of chronic atrial overdrive suppression pacing on the incidence of supraventricular tachyarrhythmias. Clin Cardiol 1992; 15:917-22. [PMID: 1473308 DOI: 10.1002/clc.4960151212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic overdrive suppression pacing has been suggested as an effective adjunctive method for reducing the incidence of cardiac tachyarrhythmias. Documentation of effectiveness during prolonged monitoring is lacking, however. To assess more accurately the long-term utility of this treatment modality for medically refractory supraventricular tachyarrhythmias (SVTs), 10 patients with atrially implanted Intermedics Intertach pacemakers were randomly assigned to either a low or a high bradycardia (back-up) pacing rate. SVT counts were performed during matching follow-up periods both at the initial rate and after rate crossover. The primary antitachycardia modality of this pacemaker (P mod) provides burst pacing to terminate tachycardia episodes, and P mod counters were utilized to quantitate SVT episodes. Tachycardia termination algorithms were programmed to "no restart" and were not changed during the study. The P mod use counter, therefore, reflected the number of discrete episodes of SVTs. Pacemaker implantation diagnoses include atrial flutter, concealed bypass tract, AV nodal reentry, intraatrial reentry, and Wolff-Parkinson-White associated tachycardia. Patient age was 59 +/- 18 yrs. The average pacemaker back-up low rate was 45.7 +/- 4 versus a back-up high rate of 85.1 +/- 2 beats/min. Follow-up was for 57.4 days +/- 33 days at the low rate and 57.3 days +/- 34 days at the high rate (r = 0.99). There was no difference in SVT incidence with a P mod usage of 98.4 +/- 106 at the low rate and 100.8 +/- 94 at the high rate (p = NS). In this blinded, randomized cross-over trial, chronic atrial overdrive suppression pacing did not reduce the overall incidence of SVT episodes during prolonged monitoring.
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Affiliation(s)
- A H Shandling
- Memorial Heart Institute, Long Beach Memorial Medical Center, CA 90801-1428
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9
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Atlee JL, Pattison CZ, Mathews EL, Bilof RM, Hedman AG. Evaluation of transesophageal atrial pacing stethoscope in adult surgical patients under general anesthesia. Pacing Clin Electrophysiol 1992; 15:1515-25. [PMID: 1383963 DOI: 10.1111/j.1540-8159.1992.tb02925.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sinus bradycardia (SB) and atrioventricular junctional rhythm (AVJR) commonly cause circulatory insufficiency in anesthetized surgical patients. Treatment is usually with drugs, which can be ineffective or have adverse effects. Cardiac pacing might be preferred, but the transvenous or epicardial routes are too invasive for routine use, and transcutaneous pacing fails to preserve atrial transport function. Transesophageal atrial pacing (TAP) lacks these disadvantages, yet unavailability of inexpensive products has prevented more widespread use. Therefore, a pacing esophageal stethoscope (PES) fabricated by addition of bipolar electrodes to disposable esophageal stethoscopes routinely used for intraoperative monitoring, was evaluated in 100 anesthetized adults. TAP thresholds (10-msec pulses) and hemodynamic effects of TAP as treatment for incidental SB (< or = 60 beats/min) or AVJR were determined. Minimum TAP thresholds (mean +/- standard error) in 48 males were 7.3 +/- 0.3 mA and in 51 females were 8.5 +/- 0.4 mA. Corresponding inferior alveolar ridge-to-electrode distances were 32.5 +/- 0.2 and 30.4 +/- 0.2 cm. For 48 patients with SB < or = 60 beats/min (54 +/- 1 beats/min), TAP (81 +/- 1 ppm) produced average 15, 11, and 14 mmHg increases in systolic, diastolic, and mean arterial pressure, respectively (P < 0.001). For 11 patients with AVJR (71 +/- 5 beats/min), TAP (92 +/- 3 ppm) produced average 23 and 15 mmHg increases in systolic and mean arterial pressure, respectively (P < 0.05). There were no apparent complications of TAP. TAP with a PES appears practical, safe, and effective for prophylaxis and treatment of SB or AVJR in anesthetized surgical patients.
