Temporary Pacemaker Implantation Research Articles

Clinical analysis of temporary pacemaker implantation in 6 children with fulminant myocarditis.

There is little literature on the use of temporary pacemakers in children with fulminant myocarditis. Therefore, we summarized the use of temporary cardiac pacemakers in children with fulminant myocarditis in our hospital. The clinical data of children with fulminant myocarditis treated with temporary pacemakers in Wuhan Children's Hospital from January 2017 to May 2022 were retrospectively analyzed. A total of 6 children were enrolled in the study, including 4 boys and 2 girls, with a median age of 50 months and a median weight of 15kg. The average time from admission to pacemaker placement was 2.75 ± 0.4h. The electrocardiogram showed that all 6 children had third-degree atrioventricular block (III°AVB). The initial pacing voltage, the sensory sensitivity of the ventricle and the pacing frequency were set to 5-10 mV, 5V and 100-120bpm respectively. The sinus rhythm was recovered in 5 patients within 61h (17-134) h, and the median time of using temporary pacemaker was 132h (63-445) h. One of the children had persistent III°AVB after the temporary pacemaker. With parental consent, the child was fitted with a permanent pacemaker on the 12th day of his illness. When fulminant myocarditis leads to severe bradycardia or atrioventricular block in children, temporary pacemakers have the characteristics of high safety to improve the heart function.

Bedside zero-fluoroscopy temporary permanent pacemaker implantation in the electrical storm treatment under the guidance of EnSite 3D system: a case report

BackgroundElectrical storm (ES) is a clinical emergency characterized by multiple malignant ventricular arrhythmias or ICD discharges within 24 h, requiring early rational management.Case presentationWe report a 55-year-old man who underwent aortic valve replacement experienced recurrent ventricular tachycardia/ventricular fibrillation. A temporary permanent pacemaker with the EnSite system was implanted, and significant inhibition of the electrical storm, attributed to the atrial overdrive pacing, ensued.ConclusionsIn emergency regarding an electrical storm, the bedside temporary permanent pacemaker implantation with the EnSite system is concluded to be feasible and safe.

An electrogram-guided transvenous temporary pacemaker implant simulator.

Transvenous temporary pacemaker (TvTP) implantation is a critical procedure often performed under time limitations, playing a crucial role in patient survival. However, the amount of training provided for resident cardiologists is variable, due to the availability of patients. Thus, the use of simulators for this cardiologic procedure could be used as training tools. The present study aimed to develop a simulator system for TvTP implantation based on electrograms, called ETTIS (Electrogram-guided Transvenous Temporary-pacemaker Implantation Simulator), and to evaluate its educational potential and cardiology residents' perceived learning efficacy as a training tool. The development of the ETTIS involved three stages: (1) Adaptation of an anatomical mannequin; (2) Design and manufacture of electronic circuits and software capable of identifying the catheter contact site within the heart chambers and reproducing electrograms in both surfaces (mode-on) and intracavitary (mode-off); (3) To evaluate its educational potential, a modified Likert questionnaire was administered to nine cardiology experts. Additionally, to evaluate the perceived learning efficacy, another modified Likert questionnaire was given to six cardiology residents both before and after training with the ETTIS. Descriptive statistics with measures of position and dispersion were employed, and the weighted Kappa test was used for agreement analysis. A high rate of acceptance (over 90%) was found among experts who evaluated the ETTIS. The cardiology residents showed significant self-perceived learning gains, as evidenced by a lack of agreement between their responses to a questionnaire before and after training. The ETTIS is a promising tool for medical training, displaying both educational potential and efficacy. It has been shown to be effective in learning a variety of skills, including cardiac catheterization and electrophysiology. Additionally, the ETTIS is highly engaging and allows cardiology residents to practice in a safe and controlled environment.

Temporary pacemaker implantation via median cubital vein: A simple safe and effective technique.

