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1.
DeFrancesco TC Hansen BD Atkins CE Sidley JA Keene BW 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2003,17(5):663-667
Temporary cardiac pacing is used in the emergency treatment of life-threatening bradyarrhythmias and for the support of heart rate and blood pressure of patients with sick sinus syndrome or high-grade atrioventricular (AV) block undergoing general anesthesia, typically for permanent pacemaker implantation. We retrospectively evaluated the safety and efficacy of a noninvasive transthoracic external cardiac pacing system in 42 dogs treated for bradyarrhythmias. Optimal placement of the patch electrodes on the skin of the thorax was initially established on 2 anesthetized normal dogs. The optimal electrode placement was determined to be on the right and left hemithoraces, directly over the heart. Afterward, by means of this electrode placement all 42 dogs treated for bradyarrhythmias in this study were successfully paced with the noninvasive transthoracic system. Dogs ranged in age from 1 to 15 years and weighed between 3.2 and 40 kg. Miniature Schnauzers, German Shepherds, and mixed breeds were most common in the study population. Indications for noninvasive transthoracic pacing included emergency treatment of hemodynamically unstable 3rd-degree AV block (2 dogs): support of heart rate during general anesthesia for permanent pacemaker implantation or lead-wire adjustment (38 dogs): and support of heart rate during general anesthesia for ophthalmologic surgery in dogs with sick sinus syndrome (2 dogs). Complications included pain and skeletal muscle stimulation, which required general anesthesia. We conclude that the noninvasive transthoracic pacing system evaluated is satisfactory for clinical veterinary use. 相似文献
2.
Permanent Transvenous Pacemaker Implantation in Forty Dogs 总被引:1,自引:0,他引:1
David Sisson DVM William P. Thomas DVM Jerry Woodfield DVM Paul D. Pion DVM Michael Luethy DVM Laura A. DeLellis DVM 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》1991,5(6):322-331
Permanent transvenous cardiac pacemakers were implanted in 40 dogs. Electrocardiographic diagnoses included persistent atrial standstill (3 dogs), sick sinus syndrome (8 dogs), and high-grade second-degree or third-degree atrioventricular (AV) block (29 dogs). Thirteen dogs were alive and well 4 to 42 months after pacemaker implantation (mean, 16.9 months). The mean and median survival times of the 26 dogs that died or were euthanatized during the study were 17.9 months and 13 months, respectively. Most of these dogs succumbed to problems unrelated to the arrhythmia and pacemaker implant. One dog was lost to follow-up. Complications associated with permanent transvenous pacemaker implantation included lead dislodgement, infection, hematoma formation, skeletal muscle stimulation, ventricular arrhythmia, migration of the pulse generator, and skin erosion. Lead dislodgement was the most common complication, occurring in 7 of 9 dogs paced using untined electrode leads and in 6 of 30 dogs paced using tined leads. Lead dislodgement did not occur in the only dog paced using an actively fixed endocardial lead. It was concluded that permanent transvenous cardiac pacing is a feasible, less traumatic alternative to epimyocardial pacing in dogs, but that successful use of this technique requires careful implantation technique and anticipation of the potential complications. 相似文献
3.
