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Management of Complete Heart Block in a Pregnant Woman with Systemic Lupus Erythematosus-Associated Complications: Treatment Considerations and Pitfalls. Medicina (B Aires) 2022; 59:medicina59010088. [PMID: 36676711 PMCID: PMC9864118 DOI: 10.3390/medicina59010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
We present a case of a pregnant woman with systemic lupus erythematosus (SLE) who was diagnosed with asymptomatic complete heart block (CHB) during pregnancy. To evaluate possible risks and benefits of pacemaker (PM) implantation, a multidisciplinary counselling board was held. Its recommendation was to perform PM implantation to prevent intra-uterine growth restriction from insufficient cardiac output using a fluoroscopic protective shield. The procedure was performed without complications and established permanent pacing on onwards ECG examinations. The patient subsequently gave birth to a healthy newborn. After a retrospective clinical case evaluation and review of relevant literature, a presumptive association between CHB and the primary diagnosis was proposed. Above that, pregnant women with SLE who develop hypertension are commonly treated with methyldopa, which may cause conduction abnormalities. Clinical recommendations for young female patients expecting pregnancy are lacking in this area. Careful diagnostic and treatment approaches should be used in the management of possible SLE-related complications in women of child-bearing age, focusing on preventable events.
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Israel CW, Richter S, Bukachi F. [Bradycardia in pregnancy : Case report and review of the literature]. Herzschrittmacherther Elektrophysiol 2021; 32:221-226. [PMID: 33956224 DOI: 10.1007/s00399-021-00773-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
We report the case of a pregnant woman with complete heart block during her first trimester who presented with dyspnea at the East African Heart Rhythm Project in Nairobi. There was no evidence of an acute cause (e.g., myocarditis, cardiomyopathy, autoimmune or neuromuscular disease). No ECG had been previously documented; therefore, congenital complete heart block was likely. We implanted a dual-chamber pacemaker using conventional fluoroscopy. Several measures at implantation allowed us to limit fluoroscopy to 30 s and radiation to < 100 µGym2. The implantation was uneventful, dyspnea improved instantaneously and further pregnancy, labor and birth were uncomplicated. Bradycardia requiring pacemaker implantation is rare during pregnancy and usually consists of symptomatic complete heart block. Beyond undiagnosed or untreated pre-existing atrioventricular block, drug therapy for fetal tachycardia, myocarditis (including Lyme borreliosis and Chagas disease), inflammatory infiltrative diseases (e.g., sarcoidosis), cardiomyopathies and neuromuscular disease may have caused bradycardia. In the absence of treatable causes, pacemaker implantation becomes necessary if bradycardia brings about risks for the mother or the fetus. Using transesophageal or intracardiac echocardiography, radiation can be avoided completely or, by taking some simple measures, may be kept to a minimum so that there is no risk for the fetus.
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Affiliation(s)
- Carsten W Israel
- Evangelisches Klinikum Bethel, Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Universitätsklinik Ostwestfalen-Lippe, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Sergio Richter
- Klinik für Innere Medizin/Kardiologie, Abt. Rhythmologie, Herzzentrum und Universität Leipzig, Leipzig, Deutschland
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Qiu J, Wang Y, Chen G, Zhao C, Wang DW. Progress in zero-fluoroscopy implantation of cardiac electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:609-617. [PMID: 32348595 DOI: 10.1111/pace.13930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
Fluoroscopy is the imaging modality routinely used for cardiac device implantation. Due to the rising concern regarding the harmful effects of radiation exposure to both the patients and operation staffs, many efforts have been made to develop alternative techniques to achieve zero-fluoroscopy implantation. In this review, we describe the different methods aimed at avoiding the application of fluoroscopy in recent years, and evaluate their feasibility and safety in cardiac electronic device implantation.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Guo P, Qiu J, Wang Y, Chen G, Proietti R, Fadhle ALS, Zhao C, Wen Wang D. Zero-fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:122-127. [PMID: 29222861 DOI: 10.1111/pace.13248] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/19/2017] [Accepted: 11/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ping Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
- Division of Cardiology, Department of Internal Medicine; The Second Affiliated Hospital of Zhengzhou University; Zhengzhou P. R. China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Riccardo Proietti
- Division of Cardiology, Morriston Hospital; Swansea University; Swansea UK
- Division of Cardiology, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - AL-Selmi Fadhle
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
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Chua KCM, Lim ETS, Chong DTT, Tan BY, Ho KL, Ching CK. Implantation of a dual-chamber permanent pacemaker in a pregnant patient guided by intracardiac echocardiography and electroanatomic mapping. HeartRhythm Case Rep 2017; 3:542-545. [PMID: 29204351 PMCID: PMC5688237 DOI: 10.1016/j.hrcr.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Kelvin C M Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Eric T S Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Daniel T T Chong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Boon Yew Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
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Payne J, Lo M, Paydak H, Maskoun W. Near-zero fluoroscopy implantation of dual-chamber pacemaker in pregnancy using electroanatomic mapping. HeartRhythm Case Rep 2017; 3:205-209. [PMID: 28491803 PMCID: PMC5419812 DOI: 10.1016/j.hrcr.2016.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jason Payne