Temporary cardiac pacemaker implantation (PM) via the femoral and subclavian veins is widely used in clinics to treat patients with severe bradycardia or tachycardia, but it is technically challenging and potentially associated with various complications. This study investigated the feasibility and safety of a novel method of PM implantation via the median cubital vein. A total of 279 patients of the First Affiliated Hospital of Xiamen University between March 2020 and December 2021 who required no-emergency PM implantation were enrolled. The patients were divided into three groups based on the temporary PM implantation routes: F-control (n = 107), via the femoral vein; S-control (n = 67), via the subclavian vein, and N-group (n = 105), via the median cubital vein. The sheath placement time (SPT), electrode placement time (EPT), electrode arrival rate (EAR), rate of sensing and pacing (RSP), radiation quantity (RD), electrode dislocation rate (EDR) and average electrode retention time (AERT) were recorded and evaluated. In addition, the Hamilton Anxiety Scale (HAMA) and Self-Rating Depression Scale (SDS) were used to evaluate the comfort levels of patients in the three groups. There were no significant differences between the groups with regard to age, EAR, RSP, EPT, RD, and AERT (p > 0.05). However, the N-group had significantly lower SPT than the F-control and S-control groups (67.0 ± 22.0 s vs. 321.7 ± 122.2 s and 307.3 ± 128.5 s, p = 0.000). Additionally, the F-control had significantly higher EDR than the S-control group and the N-group (11 (10.3%) vs. 2 (3.0%) and 3 (2.9%), p = 0.036). Besides, comparison of the HAMA and SDS scores before and after PM implantation showed significant differences in the S-control group (p = 0.010) and the N-group (p = 0.000). Temporary PM implantation via the median cubital vein is safe, effective, and less time-consuming.

Short and midterm outcome of intraprocedural sinus node dysfunction requiring stimulation during ablation of persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Ablation within the superior, antero-lateral portions of the right atrium has been described as a risk for sinus node dysfunction (SND) because of direct damage to the sinus node. The sinoatrial nodal artery arises from the right coronary artery in the majority of people and courses close to the superior posterior aspect of the interatrial septum. Rare cases of SND were observed periprocedurally during atrial fibrillation/flutter ablation. We sought to report on clinical characteristics, ablation set and acute and midterm rhythm outcome of patients who develop acute SND during/immediately after exclusively left atrial ablation. Methods We performed a retrospective analysis of AF/Aflutter ablation patients between January 2017 and December 2019 to characterize those who required temporary pacemaker (TPM) implantation due to acute sinus node dysfunction (sinus arrest, sinus bradycardia <35 beats/min with hemodynamic compromise) following atrial ablation. Results Of 1,072 patients, at nine patients [0,8%] intraprocedural temporary pacemaker implantation was necessary due to severe SND and hemodynamic compromise. The reasons for implantation were identified as sinus arrest (n=6) or severe sinus bradycardia (n=3). Eight of nine patients were male [89%], age 73 +11.2, 6/9 [67%] persistent AF, 2/9 [22%] Aflutter. The ablation set consisted of: pulmonary vein (PV) isolation in all patient (n = 9), left atrium(LA)-substrate modification in 8. In detail: roof line ablation (n = 3), mitral annulus-right superior PV line ablation ( n=8), mitral annulus-left superior PV line (n = 3). No patient had an ablation within the the right atrium. Four of nine [22%] pts. received permanent PM before discharge, performed 5 days postablation (range 3-7 days). At 3-month device interrogation, all patients were atrially paced, with a pacing proportion of >40% in 3/4 [0,3%] patients. Conclusion Acute sinus node dysfunction is a rare complication of sole left atrial ablation outside the pulmonary veins. However, a relevant fraction of these patients requires permanent implantation with substantial pacing proportion during midterm follow up.

Predictors of pacemaker implantation within three months after catheter ablation of atrial fibrillation.

It is inevitable for patients to have a temporary or permanent pacemaker implanted during or after radiofrequency catheter ablation (RFCA) for treatment of atrial fibrillation (AF) in some cases. The aim of our study was to evaluate the incidence of pacemaker implantation (PMI) during or within 3 months of RFCA for AF and to identify the risk factors that were associated with PMI. We performed a retrospective analysis of consecutive AF patients who underwent RFCA between August 2018 and October 2020 at our center. The incidence of PMI within 3 months during or after RFCA were assessed. A multivariate logistic regression model was performed to identify predictors of PMI. One thousand and five patients (mean age, 60.2±10.3 years; 37.6% women) were included in this analysis. PVI was performed in all patients. A total of 23 (2.3%) patients had a pacemaker implanted within 3 months during or after ablation. Multivariable logistic regression analysis revealed that older age (OR: 1.08 [95% CI 1.03-1.13], p=.003), female sex (OR: 3.08 [95% CI 1.28-7.45], p=.012), paroxysmal AF (OR: 4.71 [95% CI 1.09-20.45], p=.038) and repeated ablation (OR: 2.78 [95% CI 1.04-7.40], p=.041) were the independent predictors for PMI. Older age, female sex, paroxysmal AF and repeated ablation were identified as predictive risk factors for PMI after RFCA in patients with AF. A "watch and wait" strategy could be taken for patients with temporary PMI after ablation, especially for those with prolonged sinus pause after AF termination.