Bulmer BJ Sisson DD Oyama MA Solter PF Grimm KA Lamont L 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2006,20(2):257-271
Historically, ventricular demand, nonphysiologic (VVI) pacing has been the most commonly used modality to treat 3rd-degree atrioventricular (AV) block. The goal of this study was to determine the feasibility of using a commercial, single-lead, physiologic (VDD) pacemaker in dogs with 3rd-degree AV block. Furthermore, we hoped to characterize and identify differences in the radiographic, echocardiographic, neurohormonal, and quality of life consequences of physiologic versus nonphysiologic pacing. We evaluated 10 dogs during a 12-week crossover study. Acutely, rate-matched physiologic pacing reduced pulmonary capillary wedge pressure by 19% compared with nonphysiologic pacing. VDD pacing significantly reduced left atrial size normalized to body weight, left atrial-to-aortic root ratio, and left ventricular end-systolic dimension and increased fractional shortening, aortic Doppler velocity, cardiac output, and stroke volume compared with VVI pacing. Variable rate VDD pacing resulted in a significantly slower heart rate (HR) during echocardiography than fixed-rate (100 bpm) VVI pacing. AV synchronous pacing reduced circulating N-terminal proatrial natriuretic peptide (ANP), norepinephrine (NOR), and epinephrine (EPI) concentrations compared with asynchronous pacing. There were no significant differences in systemic blood pressure, thoracic radiographs, or owner-perceived quality of life. The median percentage of AV synchronous pacing during the VDD modality was 99.8% (range, 1.2 to 99.9%). This study confirms the potential to achieve physiologic pacing with a commercial, single-lead system in dogs. VDD pacing improved hemodynamics and neurohormonal profiles over asynchronous pacing although the long-term clinical benefits of these changes remain to be determined. 相似文献
4.
Kathryn J. Atkinson DVM MS DACVIM Deborah M. Fine DVM MS DACVIM Tim J. Evans DVM MS PhD DACT DABVT Safdar Khan DVM MS PhD DABVT 《Journal of Veterinary Emergency and Critical Care》2008,18(4):399-403
Objective: To describe successful treatment of third-degree atrioventricular (AV) block using temporary noninvasive transthoracic pacing and placement of a permanent transvenous pacemaker in a case of suspected lily-of-the-valley ( Convallaria majalis ) intoxication in a dog.
Case summary: A 2-year-old neutered male Beagle weighing 17.8 kg was presented to the emergency service for treatment of bradycardia, vomiting, and lethargy. An electrocardiogram revealed third-degree AV block that was nonresponsive to atropine. Ten hours after admission, the dog became obtunded. Treatment initially consisted of temporary noninvasive transthoracic pacing and eventually placement of a permanent transvenous pacemaker. The initial history did not suggest that the dog had access to any known cardiotoxins. However, C. majalis , which contains cardiac glycosides, was identified within the dog's environment and the dog's serum did contain digoxin or an immunologically cross-reactive compound.
New or unique information provided: This is the first reported successful management of C. majalis toxicosis in a dog. Temporary noninvasive transthoracic pacing was used in the management of this case as a safe and effective bridge to permanent pacemaker implantation. 相似文献
Case summary: A 2-year-old neutered male Beagle weighing 17.8 kg was presented to the emergency service for treatment of bradycardia, vomiting, and lethargy. An electrocardiogram revealed third-degree AV block that was nonresponsive to atropine. Ten hours after admission, the dog became obtunded. Treatment initially consisted of temporary noninvasive transthoracic pacing and eventually placement of a permanent transvenous pacemaker. The initial history did not suggest that the dog had access to any known cardiotoxins. However, C. majalis , which contains cardiac glycosides, was identified within the dog's environment and the dog's serum did contain digoxin or an immunologically cross-reactive compound.
New or unique information provided: This is the first reported successful management of C. majalis toxicosis in a dog. Temporary noninvasive transthoracic pacing was used in the management of this case as a safe and effective bridge to permanent pacemaker implantation. 相似文献
5.
