1.
The Cardiac Pacemaker Clinic: Memories From a Bygone Era.
Mond, HG, Sloman, JG
Heart, lung & circulation. 2021;(2):216-224
Abstract
In 1963, soon after the first ventricular pacemakers were implanted at the Royal Melbourne Hospital, attempts were made to identify impending pacing failure, thus preventing sudden death in these very vulnerable patients. By 1970, patient numbers had increased, a formal regular pacemaker clinic was established, and guidelines and protocols developed. The clinic was staffed by a physician, a biomedical engineer and cardiac technicians. The unipolar, asynchronous, non-programmable pulse generators were powered by mercuric oxide/zinc batteries and implanted in the abdomen, using either transvenous or epimyocardial leads. Although, pulse generators were electively replaced at 3 years, most had already been replaced because of power source depletion, electronic failure or lead issues. Testing in all patients involved an electrocardiographic rhythm strip and electronic analysis of the stimulus artefact using a calibrated high-speed storage oscilloscope. Results were compared to previous studies and significant changes were interpreted as impending power source depletion. As a result of this testing, 97% of cases of impending power source depletion were detected prior to failure. These findings allowed testing each 4 months and for pulse generator life to be extended beyond three years. With ventricular triggered pulse generators, new testing procedures were designed. With time, visiting regional centres and clinical evaluation of new products became important functions of the clinic.
2.
Celebrating 50 years of the lithium power source for cardiac pacemakers.
Mond, HG, Villafaña, M
Heart rhythm. 2021;(3):491-492
3.
Cardiovascular implantable electronic device infections: associated risk factors and prevention.
Rohacek, M, Baddour, LM
Swiss medical weekly. 2015;:w14157
Abstract
Infections of cardiovascular implantable electric devices (CIED) are a burden on patients and healthcare systems and should be prevented. The most frequent pathogens are coagulase-negative staphylococci and Staphylococcus aureus. The most important risk factors for CIED infections are diabetes mellitus, renal and heart failure, corticosteroid use, oral anticoagulation, fever within 24 hours before the procedure and leucocytosis, implantable cardioverter defibrillator compared with pacemaker, especially in the case of Staphylococcus aureus bacteraemia, lack of antibiotic prophylaxis, and postoperative haematoma and other wound complications. Other important risk factors are history of prior procedures and previous CIED infections, number of leads, use of povidone-iodine compared with chlorhexidine-alcohol, and centres and operators with a low volume of implants. To prevent CIED infections, patients undergoing CIED procedures and appropriate devices should be carefully selected, and interventions should be performed by trained operators. Antibiotic prophylaxis should be administered, and skin antisepsis should be done with chlorhexidine-alcohol. Oral anticoagulation should be continued during CIED procedures in high-risk patients for thromboembolism, instead of bridging with heparin. Early reintervention in cases of haematoma or lead dislodgement should be avoided. The implementation of infection prevention programmes reduces infection rates. More randomised controlled studies are needed to evaluate prevention strategies, especially skin preparation and antibiotic prophylaxis with glycopeptides.
4.
Management of anticoagulation around pacemaker and defibrillator surgery.
Birnie, DH, Healey, JS, Essebag, V
Circulation. 2014;(20):2062-5
5.
The potential of FDG PET/CT for early diagnosis of cardiac device and prosthetic valve infection before morphologic damages ensue.
Chen, W, Kim, J, Molchanova-Cook, OP, Dilsizian, V
Current cardiology reports. 2014;(3):459
Abstract
Diagnosis of cardiac mechanical device or prosthesis valve infection, and more importantly accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, annular or peri-annular valve ring abscesses remain clinically challenging. Inconclusive diagnosis can lead to delayed antibiotic therapy, device extraction or surgical intervention, which may have dire consequences to the patient. Among patients with suspected cardiac mechanical device or prosthetic valve infection, recent publications advocate the use of (18)F-fluoro-2-deoxyglucose positron emission tomography computed tomography (FDG PET/CT), particularly when anatomy based imaging studies, such as echocardiography or CT, are uncertain or negative. A potential advantage of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphologic damages ensue. However, there are many unanswered questions in the literature. There is a need for standardization amongst the various imaging studies, such as dietary preparation, duration and timing of image acquisition, image processing with and without CT attenuation correction, and more importantly image interpretation criteria. The answer for these issues awaits well designed, prospective studies.