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Affiliation(s)
- J L Atlee
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
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10
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Hii JT, Mitchell LB, Duff HJ, Wyse DG, Gillis AM. Comparison of atrial overdrive pacing with and without extrastimuli for termination of atrial flutter. Am J Cardiol 1992; 70:463-7. [PMID: 1642184 DOI: 10.1016/0002-9149(92)91191-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atrial overdrive pacing has been successfully used to terminate atrial flutter. This study compared the efficacy of atrial extrastimuli following a rapid pacing train to overdrive pacing without atrial extrastimuli for the termination of atrial flutter. Patients were randomized to treatments of short or long burst atrial overdrive pacing or atrial overdrive pacing followed by atrial extrastimuli in a crossover study design. A total of 22 patients (73%) had successful conversion of atrial flutter to sinus rhythm. The success rates in patients exposed to each therapy, including crossover therapies, were 62% with the atrial extrastimuli method, 8% with the short burst pacing method, and 8% with the long burst pacing method (p less than 0.001). Transient atrial fibrillation developed in 15 patients and in 9 of these this arrhythmia preceded conversion to sinus rhythm. Sustained atrial fibrillation was induced in 3 additional patients but never with the atrial extrastimuli method. In conclusion, the method of delivering atrial extrastimuli after a rapid pacing train is highly efficacious for the termination of atrial flutter. Furthermore, this method is more effective than atrial overdrive pacing methods delivered at the same pacing cycle length. These observations have important implications for the programming of antitachycardia pacemakers.
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Affiliation(s)
- J T Hii
- Department of Medicine, The University of Calgary, Alberta, Canada
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11
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12
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Dougenis D, Dark JH, Gold RG. Perforation of the left ventricle by a temporary pacing lead. Intensive Care Med 1990; 16:520-1. [PMID: 2286736 DOI: 10.1007/bf01709406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Krinsky VI, Biktashev VN, Pertsov AM. Autowave approaches to cessation of reentrant arrhythmias. Ann N Y Acad Sci 1990; 591:232-46. [PMID: 2197922 DOI: 10.1111/j.1749-6632.1990.tb15092.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- V I Krinsky
- Institute of Biological Physics, USSR Academy of Sciences, Pushchino, Moscow Region
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14
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Trankina MF, White RD. Perioperative cardiac pacing using an atrioventricular pacing pulmonary artery catheter. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:154-62. [PMID: 2519939 DOI: 10.1016/s0888-6296(89)92402-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
An atrioventricular pacing thermodilution pulmonary artery catheter was evaluated in 40 patients undergoing cardiac surgery. The catheter was inserted in all study patients in a timely fashion without difficulty and functioned well during the perioperative period. Before the start of cardiopulmonary bypass, atrial capture was achieved in 98% of the patients (threshold mean 4.9 mA), ventricular capture in 100% (threshold mean 3.0 mA) and atrioventricular sequential (AVS) pacing in 98%. After cardiopulmonary bypass, atrial capture was achieved in 95% of the patients (threshold mean 5.2 mA), ventricular pacing in 100% (threshold mean 3.1 mA), and sequential pacing in 95%. In 27 patients in whom cardiac outputs were recorded, cardiac index increased an average of 45% (range 8% to 95%) with atrial or AVS pacing over ventricular pacing alone. In 11 patients, extended atrial pacing was used postoperatively, the longest for 93 hours. No major complications could be attributed to the study catheter. Minor complications included diaphragmatic stimulation in one patient and supraventricular tachycardia, possibly related to atrial pacing postoperatively, in one patient. These data suggest that this catheter/pacing system is effective and reliable for hemodynamic monitoring and temporary atrial or AVS pacing. In addition, the atrial pacing probe can be used perioperatively to record atrial electrograms to facilitate the diagnosis of supraventricular tachyarrhythmias.
