Entries Tagged as 'Pacing Clin Electrophysiol'
Postoperative low-molecular-weight heparin bridging is associated with an increase in wound hematoma following surgery for pacemakers and implantable defibrillators.
Pacing Clin Electrophysiol. 2009 Mar;32(3):378-82
Authors: Robinson M, Healey JS, Eikelboom J, Schulman S, Morillo CA, Nair GM, Baranchuk A, Ribas S, Evans G, Connolly SJ, Turpie AG
BACKGROUND: The perioperative management of patients receiving oral anticoagulation therapy (OAC) who undergo pacemaker (PM) and defibrillator (ICD) surgery remains controversial. Low-molecular-weight heparin (LMWH) is often used; however, wound hematoma is a common complication. METHODS: At a single academic Canadian center, between July 2003 and June 2005, details of perioperative OAC bridging and the rate of wound hematoma requiring reoperation or interruption of OAC were reviewed for all patients receiving LMWH bridging for PM or ICD surgery. RESULTS: A total of 148 PM/ICD patients underwent perioperative bridging with LMWH. A significant hematoma occurred in 23 patients, requiring reoperation in three patients. No patient died, developed infection, or stroke. The initial bridging regimen included LMWH (enoxaparin 1 mg/kg BID) given until evening prior to surgery, and reinitiated on postoperative day 3. In response to high rates of postoperative hematoma, subsequent protocols omitted the LMWH on the evening before surgery, all postoperative LMWH, or both. The use of LMWH the night before surgery had no effect on hematoma rates (12% vs 17%, P = 0.62); however, the use of any postoperative LMWH increased hematoma rates (23% vs 8%, P = 0.01). Hematoma rates were not increased in patients receiving acetylsalicylic acid (19% vs 16%, P = 0.62) or clopidogrel (25% vs 17%, P = 0.54). In a multivariate analysis, independent predictors of significant wound hematoma included postoperative LMWH (P = 0.001), a higher international normalized ratio on the day of surgery (P = 0.03), and male sex (P = 0.05). CONCLUSION: Elimination of postoperative LMWH was associated with a substantial reduction in hematoma rates following PM and ICD surgery.
PMID: 19272069 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Pacing Clin Electrophysiol
Prevention of venous thrombosis by warfarin after permanent transvenous leads implantation in high-risk patients.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S247-51
Authors: Costa R, Da Silva KR, Rached R, Martinelli Filho M, Carnevale FC, Moreira LF, Stolf NA
BACKGROUND: The incidence of venous lesions following transvenous cardiac device implantation is high. Previous implantation of temporary leads ipsilateral to the permanent devices, and a depressed left ventricular ejection fraction have been associated with an increased risk of venous lesions, though the effects of preventive strategies remain controversial. This randomized trial examined the effects of warfarin in the prevention of these complications in high-risk patients. METHOD: Between February 2004 and September 2007, we studied 101 adults who underwent a first cardiac device implantation, and who had a left ventricular ejection fraction < or =0.40, or a temporary pacing system ipsilateral to the permanent implant, or both. After device implantation, the patients were randomly assigned to warfarin to a target international normalized ratio of 2.0-3.5, or to placebo. Clinical and laboratory evaluations were performed regularly up to 6 months postimplant. Venous lesions were detected at 6 months by digital subtraction venography. RESULTS: Venous obstructions of various degrees were observed in 46 of the 92 patients (50.0%) who underwent venography. The frequency of venous obstructions was 60.4% in the placebo, versus 38.6% in the warfarin group (P = 0.018), corresponding to an absolute risk reduction of 22% (relative risk = 0.63; 95% confidence interval = 0.013-0.42). CONCLUSIONS: Warfarin prophylaxis lowered the frequency of venous lesions after transvenous devices implantation in high-risk patients.
PMID: 19250106 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Pacing Clin Electrophysiol
Does atrial fibrillation beget ventricular fibrillation in patients with acute myocardial infarction?
Pacing Clin Electrophysiol. 2008 Dec;31(12):1612-9
Authors: Sankaranarayanan R, James MA, Nuta B, Townsend M, Kesavan S, Burtchaell S, Holloway R, Ewings P
BACKGROUND: Atrial fibrillation (AF) is associated with increased mortality and a higher complication rate postmyocardial infarction (MI), but the exact mechanisms are unknown. We investigated whether AF predisposes to ventricular arrhythmia in postmyocardial infarct patients, thereby accounting for increased mortality. METHODS: Five hundred consecutive patients admitted to our coronary care unit with acute MI were monitored for in-hospital arrhythmias. Detailed information was also compiled on past history, co-morbidities, electrolyte disturbances, drug therapies, and ejection fraction. Mortality data were collected for an average of 5.5 years. RESULTS: The results have shown that the incidence of ventricular fibrillation (VF) is much greater in patients presenting with AF (P=0.03) and multivariate analysis has shown that AF is independently associated with the development of VF. This association occurs principally in patients who are admitted with AF (P=0.01) rather than those who develop it during their admission, although these patients are also at mildly increased risk. The increased incidence of VF does account for increased mortality in the AF patients but does not explain all of their excess risk. There was no association between AF and ventricular tachycardia (VT); P=0.50. CONCLUSIONS: In conclusion, AF on admission to the hospital with acute MI is associated with an increased risk of VF and subsequent mortality.
PMID: 19067815 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Pacing Clin Electrophysiol
