Pathology of Cardiac Pacemakers and Central Catheters

Cox, John

doi:10.1007/978-3-642-76846-0_6

Cited by 5 publications

(3 citation statements)

References 385 publications

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“…Recently models capable of delivering dc shocks directly to the myocardium to terminate life threatening tachyarrythmias have been introduced. 2 While there are some published data on the reasons for pacemaker implantation, 3 the causes of death in patients with pacemakers, 4 and pacemaker assessment post mortem, [5][6][7] our aim in this study was to make a prospective audit of pacemaker function after death in patients from our cardiology caseload and to cross correlate this with the cause of death and other demographic data.…”

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confidence: 99%

A prospective audit of pacemaker function, implant lifetime, and cause of death in the patient.

Suvarna¹,

Start²,

Tayler³

1999

J Clin Pathol

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Aim-To audit prospectively the reasons for pacemaker implantation, the duration of the pacemaker use, the cause of death, and pacemaker function after removal from the patient. Methods-Pacemakers were removed at necropsy, or from the bodies of patients awaiting cremation, in three hospitals over a three year period. The cause of death was taken from the results of the necropsy or from the certified cause of death. Demographic data, including the time of implant and reasons for implantation, were checked. The pacemakers were analysed in terms of battery status, program, and output under a standard 470 ohm load. Results-69 patients were studied. Average age at death was 78 and 80 years for men and women, respectively. The average duration since pacemaker implantation was 46 months. Eleven patients had necropsies, showing that three died from ischaemic heart disease, six from cardiomyopathy, one from an aortic aneurysm, and one from disseminated neoplasia. From the necropsy results and death certificates, the distribution of causes of death in the group as a whole were ischaemic heart disease (21), cardiomyopathy (8), cerebrovascular disease (11), neoplasia (11), chest infection/chronic obstructive airways disease (8), and other causes (10). In all cases the pacemaker box function was within normal limits. Conclusions-Neither primary nor secondary pacemaker dysfunction was found. The study highlights the impact of arrhythmias in cardiomyopathy, and raises questions about the true role of ischaemic heart disease in these pacemaker requiring patients. The relatively short gap between pacemaker implantation and death requires further study. (J Clin Pathol 1999;52:677-680) Keywords: pacemaker; arrhythmias; mortality The modern cardiac pacemaker is a commonly employed device used for the control of various arrhythmias.1 It has a good record of safety and eYcacy. Recently models capable of delivering dc shocks directly to the myocardium to terminate life threatening tachyarrythmias have been introduced. 2 While there are some published data on the reasons for pacemaker implantation, 3 the causes of death in patients with pacemakers, 4 and pacemaker assessment post mortem, 5-7 our aim in this study was to make a prospective audit of pacemaker function after death in patients from our cardiology caseload and to cross correlate this with the cause of death and other demographic data. MethodsOver three years, at three hospitals, two pathologists collected cardiac pacemakers from deceased patients awaiting cremation and from cases on which a necropsy had been held. The connections and lead implantation sites were checked where possible, and the explanted units were sent for formal electronic testing. This involved a check on battery status and performance under a standard 470 ohm load. Program details were checked by electronic interrogation of the pacemaker unit according to the manufacturer's instructions.The patient's demographic details (age at death, date of birth, age at pacemaker implantation) were recorded....

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mentioning

confidence: 99%

A prospective audit of pacemaker function, implant lifetime, and cause of death in the patient.

Suvarna¹,

Start²,

Tayler³

1999

J Clin Pathol

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“…Coronary vein thrombosis has often been documented in cases of thrombosis of the coronary sinus as a result of inadvertant implantation in/or damage to it during central venous catheterization, especially by way of the left internal jugular vein and more so, in cases with anatomical variations of the coronary sinus [3,6,8,13,16,17]. It has also been described in cases of ventriculoatrial shunts [19] or in cases where a pacemaker lead was mistakenly implanted in the coronary sinus [2]. A relatively high percentage of epicardial coronary vein thrombosis has also been documented in association with myocardial infarction, in which more than 30% of the left ventricular mass was involved, in combination with valvular heart disease and a post-attack survival time of at least 24 h [5].…”

Section: Discussionmentioning

confidence: 97%

Cardiac vein thrombosis and haemorrhagic myocardial necrosis; report of a case with review of the literature

et al. 2000

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A 29-year-old woman, addicted to heroin since the age of 15 years, presented with a 4-day history of acute inspiratory chest pain, dyspnoea and vomiting associated with hypoventilation. She died 3 h after admission to the intensive care unit in spite of active resuscitative measures. The main autopsy findings were limited to the heart, which showed widespread cardiac vein thrombosis, and both ventricles and the atria were associated with multiple areas of haemorrhagic myocardial necrosis. We review the literature of this uncommon pathological entity and discuss its possible pathogenesis.

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“…Host system endothelization can occur within 1 week of implantation on the CIED leads and can protect against infection. 21 The initial interaction of the microbe with the host is mediated by various physical and chemical properties such as electrostatic charge, surface tension, and hydrophobicity of the device. 22 The various host risk factors for device infection have already been described.…”

Section: Scope Of the Problemmentioning

confidence: 99%