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Sample records for infected permanent pacemaker

  1. [Permanent pacemaker implantation. Indications and results].

    PubMed

    Gutiérrez, A; Iturralde, P; Gutiérrez Fuster, E; Martínez Ríos, N; Martínez Ríos, M A; Romero, L; Hernández, D; González Hermosillo, J A

    1990-01-01

    Clinical, laboratory and electrocardiographic data from 608 patients with permanent pacemakers implanted over a period of 8 years, were evaluated retrospectively. The number of implants was greater in males (56.5%) and in patients over 60 years of age (77.5%). Atherosclerosis was the most common disease found in this group (50%). Syncope occurred in 96.2% of the cases; and complete AV block was the most common electrocardiographic alteration (50.5%). Electrode displacement occurred in 32 patients (5.2%) and was the most commonly found early complication. Among the late complications, 10.3% of the patients had infections in the area of the generator. The total mortality was 7.7% due to the heart disease rather than pacemaker-related complication. PMID:2344227

  2. Temporary inhibition of permanently implanted demand pacemakers.

    PubMed

    Latif, P; Ewy, G A

    1977-01-01

    Temporary inhibition of permanently implanted demand pacemakers has been previously described. Demand pacemakers may be inhibited by waving a magnet over the region of the pacemaker generator or by chest wall stimulation. The former may not inhibit most of the bipolar pacemakers, whereas the latter may be time consuming and may casue patient discomfort. Another method is described which utilized a commercially available Cordis Omnicor Programmer, Model 166-B, to temporarily inhibit bipolar and unipolar pacemakers. By placing the programmer over the skin where the pacemaker generator is implanted and/or over the area of the subcutaneous pervenous lead and activating the programmer multiple times at a rate faster then the pacing rate, the demand pacemakers are inhibited. After testing the efficacy in vitro, the method was successfully tried on 45 patients. Fifteen of these patients had unipolar pacemakers. Pacemakers marketed by Medtronic, Cordis, Starr-Edwards, C.P.I., and Arco were tested. Temporary inhibition of permanent demand pacemakers is desirable under various clinical situations. The method herein described has the advantages of being simple, quick, painless, and is effective for both unipolar and bipolar pacemakers. PMID:830215

  3. Reuse of permanent cardiac pacemakers.

    PubMed Central

    Rosengarten, M D; Portnoy, D; Chiu, R C; Paterson, A K

    1985-01-01

    Cardiac pacemakers are part of a growing group of expensive implantable electronic devices; hospitals in which 100 pacemakers are implanted per year must budget over $300 000 for these devices. This cost represents a considerable burden to health care resources. Since the "life-span" of modern pacemakers often exceeds that of the patients who receive them, the recovery and reuse of these devices seems logical. Pacemakers can be resterilized and tested with current hospital procedures. Reuse should be acceptable under Canadian law, but the manner in which the pacemakers are recovered and the patients selected should follow careful guidelines. Every patient should provide written informed consent before receiving a recovered pacemaker. Properly executed, reuse of pacemakers should provide a high level of health care while maintaining or reducing the cost of these devices. PMID:4016637

  4. [Exercise test in patients with permanent pacemakers].

    PubMed

    Esturau, R; Iturralde, P; Férez, S; Galván, O; Rosado, J; Pérez, G; González Hermosillo, J A

    1991-01-01

    From June 1988 to June 1990 we studied fifty patients who had implantation of a pacemaker. (31 females and 19 males). All of them underwent stress test with Bruce's protocol. Patients were divided in two groups; pacemaker-independent (PI) and pacemaker-dependent (PD). Over 50% of the patients inhibited the pacemaker with their own rhythm, most of them had sinus dysfunction. Complete A-V block was predominant in PD. The group of PI achieved more mets and had more oxygen consumption. Blood pressure response was similar in both groups. PMID:1929668

  5. Fistula Formation 6 Years after Removal of Infected Pacemaker Leads

    PubMed Central

    Schroeter, Thomas; Kiefer, Philipp; Sauer, Matthias; Mohr, Friedrich Wilhelm

    2015-01-01

    We describe a case of a male patient who presented with a chronic ulcer below the left clavicle. Six years before the present admission a permanent pacemaker, including leads, was explanted related to endocarditis. The initial working hypothesis suspected an infected sebaceous gland as the cause of ulceration. After two periods of unsuccessful surgical treatment of the gland, further examination identified a small pacemaker lead fragment underneath the articulation between sternum and clavicle as a possible reason. PMID:26693129

  6. Fistula Formation 6 Years after Removal of Infected Pacemaker Leads.

    PubMed

    Schroeter, Thomas; Kiefer, Philipp; Sauer, Matthias; Mohr, Friedrich Wilhelm

    2015-12-01

    We describe a case of a male patient who presented with a chronic ulcer below the left clavicle. Six years before the present admission a permanent pacemaker, including leads, was explanted related to endocarditis. The initial working hypothesis suspected an infected sebaceous gland as the cause of ulceration. After two periods of unsuccessful surgical treatment of the gland, further examination identified a small pacemaker lead fragment underneath the articulation between sternum and clavicle as a possible reason. PMID:26693129

  7. Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers.

    PubMed

    Aydemir, O; Ozmen, E; Küey, L; Kültür, S; Yeşil, M; Postaci, N; Bayata, S

    1997-06-01

    Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device. PMID:9227759

  8. Long-term management of atrial myopathy in two dogs with single chamber permanent transvenous pacemakers.

    PubMed

    Schmitt, K E; Lefbom, B K

    2016-06-01

    Two young Labrador retriever dogs with bradycardia-induced syncope resulting from atrial myopathy underwent permanent transvenous pacemaker implantation. Both dogs developed heart failure 3-5 years after pacemaker implantation. Both were managed medically for approximately 7 years after pacemaker implantation and, ultimately, were humanely euthanized due to refractory heart failure signs and quality of life concerns. Long-term management of dogs with atrial myopathy and secondary atrial standstill with pacemaker implantation and medical therapy for heart failure is feasible and prognosis may be better than previously reported or speculated. PMID:26923757

  9. Remnant Pacemaker Lead Tips after Lead Extractions in Pacemaker Infections.

    PubMed

    Kim, Daehoon; Baek, Yong-Soo; Lee, Misol; Uhm, Jae-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung

    2016-07-01

    Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection. PMID:27482268

  10. Remnant Pacemaker Lead Tips after Lead Extractions in Pacemaker Infections

    PubMed Central

    Kim, Daehoon; Baek, Yong-Soo; Lee, Misol; Uhm, Jae-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung

    2016-01-01

    Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection. PMID:27482268

  11. Permanent internal pacemaker safety in air medical transport.

    PubMed

    Gordon, R S; O'Dell, K B

    1991-02-01

    Helicopter and fixed-wing air medical transportation provides an important role in the management of critically-ill patients. As the use of cardiac pacemakers continues to grow, knowledge of their expanding capabilities and sophistication is important. The environments of our "airborne intensive care units" are subject to many sources of electromagnetic and vibrational interference. Although pacemaker shielding mechanisms have become quite elaborate, further studies are needed to define their reliability in modern aircraft. Further, the possible effects of electromagnetic and vibrational interference upon inflight reprogramming require further study. PMID:10109075

  12. Pacemaker

    MedlinePlus

    ... Topics Arrhythmia Atrial Fibrillation Heart Block Implantable Cardioverter Defibrillators Long QT Syndrome Send a link to NHLBI ... arrhythmias with another device called an implantable cardioverter defibrillator (ICD). An ICD is similar to a pacemaker. ...

  13. Percutaneous permanent pacemaker implantation via the azygous vein in a patient with superior vena cava occlusion.

    PubMed

    Kamdar, Ravindu Hasmukh; Schilling, Richard John

    2008-03-01

    Occlusion of the superior vena cava (SVCO) makes implantation of permanent pacemakers challenging and difficult. We describe an extended application of a Medtronic Attain (Medtronic Inc., Minneapolis, MN, USA) guide catheter (a tool designed for delivery of left ventricular pacing leads into the coronary sinus) for delivery of a right ventricular pacing lead via the azygous vein in a 72-year-old woman with SVCO secondary to long-term central venous hemodialysis catheters. This approach allowed the use of an endocardial pacing lead, implantation under local anesthesia, and conventional positioning of the pacemaker generator in the pectoral region in a patient with SVCO. PMID:18307638

  14. Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

    PubMed Central

    Siddiqui, Adeel M; Harris, Gregory S; Movahed, Assad; Chiang, Karl S; Chelu, Mihail G; Nekkanti, Rajasekhar

    2015-01-01

    The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker. PMID:26380831

  15. Improving e-discharge letters for Permanent pacemaker insertions at Wansbeck General Hospital.

    PubMed

    Taylor, Christopher

    2013-01-01

    670 patients attend Wansbeck General Hospital each year for elective and emergency permanent pacemaker insertion or modification. Elective patients for new devices attend the cardiology department on the day of procedure and are clerked onto the cardiology ward after insertion. Patients are discharged home the following day with a letter typed by a junior doctor. Prior to October 2011, junior doctors were unaware of any guidelines regarding content of discharge letters due to poor accessibility. Vital information such as pacemaker model and indication for implantation were frequently absent from the typed summaries. In October 2011, the cardiology department reviewed the guidelines establishing the information required in all discharge summaries for pacemaker implantation and these guidelines were published on the ward in an easy to follow proforma for any junior doctor typing letters. Eight essential criteria should be included in each letter; date and indication for insertion, pacemaker type, make and model, access route, complications, chest x-ray and device check results, and follow-up details. Finally, a copy of the letter was to be sent to the cardiology department for clinic follow-up. Ten letters were audited prior to the proforma being issued. 0 letters contained 100% of the required information. Main criteria missing in most letters included indication for insertion (50%), make of device (0%), the route of access (10%) and cc to cardiology department (0%). 70 letters were audited in October 2012, one year following introduction of the discharge proforma.100% of letters contained all of the eight essential criteria required by the departmental guidelines. 53% of the letters were also received by the cardiology department. In conclusion, a set of easy to follow guidelines in the form of a published document on the cardiology ward has produced dramatic improvement in the quality of e-discharge letters for patients undergoing permanent pacemaker implantation

  16. [Syncope of unknown origin in patients with permanent auriculoventricular block with an implanted pacemaker. Usefulness of the tilt table test].