Prophylactic Intravenous Aminophylline for Preventing Bradyarrhythmias During Coronary Atherectomy: A 10-Year Single-Center Experience

<h2>Abstract</h2><h3>Background</h3> Aminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias. <h3>Methods</h3> Retrospective, observational, descriptive analysis of patients undergoing rotational atherectomy with intravenous (IV) aminophylline pretreatment during a 10-year period (2010-2020). The primary composite outcome was the occurrence of a documented bradyarrhythmia requiring pharmacologic intervention and/or temporary pacemaker (TPM) implantation. <h3>Results</h3> A total of 296 patients received IV aminophylline pretreatment. The primary composite outcome occurred in 1.7% (n = 5) of patients. None of the patients required rescue TPM. Bradyarrhythmias were documented in 2.4% (n = 7) of patients. Pharmacologic interventions, typically with IV atropine, were used in 15% (n = 43) of patients. Per-vessel analyses demonstrated that patients undergoing atherectomy to the circumflex and right coronary arteries were more likely than those undergoing atherectomy to other vessels to have bradyarrhythmias requiring pharmacologic intervention (3.4% vs 0%, <i>P</i> = .01). <h3>Conclusions</h3> In this 10-year single-center experience using IV aminophylline pretreatment to prevent major bradyarrhythmias in patients undergoing coronary atherectomy, none of the patients required rescue TPM implantation. These data demonstrate that coronary atherectomy can be performed safely without prophylactic TPM, with aminophylline pretreatment and selective use of atropine representing an effective noninvasive approach.

Screening of Influencing Factors for AKI Based on Lasso Regression

Background: Acute kidney injury (AKI) is one of the common critical diseases in hospitalized patients. There are many factors affecting acute kidney injury, difficult to obtain disease data, and short treatment time window. Early detection of AKI is critical to reducing mortality. Methods: MIMIC-IV data were used to establish the prediction model of AKI in critical patients after operation. 1585 intensive care unit (ICU) patients were randomly divided into a training set (n=1109) and a prediction set (n=476) on a 7:3 basis. LASSO regression analysis was performed on the data, area under the operating characteristic curve (AUROC) was used to evaluate the model, and Hosmer-Lemeshow (HL) was used to test the degree of fit. Results: Spinal injury, implantation of temporary cardiac pacemaker, esophageal disease, contrast media, diuretic, epinephrine, aminoglycoside antibiotics, tumor chemotherapy drugs, age, gender and red blood cells were determined to be independent risk factors for acute kidney injury. The AUROC of the model in the train set was 0.901 (95% confidence interval: 0.856~0.946). In the validation set, AUROC was 0.851 (95% confidence interval: 0.808~0.894). AUROC of the above two groups indicated that the model had a good degree of differentiation, which was greater than 70% in both groups. Hosmer-Lemeshow (HL) test showed P&gt;0.05, indicating a good fit of the model. Conclusion: This prediction model can be used for the identification of post-operative AKI patients and provide a basis for clinicians or inpatients to more quickly self-measure the risk.

Retrieval of an infectious leadless pacemaker with vegetation.

This case discusses the retrieval of a pacemaker with vegetation from a 78-year-old man. It suggests that grasping side of Micra body and pulling Micra into Agilis sheath is a possible technique for retrieval.