OBJECTIVES: To document the outcome, survival and complications involved in pacemaker implantation in dogs in a retrospective study. METHODS: Case records for all dogs in which pacemaker implantation was performed were reviewed. RESULTS: A total of 104 dogs underwent pacemaker implantation. Dogs were presented with atrioventricular (AV) block (71), sick sinus syndrome (25) or vasovagal syncope (eight). Age at presentation varied from six months to 13 years with a median age of seven years and two months. The Labrador was the most commonly represented breed (17 cases). All but one dog survived pacemaker implantation, with 93 showing resolution of their clinical signs while 10 dogs showed intermittent residual signs. One-, three- and five-year survival estimates were 86, 65 and 39 per cent, respectively. Major complications after implantation were documented in 15 dogs and three of these led to fatalities. Minor complications were noted in 23 dogs. Sudden death occurred in six dogs three to 55 months following successful pacemaker implantation. CLINICAL SIGNIFICANCE: Transvenous pacemaker implantation was successful in reducing or eliminating clinical signs in over 90 per cent of dogs with third-degree atrioventricular (AV) block or sick sinus syndrome. In dogs with vasovagal syncope, six of eight dogs had greatly reduced frequency of collapse and two became asymptomatic. Although the procedure was associated with complications, these were rarely life threatening and good survival was documented in the majority of cases. 相似文献
6.
Wess G Thomas WP Berger DM Kittleson MD 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2006,20(4):877-884
We reviewed the indications for age and breeds of dogs who received transvenous endocardial artificial pacemaker (AP) implantation (n = 105) and complications and survival thereafter at a single institution over a 6-year period. A third-degree atrioventricular (AV) block (59%) and sick sinus syndrome (SSS; 27%) were the most common indications, along with a high-grade second-degree AV block (9%) and atrial standstill (5%). The most common breeds identified were Labrador Retriever (n = 16; 11 with a third-degree AV block), American Cocker Spaniel (n = 14; 10 with SSS), and Miniature Schnauzer (n = 13; all with SSS). Common presenting complaints were syncope (n = 66) and exercise intolerance or lethargy (n = 25). Half of the dogs (n = 52) had a history of acute onset of clinical signs (<2 weeks). Mean survival time for the 60 dogs who died during the study period was 2.2 years (range, 0.1-5.8 years). Major complications occurred in 13% of dogs and included lead displacement (n = 7), sensing problems that led to syncope (n = 3), infection at the pacemaker site (n = 1), bleeding (n = 1), and ventricular fibrillation during implantation (n = 1; successfully defibrillated). Minor complications occurred in 11 dogs (11%). The success rate of transvenous AP implantation was comparatively high (all dogs survived the first 48 hours), and the complication rate was comparatively low when compared with a previous multicenter study, most likely because of how commonly the procedure was performed and supervisory experience. 相似文献
7.
Ferasin L Faena M Henderson SM Langford K Darke PG 《The Journal of small animal practice》2005,46(3):115-120
OBJECTIVES: To assess the ventricular rate response of rate-adaptive (VVIR) pacemakers in dogs using a multi-stage exercise test. METHODS: The rate-responsiveness of VVIR pacemakers was assessed in seven dogs with complete atrioventricular (AV) block and implanted with various models of pulse generators (six motion sensors and one automatic dual-sensor rate-response pacemaker). Response activity was assessed with a multi-stage exercise test on a treadmill. Atrial and ventricular rate were analysed retrospectively at the end of the test and the AV ratio was calculated after each minute of exercise. RESULTS: During exercise, the mean (sd) AV ratio recorded in all paced dogs was 1.7 (0.5) (expected physiological ratio 1.0), although a variety of individual performances was observed. A poor response (AV ratio 2.8 [0.2]) was obtained with the automatic dual-sensor pacemaker, suggesting that this type of rate-responsive device may not be indicated for implantation in dogs with complete AV block. The overall AV ratio for the six dogs implanted with motion sensors was 1.4 (0.2), showing a better performance of these pacemakers during exercise. CLINICAL SIGNIFICANCE: This multi-stage exercise test represents an easy and repeatable method for assessing the accuracy of rate-responsive sensors and offers valuable information for the correct setting of VVIR pacemakers in dogs. 相似文献
8.