    PubMed

    Márquez, Manlio F; Encarnación-Roa, Carmen F; Hermosillo, Antonio G; Benítez-Pinto, William J; Cárdenas, Manuel

    2002-04-01

    Four female patients aged 26 to 71 years, with permanent complete AV heart block and an implanted pacemaker had syncope or presyncope after the pacemaker implantation. As part of the study protocol the tilt table test was done. Neurological disease, arrhythmias, pacemaker syndrome or dysfunction of the stimulation system were ruled out. A head up tilt was performed, isosorbide was used as pharmacological challenge, since the basal test was negative. In three patients this test was positive: in one patient possibly caused by postural orthostatic tachycardia syndrome, and two with neurally mediated syncope. In one patient it was not possible a diagnosis. The head-up tilt test is a useful procedure to identify the etiology of the appearance of syncope or presyncope after a pacemaker implantation in patients with complete and permanent AV block. PMID:11975909

  17. Recurrent syncope in a hypertensive subject with vascular cognitive impairment and permanent pacemaker.

    PubMed

    Mazza, Alberto; Ravenni, Roberta; Montemurro, Domenico; Pastore, Gianni; Schiavon, Laura; Rubello, Domenico

    2012-06-14

    Syncope following permanent pacemaker (PM) implantation is a nightmare for electrophysiologists. We describe a case of daily recurrent syncope in an 84-year-old man having a dual-chamber pacemaker implanted for complete atrio-ventricular block occurred 4 years before the admission to our department. He had a history of arterial hypertension, parossistic atrial fibrillation, chronic obstructive pulmonary disease, stage-III chronic renal failure, mild vascular cognitive impairment and glaucoma. The initial work-up including electrocardiogram (ECG), repeated PM interrogations, Holter electrocardiogram, blood pressure measurement in orthostatic position, complete blood count, serum glycaemia, electrolytes and thyroid function tests showed normal findings. Syncope occurred in lying position and during 90° left clockwise neck rotation and was associated to pallor, sweating, tonic-clonic seizures and transient self-limited loss of consciousness lasting a few seconds. Electroencephalogram was normal. During continuous ECG monitoring, the right rotation of the head determined a ventricular asystolic pause lasting 9 seconds associated with loss of consciousness. Restoration of sinus rhythm was observed after bringing back the head in axis. The PM interrogation, performed during pacing failure, recorded low impedance of bipolar ventricular lead, suggesting a damage in lead insulation. It is likely that lead movements during clockwise neck rotation produced an intermittent short circuit that prevented sufficient energy delivery to the myocardium with a consequence of sudden loss of capture. PMID:23139850

  18. Electrical Injury-Induced Complete Atrioventricular Block: Is Permanent Pacemaker Required?

    PubMed Central

    Beton, Osman; Efe, Tolga Han; Kaya, Hakki; Bilgin, Murat; Dinc Asarcikli, Lale; Yilmaz, Mehmet Birhan

    2015-01-01

    A considerable percentage of electrical injuries occur as a result of work activities. Electrical injury can lead to various cardiovascular disorders: acute myocardial necrosis, myocardial ischemia, heart failure, arrhythmias, hemorrhagic pericarditis, acute hypertension with peripheral vasospasm, and anomalous, nonspecific ECG alterations. Ventricular fibrillation is the most common arrhythmia resulting from electrical injury and is the leading cause of death in electrical (especially low voltage alternating current) injury cases. Asystole, premature ventricular contractions, ventricular tachycardia, conduction disorders (various degrees of heart blocks, bundle-brunch blocks), supraventricular tachycardia, and atrial fibrillation are the other arrhythmic complications of electrical injury. Complete atrioventricular block has rarely been reported and permanent pacemaker was required for the treatment in some of these cases. Herein, we present a case of reversible complete atrioventricular block due to low voltage electrical injury in a young electrical technician. PMID:26839721

  19. Predictors of severe tricuspid regurgitation in patients with permanent pacemaker or automatic implantable cardioverter-defibrillator leads.

    PubMed

    Najib, Mohammad Q; Vittala, Satya S; Challa, Suresh; Raizada, Amol; Tondato, Fernando J; Lee, Howard R; Chaliki, Hari P

    2013-01-01

    Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ±6 vs 81 ±8 yr; P = 0.83), sex (male, 42% vs 46%; P = 0.78), and left ventricular ejection fraction (0.60 ±0.06 vs 0.58 ± 0.05; P = 0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P < 0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P = 0.03) and duration of lead placement (odds ratio=1.5/yr; P = 0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs. PMID:24391312

  20. Predictors of Severe Tricuspid Regurgitation in Patients with Permanent Pacemaker or Automatic Implantable Cardioverter-Defibrillator Leads

    PubMed Central

    Najib, Mohammad Q.; Vittala, Satya S.; Challa, Suresh; Raizada, Amol; Tondato, Fernando J.; Lee, Howard R.; Chaliki, Hari P.

    2013-01-01

    Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ±6 vs 81 ±8 yr; P = 0.83), sex (male, 42% vs 46%; P = 0.78), and left ventricular ejection fraction (0.60 ±0.06 vs 0.58 ± 0.05; P = 0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P < 0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P = 0.03) and duration of lead placement (odds ratio=1.5/yr; P = 0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs. PMID:24391312

  1. 50th Anniversary of the first successful permanent pacemaker implantation in the United States: historical review and future directions.

    PubMed

    Beck, Hiroko; Boden, William E; Patibandla, Sushmitha; Kireyev, Dmitriy; Gutpa, Vipul; Campagna, Franklin; Cain, Michael E; Marine, Joseph E

    2010-09-15

    June 2010 marks the 50th anniversary of the first successful human cardiac pacemaker implantation in the United States. On June 6, 1960, in Buffalo, New York, Dr. William Chardack implanted a pacemaker, designed and built by Wilson Greatbatch, an electrical engineer and inventor, in a 77-year old man with complete atrioventricular block, extending the patient's life by 18 months. This landmark event ushered in a new era of implantable cardiac pacemakers with batteries and leads of high reliability and increasing durability. Over the past half century, the field of electrophysiology and implantable devices for the management of cardiac conduction disturbances has evolved dramatically. Today's pacemakers include increasingly complex features such as telemetry monitoring, auto programmability, and hemodynamic sensors. New-generation leads present a sophisticated design with improved geometry and steroid-eluting tips to reduce chronic inflammation, maintaining a low pacing threshold and high sensing capability. The lithium iodide battery remains the mainstay of implantable pacemaker systems, exhibiting a multiple-year lifespan, slow terminal decay, and a reduced size and cost of production. Although Greatbatch's first successful pacemaker implantation remains a seminal scientific contribution to modern cardiovascular disease management, emerging developments in this field may challenge its preeminence. Important challenges such as imaging compatibility, lead durability, and infection prevention are being addressed. Novel concepts such as leadless and biologic pacing are under active investigation. In conclusion, Greatbatch's historic achievement 50 years ago reminds us that technologic progress is timeless, as efforts to enhance clinical outcomes and the quality of life continue unimpeded into the 21st century. PMID:21391322

  2. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block

    PubMed Central

    Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

    2016-01-01

    Abstract A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing. A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality. A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan–Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups. The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction. PMID:27583889

  3. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator. (2... end connected to an implantable pacemaker pulse generator and the other end applied to the heart....

  4. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator. (2... end connected to an implantable pacemaker pulse generator and the other end applied to the heart....

  5. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator. (2... end connected to an implantable pacemaker pulse generator and the other end applied to the heart....

  6. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator. (2... end connected to an implantable pacemaker pulse generator and the other end applied to the heart....

  7. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator. (2... end connected to an implantable pacemaker pulse generator and the other end applied to the heart....