RECURRENT SINUS ARREST DURING LAPAROSCOPIC SACRAL COLPOPEXY IN PATIENTS WITH SICK SINUS SYNDROME : A CASE REPORT

Sick sinus syndrome (SSS) is a disease in which the SA node fails to perform the function of pacemaking. ECG shows various rhythms including sinus arrest. We report recurrent sinus arrest during laparoscopic sacral colpopexy in a 77-year-old female patient with SSS. The patient was diagnosed with SSS, but as there were no symptoms, the operation was performed without pacemaker implantation. After induction of anesthesia, vital signs were stable, but sinus arrest repeatedly appeared due to elevated vagal tone during uterine traction. After operation, the patient underwent pacemaker implantation, and to this day, she is doing well without any symptoms. The anesthesiologist should pay close attention to the progress of the operation through much communication with operator during the surgery. Also, we recommend to considering temporary pacemaker implantation for patients with SSS who undergo surgery that can increase vagal tone.

Abstract 14200: Pacemaker Dependent Patients Can Be Discharged With Active Fix Temporary Pacemakers Following CIED Extraction for Infection

Introduction: Management of infected CIEDs includes removal of the device with adjunctive antibiotic therapy. Temporary device management has historically consisted of a balloon-tipped temporary pacemaker (TPM). In recent years, TPMs with an externalized standard permanent pacing generator and an active fixation permanent pacing lead have become an alternative option to the balloon tipped pacemaker. These patients are typically kept in the hospital; however, this temporary pacing system is very secure, and with adequate social supports, these patients can be discharged. Methods: We reviewed data from patients who had CEID extraction between July 2012 and October 2021 at Oregon Health and Science University, and identified patients who were pacer dependent, underwent extraction for infection, and were discharged with an active fix TPM via the right internal jugular. Data for this study were collected prospectively in an IRB-approved clinical and research database for all patients undergoing lead extraction procedures. Results: A total of 14 individuals were identified between July 2012 and October 2021. Of the 14 patients identified, the majority were male (57.1%), had a median age of 71 years, and had systemic infections (92.9%). The mean length of hospitalization was 12 days, with a follow up visit occurring 5 days after discharge on average. One patient was lost to follow up following discharge with a plan for reimplantation at an outside hospital. The remaining 13 patients were seen weekly in pacer clinic for device and site checks. The total duration of TPM implantation ranged from 6 days to 153 days, with a mean of 36 days. There were no complications including systemic or local infection from TPM implantation or from reimplant of a new permanent device. Conclusions: Discharging patients with TPMs is a safe, cost saving, and well-tolerated option for pacemaker dependent individuals while they await reimplant of a new permanent device. The active fix TPM allows for antibiotics to be given at home, opens hospital beds, and relieves pressure to reimplant a permanent device as soon as possible.

Determinants and prognostic value of in-hospital infection in patients waiting for permanent pacemaker implantation

BackgroundIn-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. MethodsWe retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. ResultsEigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0–10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705–0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18–7.16], p = 0.021) compared with their counterparts. ConclusionsThis study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event.

An Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block

Abstract&#x0D; Background&#x0D; Acute stent thrombosis is a frequent cause of myocardial infarct (MI) after stent placement. Total atrioventricular (AV) block is frequently become the conductive disturbance complication of acute reinfarct. Inferior MI has Low long-term mortality and greater reversibility than anterior MI which has higher in-hospital and long-term mortality.&#x0D; &#x0D; Case Illustration &#x0D; 44 years man, came to emergency department Cardiovascular Centre Harapan Kita with altered mental status since 12 hours ago. PPCI stenting at proximal LAD of his acute anterior MI 2 days ago. Patient had acute stent thrombosis then underwent urgent PCI at referring hospital. Patient present with blood pressure 57/30, heart rate 20 -30 with TAVB rhythm. Laboratory showed increased serum lactate level 5.2. Patient was diagnosed with Total AV block caused by MI. Patient was planned for emergency temporary pacemaker (TPM) implantation. After 24 hours close monitoring, the patient intrinsic rhythm resolved with spontaneous recovery. Patient was hemodynamically stable until discharge.&#x0D; &#x0D; Discussion &#x0D; Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch&#x0D; &#x0D; Conclusion &#x0D; This case reporting a complete atrioventricular block during the course of acute anterior reinfarct and had spontaneous resolution of the AV block. Mechanisms of spontaneous resolution of complete AV block in the setting of acute MI is associated transient ischemia after occlusion of proximal LAD.&#x0D; &#x0D; Keyword: Reinfarct, Stent Thrombosis, Total AV Block

Treatment delay and outcomes of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention during the COVID-19 era in South Korea.

