Two years experience in pacemaker implantation in AL-Kadhemia university hospital and review of its indications and related early complications.

Abd-AL-Amee, Majid

	Two years experience in pacemaker implantation in AL-Kadhemia university hospital and review of its indications and related early complications.
KUFA MEDICAL JOURNAL
Article 1, Volume 11, Issue 2, 2008, Pages 114-126
Author
Majid abd-AL-Amee
Abstract
ABSTRACT Background: More than 400000 pacemakers are implanted each year. Subclavian vein is accessed by Seldinger technique This procedure is accomplished in catheterization laboratory or x-ray room, under local anesthesia;. Generally patients stay in hospital for one night. Aim of study: To register 2 years experience of Pace maker (PM.) implantation in Al-Kadhimiah University hospital in 290 patients, emphasizing its indications and related complications. Patients and methods: 290pat. had been retrospectively reviewed for 302 implanted PM. devices, mainly due to Complete heart Block( CHB) with wide QRS. (180 pat.). 302 PM. devices were implantedn AL-Kadhemiah university hospital by an experienced medical team, supervised by Prof. Dr. Ammar Al- Hamdi in a period of 2 year, from 82003-82005. Results: 170 of them were males (mean age 75 years); the remaining 120 pat. were females (mean age: 62 years). Their main chief complaint was syncope (135 pat.) , and dizzy spells (81 pat). Their main Echo. findings were dilated LV. (18 pat.), dilated LA. (32 pat.), and LV. wall hypokinesia (15 pat.). The main indication for implantation was CHB. (221), and SND. (45). The main implanted mode was DDD. (228) and VVI. (45). Temporary PM. has been indicated in 62 pat. presented with bradycardia with ventricular rate ≤30 bpm. (including 2 emergency procedures). Ambulatory Holter monitoring was useful in approaching recurrent unexplained syncope in 48 pat, especially to document atrial- tachycardia, sinus pauses, and to exclude ventricular arrhythmia. EPS. was helpful in approaching 4 pat. with unexplained recurrent syncope (with nondiagnostic Holter). Main and serious complication was pocket –related infection (13), 12 of their lead systems and boxe had been successfully removed by cautious gradually increasing pulling force under fluoroscopy. 5 old pacing systems were smoothly extracted due to End Of Life (EOL) of SorinTM, and new systems were reimplanted, but 2 lead coils were cut with ligation of insulating part. 3 procedures were early complicated by hematoma, managed by simple needle aspiration. System upgrading was performed in 4 SorinTM reimplanted systems (from VVI. to DDD.) Conclusions: Temporary PM. implantation is not essential, except in those presenting with ventricular rate ≤30 bpm. 24 hour ambulatory ECG. monitoring is of paramount importance in approaching pat. with recurrent unexplained syncope, especially in suspected Sinus Node Dysfunction (SND).. Diabetes mellitus(DM.) was the main pat. - related risk factor to PM. infection.
Keywords
syncope; Bradycardia; ECG; Holter; Indications; Complications

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