  8. Optimized post-operative surveillance of permanent pacemakers by home monitoring: the OEDIPE trial

    PubMed Central

    Halimi, Franck; Clémenty, Jacques; Attuel, Patrick; Dessenne, Xavier; Amara, Walid

    2008-01-01

    Aims The ŒDIPE trial examined the safety and efficacy of an abbreviated hospitalization after implantation or replacement of dual-chamber pacemakers (PM) using a telecardiology-based ambulatory surveillance programme. Methods and results Patients were randomly assigned to (i) an active group, discharged from the hospital 24 h after a first PM implant or 4–6 h after replacement, and followed for 4 weeks with Home-Monitoring (HM), or (ii) a control group followed for 4 weeks according to usual medical practices. The primary objective was to confirm that the proportion of patients who experienced one or more major adverse events (MAE) was not higher in the active than in the control group. The study included 379 patients. At least one treatment-related MAE was observed in 9.2% of patients (n = 17) assigned to the active group vs. 13.3% of patients (n = 26) in the control group (P = 0.21), a 4.1% absolute risk reduction (95% CI −2.2 to 10.4; P = 0.98). By study design, the mean hospitalization duration was 34% shorter in the active than in the control group (P < 0.001), and HM facilitated the early detection of technical issues and detectable clinical anomalies. Conclusion Early discharge with HM after PM implantation or replacement was safe and facilitated the monitoring of patients in the month following the procedure. PMID:18775878

  9. Septic Pulmonary Embolism Caused by Infected Pacemaker Leads After Replacement of a Cardiac Resynchronization Therapy Device

    PubMed Central

    Said, Salah A.M.; Nijhuis, Rogier; Derks, Anita; Droste, Herman

    2016-01-01

    Patient: Male, 70 Final Diagnosis: Pacemaker leads endocarditis Symptoms: Bacterial lead endocarditis • congestive heart failure • fever • pacemaker dysfunction Medication: — Clinical Procedure: Pacemaker box replacement due to end-of-service Specialty: Cardiology Objective: Unusual clinical course Background: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. Case Report: A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009. The patient responded well to CRT. At follow-up, the pacing system functioned normally. In September 2009, in the context of a predialysis program, an abdominal computed tomography (CT) scan was performed in another hospital for assessment and evaluation of chronic kidney disease. This procedure was complicated with peripheral thrombophlebitis that was managed appropriately with complete recovery. Eight months later (May 2010), the patient was admitted to our hospital with fever, anemia, and elevated infection parameters. During admission, blood cultures grew Staphylococcus epidermidis. The chest X-ray, lung perfusion scintigraphy, and CT scan depicted pulmonary embolism and infarction. The right ventricular lead threshold was found to be increased to 7 volts with unsuccessful capture. Echocardiography demonstrated vegetations on leads. The entire pacing system was explanted, but the patient expired few days later following percutaneous removal due to multiorgan failure. Conclusions: In heart failure

  10. Seven times replacement of permanent cardiac pacemaker in 33 years to maintain adequate heart rate: a case report.

    PubMed

    Hao, Yinglu; Li, Yanping; Liao, Derong; Yang, Ling

    2015-12-01

    Over the past few decades, recent developments in pacemaker technology from fixed-rate single-chamber pacemakers to dual chamber pacemakers with pacing algorithms have changed the therapeutic landscape resulting in better healthcare outcomes by improving rate response with minimal ventricular pacing. Here, we share our longest clinical experience with an elderly Chinese male patient who was diagnosed with third-degree atrioventricular (AV) block and was admitted in our hospital 33 years ago. An 85-year-old male patient from China was hospitalized due to dizziness and syncope, with an initial diagnosis revealing third-degree AV block with a heart rate of 35-40 beats per minute (bpm) along with Aase's syndrome and primary hypertension. A single-chamber pacemaker (VVI) was implanted immediately giving the patient symptomatic relief. However, 5-year post-surgery VVI was replaced due to battery exhaustion, while the primary electrode catheter was kept in use. Few years later, the patient again complained of dizziness and re-examination revealed VVI battery debilitation due to premature battery exhaustion. Single-chamber pacemaker was again implanted via the same position of right upper chest. However, after adjusting the frequency of stimulation of the pacemaker to 70 bpm, patient had a symptomatic relief. Considering the severity of patient's disease and knowing that cardiac dysfunction was reported previously, a tri-chamber pacemaker was chosen to take place of previous single-chamber pacemaker. For 33 years, the patient underwent 7 times replacement of pacemaker for battery exhaustion or inadequacy. We successfully performed overall seven pacemaker implantations and upgradation in an elderly Chinese patient diagnosed with third-degree AV block for 33 years. A long following up till now demonstrated no major complications with normal heart rate functioning. PMID:26734649

  11. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing.

    PubMed

    Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

    2016-08-01

    A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan-Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction. PMID:27583889

  12. Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

    PubMed Central

    Young Lee, Mark; Chilakamarri Yeshwant, Srinath; Chava, Sreedivya; Lawrence Lustgarten, Daniel

    2015-01-01

    Transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option in patients with symptomatic severe aortic stenosis at prohibitive or increased risk for conventional surgical replacement. Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of this review. Atrioventricular conduction disturbances and arrhythmias before, during or after TAVR remain a matter of concern for this high-risk group of patients, as they have important consequences on hospital duration, short- and long-term medical management and finally on decisions of device-based treatment strategies (pacemaker or defibrillator implantation). We discuss the mechanisms of atrioventricular disturbances and characterise predisposing factors. Using validated clinical predictors, we discuss strategies to minimise the likelihood of creating permanent high-grade heart block, and identify factors to expedite the decision to implant a permanent pacemaker when the latter is unavoidable. We also discuss optimal pacing strategies to mitigate the possibility of pacing-induced cardiomyopathy. PMID:26835105

  13. Laser extraction of a trapped infected port catheter in a child using existing experience from pacemaker and ICD lead removal.

    PubMed

    Bastian, Dirk; Fessele, Klaus; Bednarski, Piotr; Bodenschatz, Karl; Pauschinger, Matthias; Göhl, Konrad

    2011-01-01

    A 9-year-old girl presented with systemic infection related to a Port-a-Cath system (PAC); therefore, the urgent removal of the PAC was indicated. However, the catheter was trapped and not extractable by conventional means. Using existing comprehensive experience in the removal of pacemaker and implantable cardioverter defibrillator leads, the entrapped PAC was successfully extracted by laser technique, thus avoiding open heart surgery. PMID:20345621

  14. Radiotherapy in patients with cardiac pacemakers.

    PubMed

    Last, A

    1998-01-01

    Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. Modern pacemakers, using complementary metal oxide semiconductor (CMOS) circuitry, differ from older bipolar semiconductor devices both in their sensitivity to damage and the types of malfunction observed. The mechanisms and types of radiotherapy-induced pacemaker malfunction are described and in vitro and in vivo studies of pacemaker irradiation are reviewed. Some simple precautions are recommended during the planning and administration of radiotherapy to minimize the risk of harm to patients with pacemakers. PMID:9534692

  15. Septic Pulmonary Embolism Caused by Infected Pacemaker Leads After Replacement of a Cardiac Resynchronization Therapy Device.

    PubMed

    Said, Salah A M; Nijhuis, Rogier; Derks, Anita; Droste, Herman

    2016-01-01

    BACKGROUND Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. CASE REPORT A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009. The patient responded well to CRT. At follow-up, the pacing system functioned normally. In September 2009, in the context of a predialysis program, an abdominal computed tomography (CT) scan was performed in another hospital for assessment and evaluation of chronic kidney disease. This procedure was complicated with peripheral thrombophlebitis that was managed appropriately with complete recovery. Eight months later (May 2010), the patient was admitted to our hospital with fever, anemia, and elevated infection parameters. During admission, blood cultures grew Staphylococcus epidermidis. The chest X-ray, lung perfusion scintigraphy, and CT scan depicted pulmonary embolism and infarction. The right ventricular lead threshold was found to be increased to 7 volts with unsuccessful capture. Echocardiography demonstrated vegetations on leads. The entire pacing system was explanted, but the patient expired few days later following percutaneous removal due to multiorgan failure. CONCLUSIONS In heart failure, replacement of the CRT device may be complicated by bacterial endocarditis. As noted from this case report, sudden elevation of the pacing lead threshold should prompt thorough and immediate investigation to unravel its causes, not only the electrical characteristics but also the anatomical features. PMID:27435910

  16. Programmable Pacemaker

    NASA Technical Reports Server (NTRS)

    1980-01-01

    St. Jude Medical's Cardiac Rhythm Management Division, formerly known as Pacesetter Systems, Inc., incorporated Apollo technology into the development of the programmable pacemaker system. This consists of the implantable pacemaker together with a physician's console containing the programmer and a data printer. Physician can communicate with patient's pacemaker by means of wireless telemetry signals transmitted through the communicating head held over the patient's chest. Where earlier pacemakers deliver a fixed type of stimulus once implanted, Programalith enables surgery free "fine tuning" of device to best suit the patient's changing needs.

  17. Heart pacemaker

    MedlinePlus

    ... 1 ounce. Most pacemakers have 2 parts: The generator contains the battery and the information to control ... are wires that connect the heart to the generator and carry the electrical messages to the heart. ...

  18. Advanced Pacemaker

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Synchrony, developed by St. Jude Medical's Cardiac Rhythm Management Division (formerly known as Pacesetter Systems, Inc.) is an advanced state-of-the-art implantable pacemaker that closely matches the natural rhythm of the heart. The companion element of the Synchrony Pacemaker System is the Programmer Analyzer APS-II which allows a doctor to reprogram and fine tune the pacemaker to each user's special requirements without surgery. The two-way communications capability that allows the physician to instruct and query the pacemaker is accomplished by bidirectional telemetry. APS-II features 28 pacing functions and thousands of programming combinations to accommodate diverse lifestyles. Microprocessor unit also records and stores pertinent patient data up to a year.

  19. Heart pacemaker

    MedlinePlus

    ... may not get enough oxygen. Symptoms may be light-headedness, tiredness, fainting spells, and shortness of breath. Some pacemakers can be used to stop a heart rate that is too fast ( tachycardia ) ...