- Cardiology Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Monica Lo
- Cardiology Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Arkansas Heart Hospital, Little Rock, Arkansas
| | - Hakan Paydak
- Cardiology Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Waddah Maskoun
- Cardiology Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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SILVER ERICS, NASH MARYC, LIBERMAN LEONARDO. Implantation of Permanent Pacemaker and ICD Leads in Children Using a Three-Dimensional Electroanatomic Mapping System as an Aid to Fluoroscopy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:448-54. [DOI: 10.1111/pace.12579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/10/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ERIC S. SILVER
- Division of Pediatric Cardiology, Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York New York
| | - MARY C. NASH
- Division of Pediatric Cardiology, Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York New York
| | - LEONARDO LIBERMAN
- Division of Pediatric Cardiology, Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York New York
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LEMERY ROBERT. Interventional Electrophysiology at the Crossroads: Cardiac Mapping, Ablation and Pacing Without Fluoroscopy. J Cardiovasc Electrophysiol 2012; 23:1087-91. [DOI: 10.1111/j.1540-8167.2012.02373.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Physiologic changes in maternal haemodynamics, hormones and autonomic properties contribute to arrhythmias in pregnancy. While arrhythmias most commonly occur in pregnant women with structural heart disease or those with a history of cardiac arrhythmias, they can also occur de novo in women with no documented cardiac disease.
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Schwagten B, Jordaens L, Jessurun E, Witsenburg M, Scheffer M, Szili-Torok T. Baffle puncture guided by transoesophageal echocardiography in a patient with dextrocardia and Mustard correction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:144-7. [DOI: 10.1093/ejechocard/jen196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mahmood F, Christie A, Matyal R. Transesophageal echocardiography and noncardiac surgery. Semin Cardiothorac Vasc Anesth 2008; 12:265-89. [PMID: 19033272 DOI: 10.1177/1089253208328668] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of transesophageal echocardiography (TEE) for monitoring during cardiac and noncardiac surgery has increased exponentially over the past few decades. TEE has evolved from a diagnostic tool to a monitoring device and a procedural adjunct. The close proximity of the TEE transducer to the heart generates high-quality images of the intracardiac structures and their spatial orientation. The use of TEE in noncardiac and critical care settings is not well studied, and the evidence of the benefits of its use in these settings is lacking. Despite the widespread availability of TEE equipment in US hospitals, less than 30% of anesthesiologists are formally trained in the use of perioperative TEE. In this review, the safety and indications of TEE are reviewed and detailed analysis of the best available evidence in this regard is presented. Landmark trials evaluating the use of TEE and its therapeutic impact in noncardiac surgical setting are critically reviewed. This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use.
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Affiliation(s)
- Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Pedrinazzi C, Gazzaniga P, Durin O, Tovena D, Inama G. Implantation of a permanent pacemaker in a pregnant woman under the guidance of electrophysiologic signals and transthoracic echocardiography. J Cardiovasc Med (Hagerstown) 2008; 9:1169-72. [DOI: 10.2459/jcm.0b013e3283100edc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kron J, Conti JB. Arrhythmias in the pregnant patient: Current concepts in evaluation and management. J Interv Card Electrophysiol 2007; 19:95-107. [PMID: 17687638 DOI: 10.1007/s10840-007-9139-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 05/30/2007] [Indexed: 11/24/2022]
Abstract
Maternal arrhythmias during pregnancy may jeopardize the health of both mother and fetus. The correct identification of the arrhythmia is critical in the pregnant patient. Treatment should be reserved for arrhythmias that are hemodynamically unstable or cause debilitating symptoms. When medications are deemed necessary, the physician should use as few drugs as possible at the lowest effective doses and choose drugs with a history of safe use in pregnancy. Resuscitation of a pregnant patient in cardiac arrest should be modified with regard to the normal physiologic changes of pregnancy. With careful management, most of these challenging patients will have excellent outcomes.
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Affiliation(s)
- Jordana Kron
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Box 100277, Gainesville, FL 32610-0277, USA
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Adekanye O, Srinivas K, Collis RE. Bradyarrhythmias in pregnancy: a case report and review of management. Int J Obstet Anesth 2007; 16:165-70. [PMID: 17270418 DOI: 10.1016/j.ijoa.2006.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 06/01/2006] [Accepted: 10/01/2006] [Indexed: 11/17/2022]
Abstract
We present a case of unpaced pre-existing congenital heart block in pregnancy, diagnosed for the first time in labour. Our patient was asymptomatic and was managed conservatively with temporary pacing equipment on standby. She had a post-partum cardiology follow-up and was paced in the puerperium. We discuss the aetiopathogenesis and the variable presentation patterns of bradyarrhythmia in pregnancy and the multidisciplinary approach to their management. Our recommendations combine the Advanced Life Support algorithm for treatment of bradycardia and the successful management strategies of several documented case reports in the literature.
