PM therapy reduces mortality and morbidity in children with CCAVB when compared with natural history data. Although children with PM are free from CCAVB related symptoms limited morbidity remains due to PM system related complications.
An 86-year-old man underwent pacemaker implantation for symptomatic atrio-ventricular block grade 2 Mobitz II. The patient suffered repeated admissions for iterative sterile wound necrosis, leading to two generator re-implantations. No bacterial infection was detected in the microbiological screening tests. The skin patch testing to titanium was negative. Nevertheless, we decided to remove the pacemaker system and to implant a gold-plated generator with polyurethane leads. Since then, there has been no recurrence of wound complications. Gold-plated generator and polyurethane leads are effective in treating allergic reactions to pacemaker system components in selected cases. Negative skin patch testing to titanium does not exclude allergic reaction to this pacemaker component.
Left heart atrial and ventricular epicardial pacing leads inserted through a left lateral thoracotomy demonstrate a high probability of survival, with favorable pacing characteristics, and optimal sensing thresholds at mid-term follow-up. Epicardial left heart pacing is reliable, and easy access can be achieved through a cosmetic and functional muscle-sparing left lateral thoracotomy.
SIMEON, L., ET AL.: The Impact of Automatic Threshold Tracking on Pulse Generator Longevity in Pa tients with Different Chronic Stimulation Thresholds. Automatic adjustment of the stimulation output of pacemakers to changing stimulation thresholds using the Autocapture feature increases patient safety and decreases energy consumption. This study examined the impact of Autocapture on pulse generator longevity in patients with different chronic stimulation thresholds. Eighty patients (mean age 79 ± 9 years; 37 men, 43 women) with Pacesetter Regency SR + pacemakers were included in the study. Data were col lected before discharge of the patients from the hospital, 6-12 weeks postimplant, and then every 6-12 months. Pulse generator longevity was calculated theoretically, assuming 100% stimulation with a stable threshold, at a .pacing rate of 65 ±6 beats/min and 1% backup pulses. Theoretical pulse generator longevity was calculated for low (< 1 V), intermediate ( > 1 V and < 2 V), and high (> 2 V) stimulation thresholds. Pulse generator longevity was compared among three groups: (A) Autocapture programmed On, (B) Autocapture programmed Off (C) theoretical calculations using thresholds of patients in group A with the stimulation voltage programmed at twice pacing threshold, or at a minimum of 2.4 V. The mean follow-up time since implantation was 19 ± 8 months. The calculated longevity benefits for patients in group A were 36%, 59%, and 30% compared to group B, and 19%, 32%, and 49% compared to group C in patients with low, intermediate, and high chronic stimulation thresholds, respectively. Theoretical cal culations based on chronic stimulation thresholds in our patient population with Regency SR+ pace makers suggest that Autocapture may markedly prolong pulse generator longevity in patients with a broad range of long-term pacing thresholds. (PACE 2000; 23[Pt. II]:1788-1791 pacemaker, pulse generator, longevity, threshold tracking, automatic threshold tracking
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