  20. Pacemaker and Defibrillator Lead Extraction

    MedlinePlus

    ... to cure the infection without completely removing all hardware from the body. This requires removal of the ... Footnotes References Figures & Tables Info & Metrics eLetters Article Tools Print Citation Tools Pacemaker and Defibrillator Lead Extraction ...

  1. Report of the NASPE Policy Conference training requirements for permanent pacemaker selection, implantation, and follow-up. North American Society of Pacing and Electrophysiology.

    PubMed

    Hayes, D L; Naccarelli, G V; Furman, S; Parsonnet, V

    1994-01-01

    NASPE proposes and supports the concept of a two-tracked training system in cardiac pacing. Track I training will properly train physicians for the prescription of pacemakers and the monitoring of pacemaker patients, and track II training will properly prepare physicians for the implantation of pacemakers. Regardless of specialty (cardiologist or surgeon) or training venue (cardiac pacing fellowship, cardiac electrophysiology and pacing fellowship, sabbatical or mentor sponsored training), it is recommended that these minimum standards be required for hospital credentialing. NASPE also supports the voluntary institution by training program directors of core pacing training in cardiovascular disease and cardiac electrophysiology fellowships. This core training does not in itself constitute proper track I or II training for physicians interested in adequately prescribing, monitoring, or implanting cardiac pacemakers. PMID:7511233

  2. Programmable Pacemaker

    NASA Technical Reports Server (NTRS)

    1996-01-01

    Released in 1995, the Trilogy cardiac pacemaker is the fourth generation of a unit developed in the 1970s by NASA, Johns Hopkins Applied Physics Laboratory and St. Jude Medical's Cardiac Rhythm Management Division (formerly known as Pacesetter Systems, Inc.). The new system incorporates the company's PDx diagnostic and programming software and a powerful microprocessor that allows more functions to be fully automatic and gives more detailed information on the patient's health and the performance of the pacing systems. The pacemaker incorporates bidirectional telemetry used for space communications for noninvasive communication with the implanted pacemaker, smaller implantable pulse generators from space microminiaturization, and longer-life batteries from technology for spacecraft electrical power systems.

  3. Clinical experience with nuclear pacemakers.

    PubMed

    Parsonnet, V; Myers, G H; Gilbert, L; Zucker, I R

    1975-12-01

    Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice. PMID:1188620

  4. Leadless Cardiac Pacemakers: Back to the Future.

    PubMed

    Miller, Marc A; Neuzil, Petr; Dukkipati, Srinivas R; Reddy, Vivek Y

    2015-09-01

    Despite significant advances in battery longevity, lead performance, and programming features since the first implanted permanent pacemaker was developed, the basic design of cardiac pacemakers has remained relatively unchanged over the past 50 years. Because of inherent limitations in their design, conventional (transvenous) pacemakers are prone to multiple potential short- and long-term complications. Accordingly, there has been intense interest in a system able to provide the symptomatic and potentially lifesaving therapies of cardiac pacemakers while mitigating many of the risks associated with their weakest link-the transvenous lead. Leadless cardiac pacing represents the future of cardiac pacing systems, similar to the transition that occurred from the use of epicardial pacing systems to the familiar transvenous systems of today. This review summarizes the current evidence and potential benefits of leadless pacing systems, which are either commercially available (in Europe) or under clinical investigation. PMID:26337997

  5. Heart pacemaker - discharge

    MedlinePlus

    ... on your chest below your collarbone. The pacemaker generator was then placed under the skin at this ... with your pacemaker. Stay away from large motors, generators, and equipment. Do not lean over the open ...

  6. Heart pacemaker - discharge

    MedlinePlus

    ... pacemaker is placed under your skin. These include: Battery powered cordless tools (such as screwdrivers and drills) ... will take about 15 to 30 minutes. The batteries in your pacemaker should last 6 to 15 ...

  7. Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence

    PubMed Central

    2015-01-01

    Background Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. Methods We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. Results A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6–72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Conclusions Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery. PMID:26470027

  8. [Pacemakers 16 years later].

    PubMed

    Dodinot, B

    1976-01-01

    In 1976, 10 years after the first successful implantations, the pacemaker technique is perfectly well accepted. Transvenous placement of the electrode is preferred in 95 % of the cases. Besides the 15 years nuclear power pacers (1970), conventional mercury pacemakers may reach a longevity of 4 to 5 years because of the reduction of the current drain. Lithium iodine seems a very promising source of energy. The mini-pacemakers with various iodine anodes are particularly attractive. The future is probably a well designed medium sized lithium pacemaker lasting more than 7 years. Patient follow-up is very much improved. All pacemakers exhibit an obvious rate reduction when their source of energy runs down. Therefore general practitioner and even the patients may detect this symptom. The main problem remains the lead resistance. The reduction of the frequency of pacemaker replacements and of the medical check-up makes life more simple for the pacemaker patient. PMID:1087802

  9. The effects of periradicular inflamation and infection on a primary tooth and permanent successor.

    PubMed

    Cordeiro, Mabel Mariela Rodriguez; Rocha, Maria Jose de Carvalho

    2005-01-01

    Primary teeth and the permanent successors must be understood as interdependent units, where each one of them interacts with and depends on each other. Pulpal inflammation/infection of a primary tooth and the spread of this condition over the periradicular tissues can lead to alterations in the dental germ of the permanent successor and to the surrounding structures if no therapy is done, i.e. endodontics or extraction. This work will present cases of permanent teeth that showed alteration in eruption and / or in development, as a consequence of inflammation / infection of the preceding primary teeth, such as: hypoplasia, morphological alteration on the dental crown or total arrest of. radicular formation. The teeth analysed in this study belong to patients who attended the Universidade Federal de Santa Catarina Children's Dentistry Clinic. The earlier these lesions are diagnosed, the less were the destructive effects and the consequences on the primary tooth/permanent germ unit. PMID:15926433

  10. How Does a Pacemaker Work?

    MedlinePlus

    ... the NHLBI on Twitter. How Does a Pacemaker Work? A pacemaker consists of a battery, a computerized ... these recordings to adjust your pacemaker so it works better for you. Your doctor can program the ...

  11. [Human health risks with regard to persistent infections and permanent excretors].

    PubMed

    Mayr, A

    1993-02-01

    Specifically pathogenous germs affect our environment in many different ways, e.g. through food, waste, sewage or living vectors like birds, arthropodes and other pests. Domestic animals and pets as well as human beings are the most dangerous carriers of infectious agents and permanent excretors. Persistent infections form the infectiological basis in this context. They establish the inexhaustible reservoir of the contamination of the environment with epidemic pathogens, thus endangering the health of human beings. By means of molecularbiological research on the functional bases of germ persistence we are able to classify 3 different forms of persistent infections: 1. latent infections. 2. tolerated infections. 3. occult infections. Persistent infections first, harm the infected, second, within generations their offspring through diaplacentar transmission, and third, contaminate the environment through permanent excretors. Most of the problems in infectiology arise through contamination of the environment by permanent excretors together with spread of germs by way of living and non-living vectors. The spread of specifically pathogenous germs through carriers is, however, possible without their being excreted. In these cases the sources of this spread of infection are the blood in the stage of viremia or bacteremia (biological transmission through living vectors), the reproductive organs (copulation, diaplacentar and germinal transmission) or the contaminated organs of slaughtered animals. The risks for the health of human beings due to carriers of infectious agents and permanent excretors has dramatically increased through international tourism, the problems caused by refugees, and the crowding of people in the metropoles. Medicine tries to meet this challenge by applying new methods of diagnosis and prophylaxis. PMID:8333905

  12. Factors associated with Paracoccidiodes brasiliensis infection among permanent residents of three endemic areas in Colombia.

    PubMed Central

    Cadavid, D.; Restrepo, A.

    1993-01-01

    The natural habitat of Paracoccidioides brasiliensis, the aetiologic agent of paracoccidioidomycosis, has not been determined. Consequently, the events leading to the acquisition of infection remain controversial. To identify factors associated with infection in endemic areas we conducted a survey in three rural communities in Colombia where we had previously diagnosed paracoccidioidomycosis in children. Permanent residents were surveyed taking into consideration environmental and occupational variables. Skin tests were used to classify subjects as infected or non-infected. Variables found associated with infection were: (i) community A: previous residence around Porce river and agriculture in vegetable gardens; (ii) community C: frequent use of specific water sources; (iii) community V: housekeeping activities, and (iv) total group: age > 25 years and contact with bats. Residents in communities with higher prevalence of infection were older, had more complex residence history, and referred more contact with armadillos than residents of communities with lower infection. PMID:8348926

  13. Electromagnetic Interference on Pacemakers

    PubMed Central

    Erdogan, Okan

    2002-01-01

    External sources, either within or outside the hospital environment, may interfere with the appropriate function of pacemakers which are being implanted all around the world in current medical practice. The patient and the physician who is responsible for follow-up of the pacing systems may be confronted with some specific problems regarding the various types of electromagnetic interference (EMI). To avoid these unwanted EMI effects one must be aware of this potential problem and need to take some precautions. The effects of EMI on pacemaker function and precautions to overcome some specific problems were discussed in this review article. There are many sources of EMI interacting with pacemakers. Magnetic resonance imaging creates real problem and should be avoided in pacemaker patients. Cellular phones might be responsible for EMI when they were held on the same side with the pacemaker. Otherwise they don't cause any specific type of interaction with pacemakers. Sale security systems are not a problem if one walks through it without lingering in or near it. Patients having unipolar pacemaker systems are prone to develop EMI because of pectoral muscle artifacts during vigorous active physical exercise. PMID:17006562