Mark E. Stamoulis DVM Betsy R. Bond DVM Philip R. Fox DVM MSc 《Journal of Veterinary Emergency and Critical Care》1992,2(2):67-72
Two cats with bradycardia and syncope were treated by permanent pacemaker implantation. Cat 1 had multiple episodes of syncope intermittently over a 10-month period and then multiple episodes within 24 hours; cat 2 had episodes of collapse over a 3-month period. Clinical signs included disorientation, vocalization, and collapse. High-grade second-degree AV block was recorded in both cats, with left and right bundle branch block in cat 1 and right bundle branch block in cat 2. Neither responded to pharmacologic therapy. In cat 1, an epimyocardial electrode was implanted into the left ventricular apex by a ventral abdominal transdiaphragmatic surgical approach. Cat 2 had a permanent smooth endocardial pacing lead introduced into the fight external jugular vein and directed into the right ventricular apex. Both cats were clinically normal within three days after implantation. Complications in cat 2 included failure of pacemaker capture, endocardial lead dislodgement, and pulse generator pocket seroma. Cats with symptomatic bradycardia caused by second-degree and third-degree AV block can be effectively treated by pacemaker implantation by surgical endomyocardial or perivenous endocardial lead placement. 相似文献
9.
《Journal of Veterinary Cardiology》2007,9(1):53-57
Third degree atrioventricular (AV) block in dogs is thought to be most frequently characterized by non-specific fibrotic changes in the AV node. However, it may occur secondary to an undiagnosed inflammatory process. We report a case of third degree AV block in a dog, secondary to acute lymphocytic-plasmacytic myocarditis that resulted in sudden death. This dog had cardiac troponin I levels of 44.65 ng/mL (normal <0.11 ng/mL). The serum cardiac troponin I level was five times higher than any other AV block patient measured in our laboratory, and was also substantially higher than in dogs with chronic valve disease or dilated cardiomyopathy. The severe myocardial necrosis observed at necropsy correlated with the degree of cardiac troponin I elevation. This report suggests that measurement of cardiac troponin I may be an indicated test before pacemaker implantation in dogs with third degree AV block. 相似文献
10.
Nicola Wiedemann Nicolai Hildebrandt Gabriel Wurtinger Estelle Henrich Esther Hassdenteufel Matthias Schneider 《Journal of Veterinary Cardiology》2017,19(3):247-255
Background
Increased cardiac troponin I (cTnI) concentration has been reported in dogs with atrioventricular (AV) block before and shortly following pacemaker implantation. The role of AV dyssynchrony, age, or concurrent cardiac disease on cTnI concentration remains unknown.Objectives
To investigate change in cTnI concentration following dual-chamber pacemaker implantation on short- and long-term follow-up and to compare cTnI values to a case-matched control group.Animals
Thirty-eight client-owned dogs with permanent AV block and 38 matched control dogs.Methods
Retrospective review of medical records. Pacemaker group consisted of dogs with AV block and dual-chamber pacing. Control group matched the study population in age and cardiac disease. cTnI was compared between pacemaker and control group on short- and long-term follow-up. Different lead types and influence of arrhythmia on cTnI were tested.Results
cTnI was high at presentation (median 0.66 ng/ml; range 0.03–18.6) and showed a significant reduction over time after pacemaker implantation (p < 0.0001). Median cTnI values were significantly different between pacemaker and control group on short-term (p = 0.0004; 0.11 ng/ml, range 0.03–1.36 versus 0.06 ng/ml, range 0.03–0.46), but not on long-term follow-up (p = 0.0547; 0.14 ng/ml, range 0.03–0.73 versus 0.07 ng/ml, range 0.03–0.46). Lead type and severity of arrhythmia did not show a significant correlation to cTnI concentration.Conclusions
On long-term follow-up, cTnI remained mildly elevated in some of the pacemaker dogs but was not significantly different to the matched control group. 相似文献11.