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Affiliation(s)
- M F Trankina
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905
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15
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Della Bella P, Tondo C, Marenzi G, Cipolla CM, Doni F, Grazi S, Rimondini A, Salvioni A, Guazzi MD. Facilitating influence of disopyramide on atrial flutter termination by overdrive pacing. Am J Cardiol 1988; 61:1046-9. [PMID: 3284318 DOI: 10.1016/0002-9149(88)90123-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Long-lasting (mean 30 days) type I atrial flutter was treated with overdrive pacing in 30 patients (mean age 69 years) with organic heart disease. To evaluate the effect of pretreatment with disopyramide, the study population was divided in 3 groups of 10 patients each: group A, no disopyramide therapy; group B, intravenous disopyramide (maximum dose 250 mg in 1 hour); and group C, oral disopyramide (400 mg daily for 4 days). There were no differences in baseline cycle length of atrial flutter among the 3 groups before drugs were given. The stimulation protocol included overdrive atrial pacing up to the shortest paced cycle of 150 ms performed at a maximum of 3 atrial sites. Reversion to sinus rhythm occurred in 2 patients in group A, 7 in group B (p less than 0.01) and 5 in group C. Pacing was performed from a mean number of 2.1 sites/patient in group A, 1.2 in group B and 2.0 in group C. Atrial fibrillation occurred in 7, 3 and 4 patients, respectively. Acceleration to a faster form of atrial flutter occurred in 3, 3 and 4 patients, respectively, and reversion to sinus rhythm occurred in all patients who had intravenous disopyramide and in 1 who took the drug orally. The administration of disopyramide before overdrive pacing improved the rate of conversion to sinus rhythm and allowed an easier stimulation protocol with a lower incidence of pacing-induced atrial fibrillation. Disopyramide is beneficial when overdrive atrial pacing is performed for the treatment of long-standing atrial flutter in patients with organic heart disease.
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Olshansky B, Okumura K, Hess PG, Henthorn RW, Waldo AL. Use of procainamide with rapid atrial pacing for successful conversion of atrial flutter to sinus rhythm. J Am Coll Cardiol 1988; 11:359-64. [PMID: 3339174 DOI: 10.1016/0735-1097(88)90102-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Rapid atrial pacing is a useful technique and often the therapy of choice to terminate atrial flutter in patients. However, interruption of atrial flutter by rapid atrial pacing may not always produce sinus rhythm, but rather may result in atrial fibrillation. Twelve patients with spontaneous atrial flutter that had been present for greater than 24 h were studied to assess the efficacy of atrial pacing, alone and in combination with procainamide, to convert atrial flutter to normal sinus rhythm. Rapid atrial pacing for greater than or equal to 15 s from selected atrial sites at selected pacing rates were performed during atrial flutter. The initial pacing rate was always at a cycle length 10 ms shorter than the atrial flutter cycle length. If atrial flutter persisted after cessation of pacing, it was repeated at progressively shorter cycle lengths until either a rate of 400 beats/min was achieved or atrial fibrillation was induced. In two patients, atrial flutter was converted to sinus rhythm with pacing alone. Three patients developed sustained atrial fibrillation as a result of the rapid atrial pacing, this rhythm ultimately reverting back to atrial flutter in two. Ten patients received procainamide and 9 of the 10 had lengthening of the atrial flutter cycle length by a mean of 68 ms (1 patient continued to have atrial fibrillation). Then, using the same atrial pacing protocol, high right atrial pacing alone at a mean cycle length of 227 ms interrupted atrial flutter in all these patients, returning their rhythm to sinus rhythm. It is concluded that intravenous procainamide effectively augments the efficacy of rapid atrial pacing to convert atrial flutter to sinus rhythm.
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Affiliation(s)
- B Olshansky
- Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, Ohio 44106
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Falk RH, Werner M. Transesophageal atrial pacing using a pill electrode for the termination of atrial flutter. Chest 1987; 92:110-4. [PMID: 3595221 DOI: 10.1378/chest.92.1.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To determine the efficacy of transesophageal rapid atrial pacing with a "pill-electrode" for the termination of atrial flutter, we studied 14 consecutive unselected patients presenting with atrial flutter of various etiologies. The bipolar pill-electrode (interelectrode distance 13 mm) was introduced orally without sedation. Of 14 pacing attempts, atrial capture was obtained in 13 (93 percent), and sustained alteration in rhythm (atrial fibrillation, sinus rhythm or type 2 flutter) in 12 (86 percent). Normal sinus rhythm occurred in six (43 percent), in all of whom it was preceded by transient atrial fibrillation. There was no difference in baseline flutter rates, pacing rates for atrial capture, or duration of flutter between patients reverting to sinus rhythm and those remaining in flutter or converting to atrial fibrillation. Pacing was well tolerated in all but one subject. Thus, esophageal pacing with the pill-electrode was simple to perform, well-tolerated and highly successful for atrial capture in patients with atrial flutter. Although it had a lower success rate than DC cardioversion in producing sinus rhythm, the simplicity of application makes it a useful initial alternative, particularly in patients in whom cardioversion may be hazardous.
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Abstract
This article reviews the indications for temporary pacing, describes and illustrates the techniques, discusses the fundamentals of electrical stimulation, and explores special applications, including overdrive and dual-chamber DDD pacing.