  14. Medical devices; revocation of cardiac pacemaker registry. Food and Drug Administration, HHS. Final rule.

    PubMed

    1999-11-24

    The Food and Drug Administration (FDA) is issuing a final rule to revoke a regulation requiring a cardiac pacemaker registry. The registry, which was mandated by the Deficit Reduction Act of 1984, requires any physician and any provider of services who requests or receives Medicare payment for an implantation, removal, or replacement of permanent cardiac pacemaker devices and pacemaker leads to submit certain information to the registry. The information is used by FDA to track the performance of permanent cardiac pacemakers and pacemaker leads and by the Health Care Finance Administration (HCFA) to administer its Medicare payment program for these devices. This action is being taken to implement an act to Repeal An Unnecessary Medical Device Reporting Requirement passed by Congress in 1996 to remove the cardiac pacemaker registry to eliminate duplicative and unnecessary reporting. PMID:11010690

  15. Combined Left Atrial Appendage Closure and Pacemaker Implant through a Single Right Femoral Vein Access.

    PubMed

    Regoli, François; Moccetti, Tiziano; Pasotti, Elena; Auricchio, Angelo; Moccetti, Marco

    2016-08-01

    Left atrial appendage (LAA) closure is indicated in patients with atrial fibrillation (AF) and high bleeding as well as thromboembolic risks. A subgroup of these patients may also present an indication for a single-chamber permanent pacemaker due to symptomatic low-rate AF or when "ablate and pace" strategy is indicated for rate control. A miniaturized wireless transcatheter pacing system (TPS) is now available as a single-chamber permanent pacemaker. This case presents how combined LAA closure and permanent pacemaker implant, by means of TPS, is feasible through a single femoral venous access. PMID:26970532

  16. Choosing pacemakers appropriately

    PubMed Central

    Panicker, G K; Desai, B; Lokhandwala, Y

    2009-01-01

    The range of implantable cardiac pacing devices has expanded, with the advances in available technology. Indications for cardiac pacing devices, that is pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy devices (CRTs), have expanded for the treatment, diagnosis and monitoring of bradycardia, tachycardia and heart failure. While the need for pacemakers is increasing, not all patients who require pacemakers are receiving them, especially in the Asia-Pacific region. There is a need to be more critical in advising the use of more expensive devices like ICDs and CRT/CRT-D devices, since most patients in the Asia-Pacific region pay out of pocket for these therapies. The AHA-ACC guidelines need not be blindly followed, since they are too wide-sweeping and are often based on the intention-to-treat basis of trials rather than on the parameters of the patients actually enrolled. PMID:27325922

  17. Combined use of non-thoracotomy cardioverter defibrillators and endocardial pacemakers.

    PubMed Central

    Noguera, H. H.; Peralta, A. O.; John, R. M.; Venditti, F. J.; Martin, D. T.

    1997-01-01

    OBJECTIVE: To study the potential interactions in patients with endocardial permanent pacemakers and non-thoracotomy implantable cardioverter defibrillator (ICD) systems. DESIGN: Case series and cohort study. SETTING: Tertiary referral centre. PATIENTS: Fifteen consecutive patients with both endocardial pacemakers (12 dual chamber and three single chamber) and non-thoracotomy ICD systems. MAIN OUTCOME MEASURES: Detection inhibition of induced ventricular fibrillation; double counting; and pacemaker function after shocks. In the evaluation of detection inhibition, 124 VF inductions were analysed for detection duration compared with induced VF episodes in controls with an ICD but without a pacemaker. RESULTS: Two patients (13%) showed detection inhibition of VF and required pacemaker system change at the time of the ICD implant. With the final lead position, despite frequent pacemaker undersensing of VF, ICD detection of VF was not inhibited during any induction, and neither initial detection nor redetection times for VF were different from controls. Double/triple counting of pacemaker artefact and evoked electrogram was noted in three patients (20%). In two, this was remedied during the implantation procedure, and in the other it was abolished when amiodarone treatment was discontinued. Pacemaker function was affected by ICD discharges in two patients, one who showed postshock atrial undersensing and loss of capture, and another whose pacemaker reverted to VVI mode. CONCLUSIONS: When careful testing is performed at implantation to detect and remedy device interactions, non-thoracotomy ICD treatment and endocardial pacemakers can be used safely in combination. Images PMID:9290402

  18. Pacemakers (Beyond the Basics)

    MedlinePlus

    ... is pulsed on and off at a rapid rate. For most patients with a pacemaker, this procedure is a relative contraindication. ● Transcutaneous electrical nerve/muscle stimulators (TENS), a method of pain control. ● Diathermy, which heats body tissues with high-frequency electromagnetic radiation or ...

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

    PubMed Central

    Suvarna, S K; Start, R D; Tayler, D I

    1999-01-01

    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. Images PMID:10655989

  20. [Hypersensitivity reactions to implantable cardiac pacemakers and defibrillators].

    PubMed

    Kreft, B

    2016-05-01

    Nowadays, for modern electrotherapy of cardiac arrhythmias different pacemaker systems are used. Antibradycardia pacing systems (e. g. single-chamber, two-chamber, three-chamber systems, frequency-adapted pacemaker) can be distinguished from antitachycardia pacing systems like implantable or portable cardioverter defibrillators and combined antibradycardia/antitachycardia systems. Cutaneous reactions overlying a pacemaker or defibrillator are often termed "pacemaker dermatitis". In terms of the differential diagnostic workup, these cutaneous reactions can have various causes. After exclusion of infection by analyzing clinical and laboratory-chemical results, "pressure dermatitis" or the often clinically asymptomatic "reticular telangiectatic erythema" (synonym "postimplantation erythema") must be considered. Histological examination of the affected skin can contribute to the diagnosis. In case of suspected contact hypersensitivity to implant material, allergological exploration should be realized. In addition to patch testing with commercially available contact allergens, product-related material metal alloy discs are often available from the pacemaker manufacturer for epicutaneous testing. Due to the lack of additional benefit compared to standardized patch testing, a clear recommendation for such metal alloy discs cannot be given. In selected cases of suspected hypersensitivity reaction, sensitization can eventually be analyzed by the lymphocyte transformation test. Positive reactions must always be critically interpreted taking into consideration the corresponding clinical signs. Depending on the cause, cutaneous reactions are occasionally self-limiting. In many cases, however, removal of the pacemaker is inevitable. PMID:26943358

  1. Trends in Cardiac Pacemaker Batteries

    PubMed Central

    Mallela, Venkateswara Sarma; Ilankumaran, V; Rao, N.Srinivasa

    2004-01-01

    Batteries used in Implantable cardiac pacemakers-present unique challenges to their developers and manufacturers in terms of high levels of safety and reliability. In addition, the batteries must have longevity to avoid frequent replacements. Technological advances in leads/electrodes have reduced energy requirements by two orders of magnitude. Micro-electronics advances sharply reduce internal current drain concurrently decreasing size and increasing functionality, reliability, and longevity. It is reported that about 600,000 pacemakers are implanted each year worldwide and the total number of people with various types of implanted pacemaker has already crossed 3 million. A cardiac pacemaker uses half of its battery power for cardiac stimulation and the other half for housekeeping tasks such as monitoring and data logging. The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. This paper briefly reviews various developments of battery technologies since the inception of cardiac pacemaker and presents the alternative to lithium iodine battery for the near future. PMID:16943934

  2. Defibrillator/monitor/pacemakers.

    PubMed

    2003-05-01

    Defibrillator/monitors allow operators to assess and monitor a patient's ECG and, when necessary, deliver a defibrillating shock to the heart. When integral noninvasive pacing is added, the device is called a defibrillator/monitor/pacemaker. In this Evaluation, we present our findings for two newly evaluated models, the Welch Allyn PIC 50 and the Zoll M Series CCT, and we summarize our findings for the previously evaluated models that are still on the market. We rate the models for the following applications: general crash-cart use, in-hospital transport use, and emergency medical service (EMS) use. PMID:12827940

  3. Magnetic Resonance Imaging in a Patient with a Dual Chamber Pacemaker

    PubMed Central

    Millar, Lynne Martina; Robinson, Andrew George; O'Flaherty, Maurice Thomas; Eames, Niall; Johnston, Nicola; Heyburn, Gary

    2010-01-01

    Having a pacemaker has been seen an absolute contraindication to having an MRI scan. This has become increasingly difficult in clinical practice as insertion of pacemakers and implantable cardiac defibrillators is at an all time high. Here we outline a case where a 71-year-old male patient with a permanent pacemaker needed to have an MRI scan to ascertain the aetiology of his condition and help guide further management. Given this clinical dilemma, an emergency clinical ethics consultation was arranged. As a result the patient underwent an MRI scan safely under controlled conditions with a consultant cardiologist and radiologist present. The results of the MRI scan were then able to tailor further treatment. This case highlights that in certain conditions an MRI can be performed in patients with permanent pacemakers and outlines the role of clinical ethics committees in complex medical decision making. PMID:21331383