IntroductionIn dogs, single lead ventricular pacing, ventricular sensing, inhibition response, rate adaptive (VVIR) pacemakers are routinely used to treat third degree atrioventricular block. The objectives of this study were to investigate the heart rate distribution in dogs with VVIR pacemakers, and report changes when activity settings were adjusted.AnimalsEighteen client-owned dogs with VVIR pacemakers for third degree atrioventricular block.Materials and methodsThis observational study consisted of a review of medical records of dogs with VVIR pacemakers. For dogs with >50% of paced beats at the lower pacing rate, the activity daily living (ADL) and exertion responses were increased. Re-evaluations were performed after 6–12 months.ResultsHeart rate distribution similar to healthy dogs was absent for all dogs. In nine dogs, the ADL and exertion responses were increased to the highest level. Of these, three dogs showed no improvement in heart rate distribution; for two dogs, one with an epicardial pacemaker, several activity settings were adjusted and pacing at higher heart rates was observed at re-evaluation. Four dogs died or were lost to follow-up. Clinical signs had resolved for all dogs after pacemaker implantation.ConclusionDefault activity settings of VVIR pacemakers do not result in heart rate distribution equivalent to healthy dogs. Increasing the ADL and exertion response settings to the highest levels did not improve the pacemaker rate response. Further investigations into the role of dog size, generator positioning, pacemaker settings, and whether rate responsiveness is required for dogs' quality and quantity of life are warranted. 相似文献
12.
Robert A. Sanders DVM MS Henry W. Green III DVM Daniel F. Hogan DVM Kim Sederquist RVT 《Journal of Veterinary Cardiology》2011,13(3):227-230
A 14.5-kg, 13-year-old female spayed Cocker spaniel was evaluated because of episodic hind limb weakness. Results of examination were consistent with sick sinus syndrome with intermittent second-degree atrioventricular block. Transesophageal atrial pacing was successful in providing chronotropic support during permanent pacemaker implantation. Transesophageal atrial pacing appears to be a viable option for temporary atrial pacing in dogs with hemodynamically marked bradycardia without significant atrioventricular blockade. 相似文献
13.
Estrada AH Pariaut R Hemsley S Gatson BH Moïse NS 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2012,26(3):558-564
Background
An important consideration for the treatment of sick sinus syndrome (SSS) lies in the function of the atrioventricular (AV) node because most patients with SSS retain the ability to conduct atrial impulses.Hypothesis/Objectives
This retrospective study examined the feasibility of atrial pacing (AAI) in dogs with sinus node dysfunction (SND).Animals
Sixteen dogs with SND and AAI pacing were identified.Methods
Retrospective review of medical records.Results
Follow‐up time ranged from 45 to 1,227 days (mean: 292 days). Only 1 dog developed AV block 3 days postoperatively. Complete lead dislodgment occurred in 3/16 dogs 1, 19, and 27 days postoperatively. Lead perforation into the pericardial space occurred in 2/16 dogs. Rising thresholds for pacing with possible lead microdislodgment or fibrosis were suspected in another 3/16 dogs 57, 192, and 1,016 days after implantation. None of these dogs had complete loss of capture but all required higher thresholds for pacing.Conclusions and Clinical Importance
Based on this small group of dogs, clinically important AV block does not appear to occur in the long‐term for dogs with SND. Risks of lead perforation, complete dislodgment, and rising thresholds for pacing, possibly because of microdislodgment, may be related to the initial skill level of the operator or the leads that were used. Use of leads with reduced torque at the lead tip, higher flexibility, increased lead‐tip surface of contact with the endocardium or, more likely, use of alternate locations for pacing in the small right atrium of dogs with SND may decrease the frequency of these complications. 相似文献14.
