Objective-To study the outcome of patients with arrhythmogenic right ventricular dysplasia treated with an implantable cardioverter-defibrillator (ICD) for ventricular tachyarrhythmias complicated by haemodynamic collapse. Design-Observational study. Setting-University hospital. Patients-Nine consecutive patients (eight male, one female; mean (SD) age, 36 (18) years) with arrhythmogenic right ventricular dysplasia presenting with ventricular tachycardia and haemodynamic collapse (n = 6) or ventricular fibrillation (n = 3), treated with an ICD. Main outcome measures-Survival; numbers of and reasons for appropriate and inappropriate ICD interventions. Results-After a mean (SD) follow up of 32 (24) months, all patients were alive. Six patients received a median of 19 (range 2-306) appropriate ICD interventions for events detected in the ventricular tachycardia window; four received a median of 2 (range 1-19) appropriate ICD interventions for events detected in the ventricular fibrillation window. Inappropriate interventions were seen for sinus tachycardia (18 episodes in three patients), atrial fibrillation (three episodes in one patient), and for non-sustained polymorphic ventricular tachycardia (one episode in one patient). Conclusions-Patients with arrhythmogenic right ventricular dysplasia and malignant ventricular arrhythmias have a high recurrence rate requiring appropriate ICD interventions, but they also often have inappropriate interventions. Programming the device is diYcult because this population develops supraventricular and ventricular tachyarrhythmias with similar rates. (Heart 2001;85:53-56)
A five-year-old gelding suffered syncope at the end of a period of exercise. A 24-hour electrocardiogram recording revealed intermittent pauses in the sinus rhythm of up to 10 seconds, indicating sinus node disease; the pauses occurred repeatedly, particularly after exercise. A dual-chamber, rate-adaptive pacemaker was successfully implanted, which prevented excessive postexercise bradycardia and syncope, and allowed the horse to return to work.
The purpose of the present study was to develop a feasible and safe technique for dual-chamber pacemaker implantation in healthy horses. Implantation was performed in a standing, tranquilized horse and in ponies. Atrial and ventricular leads were transvenously inserted through the cephalic vein, and a subcutaneous pacemaker pocket was created between the lateral pectoral groove and the manubrium sterni in 6 equids. Positioning of each lead was guided by echocardiography and by measuring the electrical characteristics of the lead. The implantation procedure lasted about 4 hours in each animal and was well tolerated. In all animals, dual-chamber pacemaker function was obtained, and these results remained good throughout the follow-up period. At the time of implantation, atrial and ventricular sensing were between 2.1 and 7.2 mV and 7.8 and 16.8 mV, respectively, and atrial and ventricular pacing thresholds at 0.5 millisecond varied from 0.5 to 0.7 V and from 0.3 to 1.0 V, respectively. Six months after the implantation, sensing values varied from 2 to 10 mV for the atrial lead and from 2 to 16 mV for the ventricular lead, while pacing thresholds at 0.5 millisecond varied from less than 0.5 to 2.5 V for the right atrium and from less than 0.5 to 5.0 V for the right ventricle. Atrial lead dislodgment occurred in 2 animals, requiring insertion of a new lead. Ventricular lead dislodgment was not observed.
The purpose of the present study was to develop a feasible and safe technique for dual-chamber pacemaker implantation in healthy horses. Implantation was performed in a standing, tranquilized horse and in ponies. Atrial and ventricular leads were transvenously inserted through the cephalic vein, and a subcutaneous pacemaker pocket was created between the lateral pectoral groove and the manubrium sterni in 6 equids. Positioning of each lead was guided by echocardiography and by measuring the electrical characteristics of the lead. The implantation procedure lasted about 4 hours in each animal and was well tolerated. In all animals, dual-chamber pacemaker function was obtained, and these results remained good throughout the follow-up period. At the time of implantation, atrial and ventricular sensing were between 2.1 and 7.2 mV and 7.8 and 16.8 mV, respectively, and atrial and ventricular pacing thresholds at 0.5 millisecond varied from 0.5 to 0.7 V and from 0.3 to 1.0 V, respectively. Six months after the implantation, sensing values varied from 2 to 10 mV for the atrial lead and from 2 to 16 mV for the ventricular lead, while pacing thresholds at 0.5 millisecond varied from less than 0.5 to 2.5 V for the right atrium and from less than 0.5 to 5.0 V for the right ventricle. Atrial lead dislodgment occurred in 2 animals, requiring insertion of a new lead. Ventricular lead dislodgment was not observed.
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