  4. Reuse Of Pacemakers In Ghana And Nigeria: Medical, Legal, Cultural And Ethical Perspectives.

    PubMed

    Ochasi, Aloysius; Clark, Peter

    2015-12-01

    According to the World Health Organization (WHO) cardiovascular disease (CVD) is the leading cause of death globally. Over 80% of CVD deaths take place in low- and middle-income countries (LMICs). It is estimated that 1 million to 2 million people worldwide die each year due to lack of access to an implantable cardiac defibrillator (ICD) or a pacemaker. Despite the medical, legal, cultural and ethical controversies surrounding the pacemaker reutilization, studies done so far on the reuse of postmortem pacemakers show it to be safe and effective with an infection rate of 1.97% and device malfunction rate of 0.68%. Pacemaker reutilization can be effectively and safely done and does not pose significant additional risk to the recipient. Heart patients with reused pacemakers have an improved quality of life compared to those without pacemakers. The thesis of this paper is that pacemaker reutilization is a life-saving initiative in LMICs of Nigeria and Ghana. It is cost effective; consistent with the principles of beneficence, nonmaleficence, and justice with a commitment to stewardship of resources and the Common Good. Used pacemakers with adequate battery life can be properly sterilized for use by patients in LMICs who cannot afford the cost of a new pacemaker. PMID:24720369

  5. Functiogenesis of cardiac pacemaker activity.

    PubMed

    Sakai, Tetsuro; Kamino, Kohtaro

    2016-07-01

    Throughout our investigations on the ontogenesis of the electrophysiological events in early embryonic chick hearts, using optical techniques to record membrane potential probed with voltage-sensitive dyes, we have introduced a novel concept of "functiogenesis" corresponding to "morphogenesis". This article gives an account of the framework of "functiogenesis", focusing on the cardiac pacemaker function and the functional organization of the pacemaking area. PMID:26719289

  6. Connectivity of Pacemaker Neurons in the Neonatal Rat Superficial Dorsal Horn

    PubMed Central

    Ford, Neil C.; Arbabi, Shahriar; Baccei, Mark L.

    2014-01-01

    Pacemaker neurons with an intrinsic ability to generate rhythmic burst-firing have been characterized in lamina I of the neonatal spinal cord, where they are innervated by high-threshold sensory afferents. However, little is known about the output of these pacemakers, as the neuronal populations which are targeted by pacemaker axons have yet to be identified. The present study combines patch clamp recordings in the intact neonatal rat spinal cord with tract-tracing to demonstrate that lamina I pacemaker neurons contact multiple spinal motor pathways during early life. Retrograde labeling of premotor interneurons with the trans-synaptic virus PRV-152 revealed the presence of burst-firing in PRV-infected lamina I neurons, thereby confirming that pacemakers are synaptically coupled to motor networks in the spinal ventral horn. Notably, two classes of pacemakers could be distinguished in lamina I based on cell size and the pattern of their axonal projections. While small pacemaker neurons possessed ramified axons which contacted ipsilateral motor circuits, large pacemaker neurons had unbranched axons which crossed the midline and ascended rostrally in the contralateral white matter. Recordings from identified spino-parabrachial and spino-PAG neurons indicated the presence of pacemaker activity within neonatal lamina I projection neurons. Overall, these results show that lamina I pacemakers are positioned to regulate both the level of activity in developing motor circuits as well as the ascending flow of nociceptive information to the brain, thus highlighting a potential role for pacemaker activity in the maturation of pain and sensorimotor networks in the CNS. PMID:25380417

  7. Pacemaker Created in Human Ventricle by Depressing Inward-Rectifier K+ Current: A Simulation Study

    PubMed Central

    Zhang, Yue; Li, Qince; Zhang, Henggui

    2016-01-01

    Cardiac conduction disorders are common diseases which cause slow heart rate and syncope. The best way to treat these diseases by now is to implant electronic pacemakers, which, yet, have many disadvantages, such as the limited battery life and infection. Biopacemaker has been expected to replace the electronic devices. Automatic ventricular myocytes (VMs) could show pacemaker activity, which was induced by depressing inward-rectifier K+ current (IK1). In this study, a 2D model of human biopacemaker was created from the ventricular endocardial myocytes. We examined the stability of the created biopacemaker and investigated its driving capability by finding the suitable size and spatial distribution of the pacemaker for robust pacing and driving the surrounding quiescent cardiomyocytes. Our results suggest that the rhythm of the pacemaker is similar to that of the single cell at final stable state. The driving force of the biopacemaker is closely related to the pattern of spatial distribution of the pacemaker. PMID:26998484

  8. First Wire-Free Pacemaker Approved

    MedlinePlus

    ... Wire-Free Pacemaker Approved Treats irregular heartbeat without wired leads To use the sharing features on this ... said in a news release. In traditional pacemakers, wired leads may malfunction and require the device to ...

  9. FDA Approves First Wire-Free Pacemaker

    MedlinePlus

    ... Radiological Health. He said in an agency news release: "As the first leadless pacemaker, Micra offers a new option for patients considering a single chamber pacemaker device, which may help prevent problems associated with the ...

  10. Devices That May Interfere with Pacemakers

    MedlinePlus

    ... and the devices that may interfere with pulse generators. Carry your pacemaker ID card to prove that ... 3 watts) don't appear to damage pulse generators or affect how the pacemaker works. Technology is ...

  11. Outbreak of Mycobacterium haemophilum infections after permanent makeup of the eyebrows.

    PubMed

    Giulieri, Stefano; Morisod, Benoit; Edney, Timothy; Odman, Micaela; Genné, Daniel; Malinverni, Raffaele; Hammann, Catherine; Musumeci, Enrico; Voide, Cathy; Greub, Gilbert; Masserey, Eric; Bille, Jacques; Cavassini, Matthias; Jaton, Katia

    2011-02-15

    We report a Mycobacterium haemophilum outbreak after permanent make-up of the eyebrows performed by the same freelance artist. Twelve patients presented an eyebrow lesion and cervical lymphadenitis. All were treated with antibiotics. Surgery was required in 10 cases. M. haemophilum DNA was identified in the make-up ink. PMID:21258102

  12. Intraperitoneal Migration of Epicardial Pacemakers

    PubMed Central

    García-Bengochea, José; Caínzos, Miguel; Fernández, Angel L.; Santos, Fernando; Gonzalez, Francisco

    2007-01-01

    Intraperitoneal migration of epicardial leads and abdominally placed generators is a potentially serious complication. We report the case of an 83-year-old man who experienced intraperitoneal migration of an epicardial pacing system and consequent small-bowel obstruction. Laparotomy was required in order to free constrictive lead adhesions. The patient's postoperative recovery was satisfactory after the placement of a new pacemaker generator in the abdominal wall. Predisposing factors are analyzed and the literature is reviewed in order to clarify the mechanisms of sequelae associated with the migration of epicardial pacemakers from the abdominal wall. To the best of our knowledge, this is the 1st report of pacemaker migration having caused bowel obstruction that required urgent laparotomy in an adult. PMID:17948093

  13. [Radiation therapy and cardiac pacemakers].

    PubMed

    Serafim, P; Fonseca, G; Oliveira, A; Fernandes, T

    1999-05-01

    The number of patients with cardiac pacemakers submitted annually to radiation therapy is increasing. Radiation therapy causes interference in the normal functioning processes, directly by chemical changes in the structure of the device and also by electromagnetic disturbances generated in the process of treatment. The changes in the technology used in the manufacture of cardiac pacemakers after the 70's, with the introduction of complementary metal-oxide semi-conductors (CMOS) in the circuits, drastically increased the chance of dangerous interference in the normal function of cardiac pacemakers occurring when in contact with an ionizing radiation source. The authors briefly describe the mechanisms underlying the radio-induced damage usually observed. A review of the literature on this issue is made and solutions are pointed out to perform safe radiation therapy and minimize the risk of device malfunction. PMID:10418264

  14. 21 CFR 870.3700 - Pacemaker programmers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to noninvasively change one or more...

  15. 21 CFR 870.3700 - Pacemaker programmers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to noninvasively change one or more...

  16. 21 CFR 870.3700 - Pacemaker programmers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to change noninvasively one or more...

  17. 21 CFR 870.3700 - Pacemaker programmers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to change noninvasively one or more...

  18. 21 CFR 870.3700 - Pacemaker programmers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to change noninvasively one or more...

  19. 21 CFR 870.3670 - Pacemaker charger.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker charger. 870.3670 Section 870.3670 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3670 Pacemaker charger. (a) Identification. A pacemaker charger is a...

  20. 21 CFR 870.3670 - Pacemaker charger.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker charger. 870.3670 Section 870.3670 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3670 Pacemaker charger. (a) Identification. A pacemaker charger is a...