Kellum HB Stepien RL 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2006,20(1):97-103
The effect of 3rd-degree atrioventricular block on long-term outcome in cats is unknown. Clinical findings and long-term outcome of 21 cats with 3rd-degree atrioventricular block were studied retrospectively. Median age of cats studied was 14 years (range 7-19 years). Presenting signs included respiratory distress or collapse, but 6 cats had no clinical signs of disease. Eight cats had congestive heart failure (CHF) at the time that 3rd-degree atrioventricular block was detected. Heart rates ranged from 80 to 140 beats per minute (bpm; median 120 bpm) with no difference in heart rate between cats with and those without CHF. Eleven of 18 cats that had echocardiograms had structural cardiac disease, and 6 cats had cardiac changes consistent with concurrent systemic disease. No atrioventricular nodal lesions were detected by echocardiography. One cat had atrioventricular nodal lesions detected on histologic examination. Median survival of 14 cats that died or were euthanized was 386 days (range 1-2,013 days). Survival did not differ between cats with or without CHF or between cats with or without structural cardiac disease. Thirteen cats with 3rd-degree atrioventricular block survived > 1 year after diagnosis, regardless of presenting signs or underlying cardiac disease. Third-degree heart block in cats is often not immediately life threatening. Survival was not affected by the presence of underlying heart disease or congestive heart failure at the time of presentation. Even cats with collapse might survive > 1 year without pacemaker implantation. 相似文献
15.
Oyama MA Sisson DD Lehmkuhl LB 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2001,15(3):229-239
Artificial pacing (AP) is a treatment for symptomatic bradyarrhythmias unresponsive to medical therapy. This retrospective study was designed to define the practices and outcome of AP in dogs at 7 referral institutions participating in the Companion Animal Pacemaker Registry and Repository (CANPACERS). The indications, implantation techniques, complications, long-term outcome, and owner satisfaction were examined. One hundred fifty-four dogs were identified as undergoing AP from January 1, 1991, to January 1, 1996. Third-degree atrioventricular (AV) block (n = 91; 59%) and sinus node dysfunction (n = 45; 29%) were the most common indications for AP Transvenous endocardial AP systems were implanted in 136 dogs (88%), and epicardial systems were implanted in 18 (12%). Complications associated with AP were reported in 84 dogs (55%). Major complications occurred in 51 dogs (33%), including dislodgement of the pacing lead (n = 15; 10%), generator failure (n = 10; 6%), cardiac arrest during implantation (n = 9; 6%), and infection (n = 7; 5%). Minor complications occurred in 47 dogs (31%), including seroma formation (n = 18; 12%), muscle twitch (n = 17; 11%), and inconsequential arrhythmias (n = 15; 10%). Fourteen dogs (9%) experienced both major and minor complications. Survival analysis revealed 1-, 2-, and 3-year survival rates of 70, 57, and 45%, respectively. Age and presence of preexisting congestive heart failure (CHF) had a negative effect on survival (P = .001). Sixty percent of dogs with preexisting CHF died within 1 year of implantation, whereas 25% of dogs without heart failure died during the same period. Owners rated their satisfaction with the procedure as high in 80% of the dogs. 相似文献
16.
Petrie JP 《Clinical Techniques in Small Animal Practice》2005,20(3):164-172
Transvenous cardiac pacing is a commonly employed treatment for symptomatic bradyarrhythmias in dogs. Medical management of these conditions has not proven to be successful leaving pacing as the only viable alternative. The technique of pacemaker implantation is not difficult, but successful pacemaker therapy requires an understanding of electrophysiology, cardiac fluoroscopic anatomy, pacemaker instrumentation, and programming. Proper patient selection and identification of the underlying rhythm disturbance is essential to a successful clinical outcome. This article discusses the indications, equipment, techniques, complications, and outcome of permanent transvenous cardiac pacing. 相似文献
17.