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Kuchar DL, Keogh AM, Thorburn CW. Pacemaker reversion for suspected supraventricular tachycardia. Anaesth Intensive Care 1985; 13:163-7. [PMID: 4014637 DOI: 10.1177/0310057x8501300209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Overdrive atrial pacing was employed in twelve patients with suspected supraventricular tachycardia resistant to drug therapy. Eleven of these patients reverted to sinus rhythm with pacing either immediately or after a short episode of atrial fibrillation. In one patient, recordings from the atrial electrode indicated that a broad complex tachycardia was of ventricular rather than supraventricular origin. No complications were encountered and the procedure was well tolerated in all. Overdrive pacing is suggested as a safe alternative to DC cardioversion in drug-resistant supraventricular tachycardia, particularly in the presence of digitalis, in the elderly and in patients with chronic lung disease.
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Donovan KD, Lee KY. Indications for and complications of temporary transvenous cardiac pacing. Anaesth Intensive Care 1985; 13:63-70. [PMID: 3977066 DOI: 10.1177/0310057x8501300109] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A prospective survey was conducted of the indications for and complications of 153 temporary transvenous cardiac pacing lead insertions in 148 patients. Pacing for bradyarrhythmias or potential bradyarrhythmias (Group I) accounted for 105 insertions, wide complex tachycardia (Group II) 17, and narrow complex tachycardia (Group III) 31 pacing electrode insertions respectively. The infraclavicular subclavian vein approach was used in 73%. The median insertion time was 20 minutes. Group I: 77% were undertaken because of severe symptoms. On 64 occasions (61%) the patient had complete heart block or ventricular asystole. Group II: The lead was inserted to treat and often assist in the diagnosis of the wide complex tachycardia. Ventricular 'burst' pacing reverted ventricular tachycardia in 13 (76%). Group III: Rapid atrial 'burst' pacing was used to treat supraventricular tachyarrhythmias (paroxysmal supraventricular tachycardia and atrial flutter) resistant to medical therapy. Pacing was successful in reverting 28 (90%). A complication occurred in 27 (18%) of 153 lead insertions, 11 (7%) were serious. No complication resulted in the death of a patient. Temporary transvenous pacing is safe and effective for the treatment of bradyarrhythmias and certain tachyarrhythmias.
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Abstract
Cardiac pacing techniques and equipment have developed dramatically in recent years. Bradycardias and tachycardias may be effectively treated by pacing. Bradyarrhythmias: It is generally accepted that pacing is indicated for a sustained symptomatic bradycardia. Prophylactic pacing for 'high-risk' bundle branch block in acute myocardial infarction is more controversial. A new era in cardiology has been introduced with the advent of 'physiological pacing', i.e. pacing of the heart with the maintenance of atrioventricular synchrony and varying the heart rate according to the body's metabolic leads. Modern pacing systems, which allow the atria and ventricles to contract in sequence, improve cardiac haemodynamics, result in subjective improvement and increase exercise tolerance. There are, however, pacemaker-associated and pacemaker-mediated tachyarrhythmias. Further advances in technology should overcome these problems. Tachyarrhythmias: Intracardiac electrocardiograms are often useful in the diagnosis of tachyarrhythmias, especially wide complex tachycardias. Rapid pacing of the atria in certain supraventricular tachycardias or of the ventricle in ventricular tachycardia is an alternative to cardioversion in many instances. This form of treatment is usually utilised in conjunction with drug therapy.
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Waldo AL, Henthorn RW, Epstein AE, Plumb VJ. Diagnosis and treatment of arrhythmias during and following open heart surgery. Med Clin North Am 1984; 68:1153-69. [PMID: 6208443 DOI: 10.1016/s0025-7125(16)31090-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The ability to record electrograms directly from the atria and to pace the atria and/or ventricles provides an effective, rapid, easy, and remarkably safe way to treat most disorders of rhythm and conduction in patients during and following open heart surgery. This article reviews various applications of those techniques.