  1. Secure pacemaker fixation critical for prevention of Twiddler's syndrome.

    PubMed

    Zimmerman, Sarah A; Bright, Janice M

    2004-05-01

    A two year old, female spayed border collie presented three weeks after permanent pacemaker implantation for weakness, lethargy and collapse. Electrocardiogram documented complete (3(rd) 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. PMID:19083303

  2. Overdrive suppression of implanted pacemakers in patients with AV block.

    PubMed Central

    Grendahl, H; Miller, M; Kjekshus, J

    1978-01-01

    Patients being permanently paced for symptomatic AV block were studied by overdrive suppression of the QRS-inhibited pacemaker, in order to observe the underlying heart rhythm. The chest wall stimulation method was used. In complete AV block the escape rhythm recovery time proved highly reproducible on repeated testing on the same day, and in many patients remained so over months or years. Occasionally, a doubling of the escape rhythm recovery time was seen, suggesting initial exit block of the escape focus. Resetting of the escape rhythm usually followed an exponential curve until stabilisation after about 3 minutes. An early escape rhythm with a recovery time of less than 4 seconds was found on every occasion in 21 of 58 patients with complete AV block, and inconstantly in 23 more; in 14 it was never observed. Accidental pacing failure was seen in 15 patients. The overdrive suppression test was helpful in selecting pacemaker dependent patients. PMID:637960

  3. Optimal resources for implantable cardiac pacemakers. Pacemaker Study Group.

    PubMed

    Parsonnet, V; Furman, S; Smyth, N P; Bilitch, M

    1983-07-01

    In this document, the 1974 Inter-Society Commission for Heart Disease Resources (ICHD) report, Implantable Cardiac Pacemakers, has been revised and updated to emphasize the increased complexity of present-day pacing, to propose realistic guidelines for various aspects of pacing practivce, and to identify the resources needed for delivery of this important mode of health care. The first section of the report describes the several types of pacemakers currently available, how they function, and how and to what purpose they may be modified through noninvasive programming. Recommendations are given for a modified and updated version of the widely accepted ICHD code for identification of pacing modes. The emphasis of the second section of the report is on physical and personnel resources. Matters considered in some depth include the training and qualification of the various medical, technical, and paramedical specialists involved in an implantation procedure; requirements for, and methods of achieving, short and long-term surveillance of pacemaker patients; and the role of the hospital, the manufacturers, and the FDA in this new era of complex dual-chamber, multiprogrammable pacemakers. PMID:6681266

  4. A premature low-birth-weight infant with congenital complete atrioventricular block and myocarditis successfully treated by staged pacemaker implantation.

    PubMed

    Fujioka, Tao; Nii, Masaki; Tanaka, Yasuhiko

    2016-06-01

    Congenital complete atrioventricular block is a known lethal condition. Although antenatal diagnosis and the technical advances of pacemaker treatment have reduced its mortality, treatment of premature babies with significant myocardial damage remains a challenge. In this paper, we report the case of a premature low-birth-weight infant with congenital complete atrioventricular block and extremely low ventricular rate, fetal hydrops, and myocarditis who was successfully treated with staged permanent pacemaker implantation. PMID:27071550

  5. [Wide QRS tachycardia preceded by pacemaker spikes].

    PubMed

    Romero, M; Aranda, A; Gómez, F J; Jurado, A

    2014-04-01

    The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Although these conditions are diagnosed and treated in hospitals with catheterization laboratories using the application programmer over the pacemaker, patients presenting in primary care clinic and emergency forced us to make a diagnosis and treat the haemodynamically unstable patient prior to referral. PMID:23768570

  6. Electrical interference in non-competitive pacemakers.

    PubMed

    Sowton, E; Gray, K; Preston, T

    1970-09-01

    Patients with 41 implanted non-competitive pacemakers were investigated. A variety of domestic electrical equipment, a motor-car, and a physiotherapy diathermy apparatus were each operated in turn at various ranges from the patient. Interference effects on pacemaker function were assessed on the electrocardiograph. Medtronic demand 5841 pacemakers were stopped by diathermy while Cordis Ectocor pacemakers developed a fast discharge rate. Cordis triggered pacemakers (both Atricor and Ectocor) were sensitive to interference from many items of domestic equipment and the motor car. The Elema EM153 ran at an increased rate when an electric razor was running close to the pacemaker. The Devices demand 2980 and the Medtronic demand 5841 were not affected by the domestic equipment tested. The significance of interference effects is discussed in relation to pacemaker design. PMID:5470044

  7. Refractory chronic spontaneous urticaria and permanent atrial fibrillation associated with dental infection: Mere coincidence or something more to it?

    PubMed

    Kasperska-Zajac, Alicja; Grzanka, Alicja; Kowalczyk, Jacek; Wyszyńska-Chłap, Magdalena; Lisowska, Grażyna; Kasperski, Jacek; Jarząb, Jerzy; Misiołek, Maciej; Kalarus, Zbigniew

    2016-03-01

    Controversy surrounds the role of dental infection/inflammation in the oral cavity in chronic spontaneous urticaria (CSU) and atrial fibrillation (AF), which is mainly due to scarce literature in this area. Therefore, this case report and review of literature illustrate a possible association between the acute-phase response (APR) and clinical conditions, such as CSU and dental infection/inflammation of oral cavity and AF.We describe a 36-year-old man with an 8-year history of difficult-to-treat, uncontrolled CSU, co-existent with dental infection/inflammatory processes of oral cavity and permanent atrial fibrillation (AF). In the presented case, the most likely triggering or aggravating/maintaining factor of the symptoms was the inflammation/dental infection of the oral cavity because of rapid reduction of the urticarial symptoms, drug doses, and serum CRP levels after the dental therapy. Dental treatment may have a beneficial effect on the systemic inflammatory response, reducing/normalizing the circulating levels of APR markers. APR activation appears to worsen CSU course, early identification and treatment of infectious/inflammatory foci in the oral cavity would form the mainstay of supportive therapy for CU probably through reduction of the systemic inflammatory burden. APR associated with infectious/inflammatory foci in the oral cavity could be taken into account as a predisposing agents to AF. PMID:26634403

  8. An unusual case of vancomycin-related systemic reaction accompanied with severe thrombocytopenia mimicking pacemaker-related infective endocarditis: a case report and review of literature.

    PubMed

    Candemir, Basar; Aribuca, Aynur; Koca, Cigdem; Ozcan, Ozgur Ulas; Gerede, Menekse; Kaya, Cansin T

    2013-11-01

    Vancomycin is a glycopeptide antibiotic used in the prophylaxis and treatment of infections caused by Gram-positive resistant bacteria. In recent years, several cases of vancomycin-associated immune thrombocytopenia have been presented as case reports, but the real incidence of this side effect is still unknown. In this report, we would like to present a case during which we confronted with a great dilemma: urgent removal of whole defibrillator system due to highly suspected infective endocarditis or leaving the defibrillator in place and simply switching vancomycin to another antibiotic agent and wait. PMID:23080329

  9. Testosterone-induced permanent changes of hepatic gene expression in female mice sustained during Plasmodium chabaudi malaria infection.

    PubMed

    Delić, Denis; Gailus, Nicole; Vohr, Hans-Werner; Dkhil, Mohamed; Al-Quraishy, Saleh; Wunderlich, Frank

    2010-12-01

    Testosterone has been previously shown to induce persistent susceptibility to Plasmodium chabaudi malaria in otherwise resistant female C57BL/6 mice. Here, we investigate as to whether this conversion coincides with permanent changes of hepatic gene expression profiles. Female mice aged 10-12 weeks were treated with testosterone for 3 weeks; then, testosterone treatment was discontinued for 12 weeks before challenging with 10⁶ P. chabaudi-infected erythrocytes. Hepatic gene expression was examined after 12 weeks of testosterone withdrawal and after subsequent infection with P. chabaudi at peak parasitemia, using Affymetrix microarrays with 22 ,690 probe sets representing 14, 000 genes. The expression of 54 genes was found to be permanently changed by testosterone, which remained changed during malaria infection. Most genes were involved in liver metabolism: the female-prevalent genes Cyp2b9, Cyp2b13, Cyp3a41, Cyp3a44, Fmo3, Sult2a2, Sult3a1, and BC014805 were repressed, while the male-prevalent genes Cyp2d9, Cyp7b1, Cyp4a10, Ugt2b1, Ugt2b38, Hsd3b5, and Slco1a1 were upregulated. Genes encoding different nuclear receptors were not persistently changed. Moreover, testosterone induced persistent upregulation of genes involved in hepatocellular carcinoma such as Lama3 and Nox4, whereas genes involved in immune response such as Ifnγ and Igk-C were significantly decreased. Our data provide evidence that testosterone is able to induce specific and robust long-term changes of gene expression profiles in the female mouse liver. In particular, those changes, which presumably indicate masculinized liver metabolism and impaired immune response, may be critical for the testosterone-induced persistent susceptibility of mice to P. chabaudi malaria. PMID:20844152

  10. A short history on pacemakers.

    PubMed

    Ward, Catherine; Henderson, Susannah; Metcalfe, Neil H

    2013-11-15

    Artificial pacemakers have taken part or possibly driven many developments in cardiac science and medicine and are therefore a very important story to remember. This 300-year journey of discovery has been contributed to by experts from across the Globe. The essential foundation of knowledge such as basic electrophysiology and applied electrotherapy was built in the 18th century and is now academically and socially accepted. This line of inventions and research has seen: early use of meta-analyses, the initial coming together of medical or bioengineering and the concept of cardiac monitoring--now a mainstay in the hospital care of a patient. In the 21st century pacemaker developments are no longer solely about reducing mortality but improving morbidity. Design developments reduce: discomfort, additional surgeries and invasive procedures. New energy sources have become lighter, smaller and with a longer life span. PMID:24083883

  11. Pacemakers and implantable cardioverter defibrillators.

    PubMed

    Allen, M

    2006-09-01

    An increasing number of patients are now treated cardiac pacemakers and implantable cardioverter defibrillators and the technology of these is constantly changing. It is vital to have a good understanding of how they function and what the real risks are. Understanding how the device should work when functioning normally, and the possible effects of electromagnetic interference, is paramount to their safe management in the peri-operative period. Knowing when a device should be disabled or reprogrammed requires careful consideration. Information from the patient's pacemaker clinic should be sought whenever possible and can be invaluable. In addition, the Medicines Healthcare products Regulatory Agency have published the first set of UK guidelines on the management of implantable devices in the presence of surgical diathermy and this will undoubtedly provide a firm foundation on which anaesthetists can base much of their practice. PMID:16922756

