Pacemaker Placement

Abstract: The present invention refers to the field of cardiac electrophysiology (EP) and, more specifically, to image-guided radio frequency ablation and pacemaker placement procedures. For those procedures, it is proposed to display the overlaid 2D navigation motions of an interventional tool intraoperatively obtained from the same projection angle for tracking navigation motions of an interventional tool during an image-guided intervention procedure while being navigated through a patient's bifurcated coronary vessel or cardiac chambers anatomy in order to guide e.g. a cardiovascular catheter to a target structure or lesion in a cardiac vessel segment of the patient's coronary venous tree or to a region of interest within the myocard. In such a way, a dynamically enriched 2D reconstruction of the patient's anatomy is obtained while moving the interventional instrument. By applying a cardiac and/or respiratory gating technique, it can be provided that the 2D live images are acquired during the same phases of the patient's cardiac and/or respiratory cycles. Compared to prior-art solutions which are based on a registration and fusion of image data independently acquired by two distinct imaging modalities, the accuracy of the two-dimensionally reconstructed anatomy is significantly enhanced.

Abstract: Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure.

Abstract: Long-term left atrial pacing was successfully accomplished in three patients by positioning permanently implanted pervenous pacemaker catheters in the proximal portion of the coronary vein. Left atrial stimulation was documented by the configuration of the P waves on the electrocardiogram—the P waves were inverted in leads I and V 6 and upright in V 1 . Roentgenograms of the chest revealed that the pacemaker electrodes were located inferiorly and posteriorly to the left atrium. In one patient, angiocardiography was used to document the position of the catheter in the coronary vein. One patient died of causes unrelated to the pacemaker one month after implantation, and the catheter tip was located in the coronary vein which was not thrombosed. The other two patients are doing well 13 and 18 months, respectively, after pacemaker placement, and consistent and stable atrial pacing has continued throughout this period of time.

Abstract: Objective Although many Fontan patients undergo pacemaker placement, there are few studies characterizing this population Our purpose was to compare clinical characteristics, functional status and measures of ventricular performance in Fontan patients with and without a pacemaker Patients and Design The National Heart, Lung, and Blood Institute funded Pediatric Heart Network Fontan Cross-Sectional Study characterized 546 Fontan survivors Clinical characteristics, medical history and study outcomes (Child Health Questionnaire [CHQ]), echocardiographic evaluation of ventricular function, and exercise testing) were compared between subjects with and without pacemakers Results Of 71 subjects with pacemakers (13%), 43/71 (61%) were in a paced rhythm at the time of study enrollment (age 119 ± 34 years) Pacemaker subjects were older at study enrollment, more likely to have single left ventricles, and taking more medications There were no differences in age at Fontan or Fontan type between the pacemaker and no pacemaker groups There were no differences in exercise performance between groups CHQ physical summary scores were lower in the pacemaker subjects (397 ± 143 vs 461 ± 112, P =001) Ventricular ejection fraction z-score was also lower (−14 ± 19 vs −08 ± 20, P =05) in pacemaker subjects Conclusions In our cohort of Fontan survivors, those with a pacemaker have poorer functional status and evidence of decreased ventricular systolic function compared to Fontan survivors without a pacemaker