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Affiliation(s)
- O Adekanye
- Department of Anaesthetics and Intensive Care Medicine, Wales College of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK.
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Szili-Torok T, Kimman G, Theuns D, Res J, Roelandt JR, Jordaens LJ. Transseptal left heart catheterisation guided by intracardiac echocardiography. Heart 2001; 86:E11. [PMID: 11602562 PMCID: PMC1729980 DOI: 10.1136/heart.86.5.e11] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop a novel approach of transseptal puncture guided by intracardiac echocardiography and to assess its efficacy. METHODS Transcatheter intracardiac echocardiography with a 9 MHz rotating transducer was performed to guide transseptal puncture in 12 patients (mean age 43.1 years, range 31-68) who underwent radiofrequency catheter ablation of left sided accessory pathways. Initially, the echocardiography and transseptal catheters were placed adjacent to each other in the superior vena cava and were withdrawn to the level of the fossa ovalis. RESULTS The successful puncture site was associated with visualisation of the fossa ovalis (12 patients, 100%) and the aorta (12 patients, 100%), tenting of the fossa (six patients, 50%), penetration of the needle visualised by the ultrasound catheter (12 patients, 100 %), and echocardiographic contrast material applied in the left atrium (12 patients, 100%). The characteristic jump of the needle onto the fossa ovalis was observed simultaneously with fluoroscopy and intracardiac ultrasound (12 patients, 100%). All procedures were successful. There were no complications associated with the transseptal procedure. CONCLUSIONS Intracardiac echocardiography is feasible to guide transseptal puncture. The optimal puncture site can be assessed by simultaneous detection of the characteristic downward jump of the transseptal needle onto the fossa ovalis by intracardiac ultrasound and fluoroscopy.
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Affiliation(s)
- T Szili-Torok
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Loon G, Fonteyne W, Rottiers H, Tavernier R, Jordaens L, D'Hont L, Colpaert R, Clercq T, Deprez P. Dual-Chamber Pacemaker Implantation via the Cephalic Vein in Healthy Equids. J Vet Intern Med 2001. [DOI: 10.1111/j.1939-1676.2001.tb01592.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Antonelli D, Bloch L, Rosenfeld T. Implantation of permanent dual chamber pacemaker in a pregnant woman by transesophageal echocardiographic guidance. Pacing Clin Electrophysiol 1999; 22:534-5. [PMID: 10192866 DOI: 10.1111/j.1540-8159.1999.tb00485.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 37-year-old woman complained of fatigue and dizziness because of intermittent sinus arrest and asystole up to 5.2 seconds. She was 3 months into her pregnancy and a dual chamber permanent pacemaker was implanted by transesophageal echocardiographic guidance.
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Affiliation(s)
- D Antonelli
- Department of Cardiology, Central Emek Hospital, Afula, Israel
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Abstract
Although arrhythmias are one of the most frequent consultations during pregnancy, fortunately the majority are benign. Usually, they are well tolerated assuming they occur in patients with structurally normal hearts. However, pregnancy adds a new aspect to the so called "arrhythmia tolerance", because arrhythmia and therapy may jeopardize the fetus. For acute treatment of narrow and wide tachycardias, with few exceptions, antiarrhythmic medications appear to be safe. In addition to the relative security of drugs such as adenosine, digoxin, propranolol, procainamide and flecainide, we could use direct current countershock with no evidence of significant complications. Because no drug is absolutely safe, chronic pharmacologic therapy is best avoided during pregnancy. Finally, radiofrequency ablation could be recommended as an alternative in women with previous tachycardias who would like to become pregnant.
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Affiliation(s)
- T Alberca Vela
- Servicio de Cardiología, Hospital Universitario de Getafe, Madrid
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Tzankis G, Morse DS. Cesarean section and reoperative aortic valve replacement in a 38-week parturient. J Cardiothorac Vasc Anesth 1996; 10:516-8. [PMID: 8776649 DOI: 10.1016/s1053-0770(05)80016-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- G Tzankis
- Anesthesia Department, Brigham and Women's Hospital, Boston, MA 02115, USA
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Estrada-Quintero T, Kross DE, Gorcsan J. Identification of a malpositioned atrial pacemaker lead across a patent foramen ovale by transesophageal echocardiography. J Am Soc Echocardiogr 1995; 8:560-2. [PMID: 7546797 DOI: 10.1016/s0894-7317(05)80348-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transesophageal echocardiography was used for defining the unusual left atrial location of a malpositioned atrial pacemaker lead. This malpositioning occurred in a 75-year-old woman who had a small atrial septal aneurysm and a patent foramen ovale. Neither the precise location of the pacemaker lead tip nor the course of the lead was apparent by radiographic or transthoracic echocardiographic techniques. This report extends the potential utility of transesophageal echocardiography for the identification of malpositioned atrial pacemaker leads.