Suzanne M. Cunningham DVM John E. Rush DVM MS Dipl ACVIM Dipl ACVECC 《Journal of Veterinary Cardiology》2007,9(2):129-134
The case reported herein describes the placement of a permanent transvenous pacemaker in an older dog with a previously undiagnosed persistent left cranial vena cava (PLCVC) and recent onset symptomatic third-degree atrioventricular (AV) block. On presentation the dog was found to have atrial flutter and third-degree AV block and echocardiography demonstrated evidence of chronic valvular disease and pulmonary arterial hypertension. The persistent left cranial vena cava was discovered via angiography when difficulties were encountered with pacemaker placement. Successful right ventricular pacing necessitated passage of the lead through the coronary sinus. The attendant complications in pacemaker placement in the presence of a PLCVC are well-described in man but, to the authors' knowledge, have not been described in companion animals. 相似文献
18.
Ferasin L van de Stad M Rudorf H Langford K Hotston MA 《The Journal of small animal practice》2002,43(3):124-128
A four-and-a-half-year-old neutered male shorthair cat was presented with a three-week history of episodic fainting. Twenty-four hour electrocardiographic (Holter) recording revealed frequent prolonged episodes of complete atrioventricular (AV) block with ventricular standstill. The fainting episodes coincided with the longest periods of ventricular inactivity. A permanent transjugular pacemaker was placed to prevent further life-threatening episodes of syncope. Three months after discharge, the patient was re-presented with sudden onset dyspnoea associated with chylothorax and electrocardiography showed a third degree (complete) AV block. The pacemaker was reprogrammed in view of the third degree AV block and the chylous effusion was successfully treated by repeated thoracocentesis and long-term diuresis. However, the patient's general condition deteriorated progressively and the cat was euthanased five and a half months after implantation of the pacemaker. 相似文献
19.
Sarah A Zimmerman DVM Janice M Bright BSN MS DVM Dipl. ACVIM 《Journal of Veterinary Cardiology》2004,6(1):40-44
A two year old, female spayed border collie presented three weeks after permanent pacemaker implantation for weakness, lethargy and collapse. Electrocardiogram documented complete (3rd degree) atrioventricular (AV) block, the absence of pacing and a ventricular escape rhythm. Thoracic radiographs revealed retraction and dislodgement of the passive fixation lead from the right ventricular apex. During a procedure to reposition the lead, it was noted that lead retraction had resulted from rotation of the generator with twisting and entanglement of the lead on itself and around the generator, a complication recognized in human patients as “Twiddlers syndrome”. The pacemaker lead was removed, a new lead securely placed at the right ventricular apex, and the generator was secured into a revised subcutaneous pocket. Pacing was re-established and the Twiddler's syndrome has not reoccurred. 相似文献
20.
Rebecca S. Syring DVM DACVECC Merilee F. Costello DVM DACVECC Robert H. Poppenga DVM PhD DABVT 《Journal of Veterinary Emergency and Critical Care》2008,18(1):75-80
Objective: This case report presents the clinical findings of a dog with diltiazem intoxication and the utilization of temporary transvenous pacing for management of high‐grade second‐degree atrioventricular (AV) block with associated bradycardia and hypotension. Case summary: A nine‐year‐old spayed female Basset Hound, who ingested between 95 and 109 mg/kg of sustained‐release diltiazem exhibited clinical signs of cardiac arrhythmias, bradycardia, hypotension, mental depression and gastrointestinal (GI) upset. Bradycardia was present initially, then was followed by high‐grade second‐degree AV block with ventricular escape. Traditional medications to treat calcium channel blocker (CCB) intoxication, including atropine, calcium gluconate, dopamine and glucagon were initially successful in managing the cardiac rhythm disturbances and hypotension. Twenty‐two hours post‐ingestion, however, the dog became refractory to these medications following sedation for GI decontamination and a temporary transvenous pacemaker was placed. The dog was paced for 19 hours. Transvenous pacing effectively increased heart rate, which increased blood pressure into an acceptable range. The dog was successfully discharged from the hospital following treatment. New or unique information provided: The use of a temporary pacemaker should be considered an acceptable treatment for bradycardia, AV block and hypotension associated with CCB intoxication when conventional medical therapy fails. 相似文献