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Ector H, Van Brabandt H, De Geest H. Treatment of life-threatening ventricular arrhythmias by a combination of antiarrhythmic drugs and right ventricular pacing. Pacing Clin Electrophysiol 1984; 7:622-7. [PMID: 6205361 DOI: 10.1111/j.1540-8159.1984.tb05588.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thirteen patients with intractable ventricular arrhythmias were studied; they underwent long-term treatment by a combination of antiarrhythmic drugs and ventricular pacing. Eleven patients had a history of tachycardia and two had torsade de pointes; eleven of thirteen had had cardioversion and/or defibrillation. Prior to permanent pacemaker implantation, temporary pacing in the VVI mode was used in combination with one or more of the following drugs: amiodarone, aprindine, digitalis, metoprolol, mexiletine, procainamide, pindolol, propranolol, or quinidine. Various pacing rates were tried; when permanent pacing was instituted, a unipolar system which was at least rate-programmable was used. Right ventricular VVI pacing, combined with drug therapy, was successful in ten of thirteen patients. Five of the ten patients are alive and free of arrhythmias after 78, 72, 72, 54, and 11 months, respectively. Although five patients died (after 60, 48, 30, 24, and 9 months, respectively), none of the deaths were related to arrhythmias. We suggest that in patients with ventricular arrhythmias refractory to conventional treatment, a therapeutic trial of right ventricular VVI pacing in combination with a drug regimen be used.
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Waldo AL, Henthorn RW, Plumb VJ. Relevance of electrograms and transient entrainment for antitachycardia devices. Pacing Clin Electrophysiol 1984; 7:588-600. [PMID: 6204318 DOI: 10.1111/j.1540-8159.1984.tb04954.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Clearly, understanding what occurs during rapid pacing of tachyarrhythmias due to reentry with an excitable gap does not provide the panacea to the rapid pacing treatment of these arrhythmias. However, it does advance the field considerably, and provides insights which should be useful for the development of improved antitachycardia pacing techniques.
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Mehra R. Control of tachyarrhythmias by electrical stimulation ¿ techniques and mechanisms. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 1984; 3:29-34. [PMID: 19493742 DOI: 10.1109/memb.1984.5006056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Waldo AL, Plumb VJ, Arciniegas JG, Henthorn RW, Zimmern SH. Verapamil therapy in the treatment of supraventricular arrhythmias following open heart surgery. Angiology 1983; 34:755-63. [PMID: 6660591 DOI: 10.1177/000331978303401201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Certain general conclusions suggest themselves on the basis of our extensive experience with treating arrhythmias in patients following open heart surgery, our specific results with verapamil therapy in the treatment of atrial fibrillation and atrial flutter in patients following open heart surgery, and the results of verapamil therapy administered in other groups of patients. First, verapamil can provide highly effective, rapid, and safe control of the ventricular response in the treatment of atrial fibrillation and atrial flutter in patients following open heart surgery. Usually, it should be used in concert with digitalis therapy. Second, extrapolation from the data of others suggests that verapamil has an important role to play in the treatment of most other supraventricular arrhythmias in patients following open heart surgery, particularly if temporary wire electrodes are not available.
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Abstract
The authors look at the use of pacemakers in three groups of patients: one with previously implanted cardiac pacemakers, one requiring temporary pacing systems for reasons related to their heart, and one in whom indications exist for permanent pacemaker implantation, but because of a surgical emergency, cannot have a permanent unit implanted before the noncardiac operation.
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Waldo AL, Plumb VJ, Arciniegas JG, MacLean WA, Cooper TB, Priest MF, James TN. Transient entrainment and interruption of the atrioventricular bypass pathway type of paroxysmal atrial tachycardia. A model for understanding and identifying reentrant arrhythmias. Circulation 1983; 67:73-83. [PMID: 6847807 DOI: 10.1161/01.cir.67.1.73] [Citation(s) in RCA: 170] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Meester GT, Simoons ML, Slager CJ, Kint PP, Spaa W, Hugenholtz PG. Use of the fluid column in a cardiac catheter for emergency pacing. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1983; 9:507-13. [PMID: 6640667 DOI: 10.1002/ccd.1810090511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Given the not infrequent need for intracardiac pacemaking during intensive cardiac care, a new type of cardiac pacemaker has been designed and tested [1]. With this pacemaker the heart can be stimulated through the fluid column of any conventional catheter, provided it is filled with a 0.9% NaCl solution. This fluid column pacemaker (FCP) is of the "constant current" type. The FCP was tested in 37 animals, in 30 patients in sinus rhythm, and also in two critical patients. In addition to the pacemaker circuit, a special connector was designed, enabling a fast, effective, and safe contact between patient and pacemaker. The FCP is considered to be ideally suited for use in emergency cardiac pacing in intensive care units and other areas where sudden bradycardias may occur and where intrathoracic catheters are inserted for a variety of reasons.
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