Background/AimsLittle is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI) in Korea during the coronavirus disease 2019 (COVID-19) era. We aimed to evaluate the clinical characteristics and treatment outcomes of patients with STEMI in the COVID-19 era.MethodsA total of 588 consecutive patients with STEMI who underwent primary percutaneous coronary intervention were included in this study. The patients were categorized into the COVID-19 (from January 20, 2020 to December 31, 2020) and control groups (from January 20, 2019 to December 31, 2019).ResultsThe COVID-19 group showed pre-hospital and in-hospital delays than the control group. The control group underwent more thrombus aspiration and had a higher proportion of left main coronary artery diseases, while the COVID-19 group had a higher proportion of multivessel diseases with a marked increase in the number and total length of stents than the control group. As for the prescribed medications, the COVID-19 group was administered more beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins than the control group. The clinical outcomes were comparable between the groups, except for higher incidences of atrioventricular block and temporary pacemaker implantation in the COVID-19 group.ConclusionsReperfusion after STEMI treatment during the COVID-19 period was delayed; therefore, efforts should be made to improve on reperfusion.

Early and mid-term results of transcatheter closure of perimembranous ventricular septal defect using Amplatzer Ductal Occluder type 1

Objectives: To study the early and midterm results of transcatheter closure of perimembranous VSD using Amplatzer Ductal Occluder type 1.&#x0D; Methods: Prospective study of one hundred thirteen patients with perimembranous VSD (PMVSD) who referred to catheterization laboratory and underwent transcatheter closure of their defects by using Amplatzer Ductal Occluder type 1 device. Routine right and left heart catheterization was performed with evaluation of the pulmonary and systemic pressure. All the procedures were done under fluoroscopy and transthoracic echocardiography guide. Follow up evaluations were done between 1 month and 12 months after discharge (mean 4.5 ± 1.13 months) with transthoracic echocardiography and 12 lead electrocardiography.&#x0D; Results: The age of patients range from 2 to 34 years at procedure (mean 10.60 ± 7.31 years), weight range from 10 to 85 kg (mean 32.38 ± 19.70 kg). The mean echocardiographic defect size was 5.69 ± 1.63 mm and the mean angiographic size was 5.89 ± 1.70 mm. The devices size used range from 6/4 – 16/14 mm. The most common device used was 10/8. The ADOs were successfully implanted in 108 patients (95.6 %). The VSD occlusion rate was 85.2% at completion of the procedure, rising up to 90.7 % next day at discharge, 93.5% at one month and 97.2% at 6 months during follow-up. Two patients (1.9%) developed CAVB, one case within 24 hours and the other case after 2 days of the procedure, they were admitted in hospital treated by temporary pacemaker implantation, steroids and NSAIDs (high dose aspirin) with complete remission within 5 days. Conclusion: Transcatheter closure of PMVSD with ADO1 in children is a safe and effective treatment associated with excellent success and closure rates and with no significant adverse events, but long-term follow-up in a large number of patients would be warranted.

P144 PEMBROLIZUMAB–INDUCED MYOCARDITIS

Abstract Introduction Patients treated with Immunocheckpoint Inhibitors (ICI) can develop adverse cardiovascular events, most frequently myocarditis, but also arrhythmias, conduction abnormalities, pericarditis, Takotsubo syndrome, ACS, heart failure, cardiac arrest. Myocarditis occurs early, within the first 3–4 administrations of therapy, and is fraught with a high mortality rate. Case Presentation 80–year–old patient with renal pelvic carcinoma who underwent nephroureterectomy and subsequent adrenalectomy. Twenty days after the first cycle of Pembrolizumab, the patient is admitted to cardiology for syncope and ECG finding of Left Posterior Fascicular Block (LPFB) and right bundle branch block (RBBB) with significant increase in troponin without any alterations in regional kinetics and normal ventricular function (EF). The patient also complains of widespread muscle pain and severe hyponatremia on blood tests. On ECG monitoring, alternation of RBBB with associated LPFB and Left Posterior Fascicular Block, left bundle branch block, first and second degree atrio–ventricular block (AV block) and on day II appearance of complete paroxysmal AV block controlled with temporary pacemaker implantation. On the 4th day, we documented changes in the segmental motion of the left ventricle (LV) and progressive gradual worsening of the EF. During the hospitalization the patient manifested episodes of general malaise with profuse sweating and marked hypotension with possible SIADH picture. In suspicion of acute myocarditis, peripheral myositis and possible Pembrolizumab SIADH, the patient was treated with high dose methylprednisolone (1000 mg / day) with little benefit. On the 6th day the patient was found in critical condition, severely suffering, hypotensive and oliguric, resigned herself. Conclusions Our case highlights how even a single dose of Pembrolizumab can trigger an acute inflammatory pattern affecting the myocardium with prevalent involvement of the conduction tissue even before the appearance of alterations in the kinetics and ventricular dysfunction. During ICI therapy cycles it is therefore important to monitor the ECG and troponin levels in order to be able to diagnose myocardial involvement early. In fact, although this complication is rare, it is burdened by a high mortality rate. The only treatment currently available involves the suspension of immunotherapy and the administration of high–dose methylprednisolone.