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Affiliation(s)
- W G Daniel
- Department of Medicine, University Clinic, Dresden, Germany
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SARNOSKI JOSEPH, BAJWA TANVIR, DESHPANDE SANJAY, SCHMIDT DONALDH, GAL RAMI. Transesophageal Echocardiography During Radiofrequency Ablation of Left-Sided Free Wall Atrioventricular Accessory Pathways in Wolff-Parkinson-White Syndrome. Echocardiography 1994. [DOI: 10.1111/j.1540-8175.1994.tb01086.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lee MS, Evans SJ, Blumberg S, Bodenheimer MM, Roth SL. Echocardiographically guided electrophysiologic testing in pregnancy. J Am Soc Echocardiogr 1994; 7:182-6. [PMID: 8185965 DOI: 10.1016/s0894-7317(14)80126-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Electrophysiologic testing is usually performed with fluoroscopy to guide catheter positioning. This method of visualizing catheter placement may not be ideal for patients who are pregnant. We report four cases of echocardiographically guided placement of catheters for electrophysiologic testing because of the consideration of pregnancy. Adequate visualization of catheters was possible, allowing for proper catheter positioning and complete electrophysiologic testing, including the recording of atrial, His-bundle, and ventricular potentials, as well as cardiac stimulation and induction of tachycardia. This method holds promise for patients in whom fluoroscopy may be relatively contraindicated, such as pregnant patients, as well as patients in whom it is desirable to avoid x-ray exposure such as women of childbearing age and young children.
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Affiliation(s)
- M S Lee
- Division of Adult Cardiology, Harris Chasanoff Heart Institute, Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Affiliation(s)
- A Ansari
- Department of Medicine, Fiarview Southdale Hospital, Edina, MN
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Connelly DT, de Belder MA, Cunningham D, Lopes AN, Rickards AF, Rowland E. Long-term follow up of patients treated with a software based antitachycardia pacemaker. BRITISH HEART JOURNAL 1993; 69:250-4. [PMID: 8461225 PMCID: PMC1024990 DOI: 10.1136/hrt.69.3.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Over the past decade, several advances have been made in the management of tachycardias by pacing techniques, but limited data are available on the long-term outcome of patients treated with antitachycardia pacemakers. PATIENTS AND METHODS An antitachycardia pacemaker, the Intermedics Intertach, was implanted in 22 (17 female) patients with supraventricular tachycardia over a five year period. All were selected after detailed evaluation and testing of a temporary antitachycardia pacemaker system showed that their arrhythmia could be stopped promptly, reliably, and under different physiological conditions. RESULTS The 22 patients have been followed up for a mean period of 57.3 (range 19-76) months. All except one of the patients has had frequent episodes of tachycardia reliably ended by the pacemaker. Complications have occurred in seven patients, necessitating removal of the pacing system in four. Of the 18 patients who continue to have pacemakers, seven are being treated with beta blockers or verapamil; no other antiarrhythmic drugs are being taken. CONCLUSIONS Antitachycardia pacing is an acceptable long-term option for carefully selected patients with supraventricular tachycardia, but even after extensive testing a substantial number of the patients may continue to require drug treatment. Furthermore, the widespread use of curative techniques for supraventricular arrhythmias (catheter ablation and surgery) has decreased the need for this palliative treatment.
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Affiliation(s)
- D T Connelly
- Royal Brompton National Heart and Lung Hospital, London
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Affiliation(s)
- M F Stoddard
- Cardiology Division, University of Louisville, KY 40202
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Goldman AP, Irwin JM, Glover MU, Mick W. Transesophageal echocardiography to improve positioning of radiofrequency ablation catheters in left-sided Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 1991; 14:1245-50. [PMID: 1719501 DOI: 10.1111/j.1540-8159.1991.tb02863.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two patients with the Wolff-Parkinson-White syndrome who underwent successful radiofrequency catheter ablation of their left-sided bypass tracts are described. Transesophageal echocardiography, a relatively new echocardiographic technique, was utilized in both patients and provided excellent visualization of intracardiac anatomy as well as the catheter tip. Transesophageal echocardiography was also synergistic with fluoroscopy and the intracardiac electrogram in providing more precise catheter placement. In addition, the use of transesophageal echocardiography may reduce fluoroscopic exposure and shorten the procedure time.
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Affiliation(s)
- A P Goldman
- St. Joseph's Hospital and Heart Institute, Tampa, Florida 33607
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