The SelectSecure catheter delivery system and active fixation 4.1 French diameter Model 3830 pacing lead (Medtronic, Inc, Minneapolis, MN, USA) has the advantage of permitting precise implant at nearly any desired location due to catheter maneuverability. However, as the lead lacks an internal stylet lumen, it is intrinsically floppy and any repositioning after the delivery catheter is removed is nearly impossible, necessitating lead extraction and a repeat of the implant process. At present, there are no commercially available tools to precisely reposition this lead. This report presents a simplified approach to reimplant a dislodged Model 3830 lead using currently available materials to create an effective maneuverable and removable encircling snare.
Endomyocardial biopsy is the gold standard survey for cardiac graft rejection. Signal-averaged electrocardiography (SAECG) identifies slowly conducting, diseased myocardium. We sought to determine whether SAECG is a sensitive, noninvasive transplant surveillance method in the young.Ninety-four SAECGs recorded prior to biopsy in 20 young transplant (OHT) patients and those from 15 healthy age-matched controls (CTL) were analyzed. In the OHT group, 56 no-rejection (NOREJ) (ISHLT grades 0 or 1 A) and 37 acute rejection (REJ) (ISHLT grades IB, 2, and 3A) SAECGs were compared, SAECGs were filtered at 40-255 Hz. Total QRS duration (QRSd), duration of terminal low amplitude of QRS under 40 microV (LAS), and root mean square amplitude of terminal 40 msec of QRS (RMS40) were compared.SAECGs were significantly different in CTL vs NOREJ but not in NOREJ vs REJ: QRSd, 81.7 +/- 8, 107.2 +/- 18.4, and 112.3 +/- 21.6 msec, respectively; LAS, (18 +/- 5.8, 23.6 +/- 10.7, and 27 +/- 14.8 msec, respectively; and RMS40, (169.3 +/- 100.4, 68 +/- 48.8, and 57.5 +/- 45.6 microV, respectively. Children following OHT exhibited significant differences in the SAECG compared to controls. Differences between the NOREJ and REJ groups were negligible. Therefore, SAECG may not be effective in detecting OHT rejection in the young.
Objective: Catheter ablation for supraventricular tachycardias (SVTs) traditionally has utilised fluoroscopic imaging (FI). However, radiation concerns have recently contributed to the evolution of non-fluoroscopic three-dimensional imaging (3DI) systems. A few recent studies have advocated non-FI in lieu of FI. To date, there are only a few studies reporting use of limited FI with 3DI usage in children undergoing SVT ablations. This study evaluates time, efficacy, cost and safety of limited FI plus 3DI for SVT ablation in the young.Methods: Electrophysiology study (EPS) and ablation data for standard forms of SVT from October 2009 to June 2012 were reviewed. Patient radiation time, radiation dose area product (DAP), EPS time, anaesthesia duration and cost, and ablation success rates were evaluated.Results: A total of 81 patients (mean age 13.2 ± 3.4 years) underwent ablation. Type of SVT, gender, age, acute success, adverse events and recurrences were recorded post-ablation for over 2.5 years. Acute procedural success was 93.8 %. Of these, chronic sustained success was 85.5 %. As expected, limited FI plus 3DI was associated with some radiation exposure (2.47 ± 2.78 milliGray-m2) but less than historically associated with paediatric tachycardia ablations.Conclusion: A conscious awareness to use limited FI combined with 3DI is associated with excellent long-term success, lack of complications and marked decrease in radiation exposure. Although 3DI-only has some appeal, use of combined limited radiation is associated with some advantages overall. Potential adverse effects of limited radiation need to be weighed in when deciding which imaging or combination to use.
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