Cardiac Conduction Disorders in Acute Coronary Syndrome with St Elevation: Study of 51 Cases

1. Introduction: Cardiac conduction disorders are complications that can occur in the early development of acute coronary syndrome with ST segment elevation and have a significant influence on the patients prognosis. Objective: The determine the epidemiological clinical and therapeutic aspects of conduction disorders with elevation in the ST segment. Methods: We have performed a descriptive retrospective study of 51 cases of conduction disorder among 228 cases of coronary syndromes with ST segment elevation. Results: The prevalence of cardiac conduction disorders was 14.1% over a period of 4 years. The average age of our patients was 59 years old (extremes: 42 to 81 years old). Diabetes was the most prevalent risk factor (52.4%). Low location was the most found (56%) and conduction disorders were dominated by atrioventricular block (45.09%).Coronary angiography was performed in all our patients. The found lesions in coronary angiography concerned more the right coronary (37.3%) and circumflex artery (34.1%). Coronary angioplasty has been performed in 72 % of cases, and thrombolysis in 9, 8%. The implantation of temporary pace maker was done in 33% of cases. The evolution was favorable for all our patients. Conclusion: Conduction disorders in ST-segment elevation coronary syndrome should be diagnosed early for timely and adequate management in order to reduce the high objective mortality rates.

Clinical analysis of temporary pacemaker implantation in 13 children.

BackgroundAt present, temporary pacemaker implantation is very common in the treatment of cardiovascular diseases in adults. However, the number of pediatric pacemakers implanted is still relatively small, and relevant research is also far less than that of adults. This study aimed to explore the application of temporary pacemakers in children with acute and critical cardiovascular diseases.MethodsThe clinical data of children with cardiovascular diseases who were treated with temporary pacemakers in Tianjin Children’s Hospital from October 2017 to February 2021 were analyzed retrospectively.ResultsA total of 13 children with cardiovascular diseases were included in this study, including 4 males and 9 females, mean age of 71.2±56.3 months, and median body weight of 15.5 kg. There were 9 children with endocardial pacing and 4 children with epicardial pacing. The types of diseases included fulminant myocarditis (n=8), complete atrioventricular block (CAVB; n=1), and arrhythmias after open heart surgery (n=4). The median time from onset to admission was 1.0 days in children with endocardial pacing and there was cardiac arrest in 2 children, heart failure in 9 children, cardiogenic shock in 8 children, and Adams-Stokes attack in 7 children. The median time from admission to implantation of temporary pacemakers was 3.0 h and the operation time was 55.0±19.4 min. All 4 children with epicardial pacing had pacemakers implanted during operation because of CAVB. The pacing mode was VVI mode. The initial perceptual voltage was 1–2 mv, the output voltage was 5v, and the pacing frequency was 70–145 bpm. A total of 11 children reverted to sinus rhythm within 5.0 (1.8–34.0) h and the working time of temporary pacemakers was 134.0 (15.0–191.0) h. There was poor pacing in 2 children and catheter displacement in 1 child during pacing. A total of 12 children were followed up for 20.0±12.5 months and 1 was lost to follow-up. During the follow-up period, the cardiac functions were basically normal and no new arrhythmia appeared.ConclusionsTemporary pacemakers have the advantage of simple operation, definite effect, and safety which has a remarkable effect in the treatment of acute and critical cardiovascular diseases in children.

Efficacy of combined treatment with mechanical circulation support devices and immunomodulation therapy for patients with fulminant myocarditis

Objective: To summarize the efficacy of combined treatment strategy of mechanical circulation support devices and immunomodulation therapy for patients with fulminant myocarditis. Method: We retrospectively analyzed the clinical data and outcomes of 37 fulminant myocarditis patients complicating cardiogenic shock, who were hospitalized from October 2017 to December 2019 in our department. Patients received guideline therapy according to "Chinese expert consensus statement on clinical diagnosis and treatment of fulminant myocarditis in adults"issued by Chinese Society of Cardiology of Chinese Medical Association. Patients were divided into IABP group (n=19), ECMO group (n=5) and IABP+ECMO group (n=13) according to different mechanical circulation support regimen. The treatment effectiveness among various groups were compared. The major endpoint was in-hospital mortality. The duration and outcome of mechanical circulation support were also analyzed. Furthermore, relationships between baseline data, proportion of different treatments (including medicine treatment, temporary pacemaker and continuous renal replacement treatment, immunomodulation therapy) and clinical outcome were analyzed. Results: The age of the 37 patients in the cohort was (37.4±17.0) years, and there were 22 male among them. Immunomodulation therapy included glucocorticoid (methylprednisolone) and intravenous immunoglobin. At admission, blood pressure was (70.21±17.37)mmHg(1 mmHg=0.133 kPa),heart rate was(100±30)beat/minutes,there were 10 cases of Ⅲ° atrioventricular block and all received temporary pacemaker implantation, 12 cases of ventricular tachycardia and fibrillation,1 patient received temporary pacemaker implantation due to electronic storm, peak cardiac troponin I level was (18.61±9.55)μg/L, peak B type natriuretic peptide level was 1 670(518,3 410)ng/L,left ventricular ejection fraction (LVEF) was(32.3±10.4)%. Thirty-four out of the 37 patients survived and 3 patients died. Hospital duration was (22.7±8.2)days, LVEF was (50.1±10.5)% at discharge. Lactic acid level was significantly higher in IABP+ECMO group than in IABP group and ECMO group(P<0.001 or =0.005),LVEF was significantly lower in IABP+ECMO group than in IABP group(P=0.004),the proportion of ventilator usage was higher in IABO+ECMO group than in IABP group (P<0.05). Survival rate was similar among the three groups. Conclusion: Comprehensive treatment regimen with combined mechanical circulation support and immunomodulation therapy as the core strategies is effective in the treatment of fulminant myocarditis complicated with cardiogenic shock.

Application of the improved simple bedside method for emergency temporary pacemaker implantation suitable for primary hospitals

The purpose of the research was to evaluate the safety and effectiveness of the X-ray-free improved simple bedside method for emergency temporary pacemaker implantation as well as the practicability of the method in primary hospitals. Patients [including those suffering from sick sinus syndrome and third-degree and advanced atrioventricular blockage (AVB)] who needed emergency temporary pacemaker implantation from July 2017 to August 2020 in Hunan Provincial People’s Hospital were selected. They were stochastically divided into a research group (95 cases) treated with the improved simple bedside method and a control group (95 cases) with X-ray guidance. The ordinary bipolar electrodes were used in both groups. On this condition, the operation duration, the first-attempt success rate of electrodes, pacing threshold, success rate of the operation, the rate of electrode displacement, and complications in the two groups were separately calculated. The comparison results of the research group with the control group are shown as follows: operation time [(18 ± 5.91) min vs. (43 ± 2.99) min, P < 0.05], the first-attempt success rate of the electrode (97% vs. 98%, P > 0.05), pacing threshold [(0.97 ± 0.35) vs. (0.97 ± 0.32) V, P > 0.05], success rate of the operation (98.9% vs. 100%, P > 0.05), the rate of electrode displacement (8.4% vs. 7.3%, P > 0.05) and complications (3.2% vs. 2.1%, P > 0.05). The emergency temporary pacemaker implantation based on the improved simple bedside method is as safe and effective as the surgical method under X-ray guidance, and the operation is simpler and easier to learn and requires a shorter operating time, therefore, it is more suitable for use in emergency and primary hospitals.