  12. Syncope in Patients with Pacemakers

    PubMed Central

    Sutton, Richard

    2015-01-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5–55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative tests approach results in pacing for AV block and those with a positive tilt test show no better results than with no pacemaker. The implication of tilt results is that a hypotensive tendency is clearly demonstrated by tilt positivity pointing to syncope recurrence with hypotension. This problem may be addressed by treatment with vasoconstrictor drugs in those who are suited or, more commonly, a reduction or cessation of hypotensive therapy in hypertensive patients. Other causes of syncope such as tachyarrhythmias are rare. The clinical approach to patients who report syncope is detailed. PMID:26835124

  13. Space Derived Health Aids (Cardiac Pacemaker)

    NASA Technical Reports Server (NTRS)

    1981-01-01

    St. Jude Medical's Cardiac Rhythm Management Division's (formerly known as Pacesetter Systems, Inc.) pacer is a rechargeable cardiac pacemaker that eliminates the recurring need for surgery to implant a new battery. The Programalith is an advanced cardiac pacing system which permits a physician to reprogram a patient's implanted pacemaker without surgery. System consists of a pacemaker, together with a physician's console containing the programmer and a data printer. Signals are transmitted by wireless telemetry. Two-way communications, originating from spacecraft electrical power systems technology, allows physician to interrogate the pacemaker as to the status of the heart, then to fine tune the device to best suit the patient's needs.

  14. Lithium iodide cardiac pacemakers: initial clinical experience.

    PubMed Central

    Burr, L. H.

    1976-01-01

    A new long-life cardiac pacemaker pulse generator powered by a lithium iodide fuel cell was introduced in Canada in 1973. The compact, hermetically sealed unit is easily implanted and reliable, has excellent patient acceptance and has an anticipated battery life of almost 14 years. Among 105 patients who received a lithium iodide pacemaker, complications occurred in 18. The lithium iodide pacemaker represents a significant advance in pacemaker generator technology and is recommended for long-term cardiac pacing; the manufacturer guarantees the pulse generator for 6 years. Images FIG. 1 PMID:974965

  15. Pacemaker lead-associated thrombosis in cardiac resynchronisation therapy.

    PubMed

    Buttigieg, Jesmar; Asciak, Rachelle; Azzopardi, Charles Mallia

    2015-01-01

    Pacemaker lead-associated thrombosis is a possible complication of any cardiac implantable electronic device. We present a case of a middle-aged woman with a history of ischaemic left ventricular failure, who presented with fever and other non-specific symptoms 4 months after cardiac resynchronisation therapy. A transoesophageal echocardiogram confirmed a vegetation-like structure originating from the pacemaker lead in the right atrium. The patient was treated with intravenous antibiotics followed by open heart surgery in order to remove this mass as well as the pacing device, including all three pacing leads. Histology and culture of the retrieved mass confirmed a sterile thrombus with no features to suggest an infected mass (vegetation). The patient made an uncomplicated recovery and there were no long-term sequelae on follow-up during the 2 years after the event. PMID:26153289

  16. Pacemaker interactions induce reentrant wave dynamics in engineered cardiac culture

    NASA Astrophysics Data System (ADS)

    Borek, Bartłomiej; Shajahan, T. K.; Gabriels, James; Hodge, Alex; Glass, Leon; Shrier, Alvin

    2012-09-01

    Pacemaker interactions can lead to complex wave dynamics seen in certain types of cardiac arrhythmias. We use experimental and mathematical models of pacemakers in heterogeneous excitable media to investigate how pacemaker interactions can be a mechanism for wave break and reentrant wave dynamics. Embryonic chick ventricular cells are cultured invitro so as to create a dominant central pacemaker site that entrains other pacemakers in the medium. Exposure of those cultures to a potassium channel blocker, E-4031, leads to emergence of peripheral pacemakers that compete with each other and with the central pacemaker. Waves emitted by faster pacemakers break up over the slower pacemaker to form reentrant waves. Similar dynamics are observed in a modified FitzHugh-Nagumo model of heterogeneous excitable media with two distinct sites of pacemaking. These findings elucidate a mechanism of pacemaker-induced reentry in excitable media.

  17. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    SciTech Connect

    Kirova, Youlia M.; Menard, Jean; Chargari, Cyrus; Mazal, Alejandro; Kirov, Krassen

    2012-07-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  18. 21 CFR 870.3670 - Pacemaker charger.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker charger. 870.3670 Section 870.3670 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3670 Pacemaker charger....

  19. 21 CFR 870.3670 - Pacemaker charger.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker charger. 870.3670 Section 870.3670 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3670 Pacemaker charger....

  20. The Nonlinear Dynamics of Pacemaker Dependency

    NASA Astrophysics Data System (ADS)

    Buechley, Leah

    2003-08-01

    A person is considered pacemaker dependent when most of his or her heartbeats are supplied by a pacemaker. The purpose of this study was to determine whether there are significant differences between the heart dynamics of pacemaker-dependent patients and those of normal patients. Nonlinear dynamics techniques and statistical methods were used to analyze the ECGs of normal patients and pacemaker-dependent patients. Standard embedding of the ECG data yielded inconclusive results, but embedding the beat intervals proved to be much more useful. Lyapunov exponent calculations, recurrence plot analyses, and standard statistical analyses of these data showed significant differences in heart behavior between the two groups of patients. In particular, the beat intervals appear to exhibit chaotic behavior for the normal patients and fixed-point dynamics for pacemaker-dependent patients.

  1. Creating a cardiac pacemaker by gene therapy.

    PubMed

    Anghel, Traian M; Pogwizd, Steven M

    2007-02-01

    While electronic cardiac pacing in its various modalities represents standard of care for treatment of symptomatic bradyarrhythmias and heart failure, it has limitations ranging from absent or rudimentary autonomic modulation to severe complications. This has prompted experimental studies to design and validate a biological pacemaker that could supplement or replace electronic pacemakers. Advances in cardiac gene therapy have resulted in a number of strategies focused on beta-adrenergic receptors as well as specific ion currents that contribute to pacemaker function. This article reviews basic pacemaker physiology, as well as studies in which gene transfer approaches to develop a biological pacemaker have been designed and validated in vivo. Additional requirements and refinements necessary for successful biopacemaker function by gene transfer are discussed. PMID:17139515

  2. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that...

  3. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Implantable pacemaker pulse generator. 870.3610... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that has... implantable pacemaker pulse generator device that was in commercial distribution before May 28, 1976, or...

  4. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Implantable pacemaker pulse generator. 870.3610... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that has... implantable pacemaker pulse generator device that was in commercial distribution before May 28, 1976, or...

  5. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that...

  6. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that...

  7. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that...

  8. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that...

  9. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an adhesive, a sealant, a screw, a crimp, or any other material used to repair a pacemaker lead or to reconnect a pacemaker lead to a pacemaker pulse generator. (b) Classification. Class III (premarket...

  10. [Permanent cardiac pacing in women--light and shadow].

    PubMed

    Małecka, Barbara; Wysokińsk, Andrzej

    2015-01-01

    Permanent cardiac pacing has survived a sharp increase in quality improvement and frequency of usage. Nowadays particular aspects of this method of treatment are being considered. In this paper distinctiveness of women population treated by permanent pacing is discussed. Indications for heart pacing in women appear at a later age than in men. Moreover, women remain longer in follow-up, therefore their prognosis is better. The most serious late pacing complications, i.e., infections are less frequent in women. However, implantations procedures seem to be more difficult in female gender, most probably due to a smaller body size, especially of afferent veins. This leads to a higher periprocedural complication rate and refers especially to endocardial lead implantation, which in women is connected with double risk of pneumothorax. Late complications of permanent pacing are effectively treated by transvenous lead extraction. Female gender has been demonstrated as an independent risk factor of extraction failure. It seems that reasonable qualification for pacemaker implantations and leaving the procedures in the hands of experienced operators will strengthen the "light side" and limit the "dark side" of this therapy in women. PMID:26455022

  11. Delayed right-ventricular perforation by pacemaker lead; a rare complication in a 12-year-old girl.

    PubMed

    Aykan, Hayrettin Hakan; Akın, Alper; Ertuğrul, İlker; Karagöz, Tevfik

    2015-03-01

    Developments in the diagnosis and treatment of congenital heart diseases have led to an increase in the need for intracardiac pacemaker and implantable cardioverter defibrillator (ICD) implantation. Various complications related to these interventions can be seen in the short term (pneumothorax, pericardial effusion, cardiac perforation, etc…) and in the long term (infection, subclavian vein thrombosis, sensing and pacing problems, battery erosion and cardiac perforation). In this report, we present a rare case of cardiac perforation occurring 2 years after pacemaker implantation. PMID:25782125

  12. Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains

    PubMed Central

    Topjian, Alexis A; Stuart, Amber; Pabalan, Alyssa A.; Clair, Ashleigh; Kilbaugh, Todd J.; Abend, Nicholas S.; Berg, Robert A.; Heuer, Gregory G.; Storm, Phillip B.; Huh, Jimmy W.; Friess, Stuart H.

    2014-01-01

    Introduction Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion. Methods Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009 Results Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt (EXSHUNT) in 196 patients (52%), brain tumor in 122 patients (32%), intracranial hemorrhage (ICH) in 23 patients (6%), traumatic brain injury (TBI) in 17 patients (5%), meningitis in 9 patients (2%) or other in 13 patients (3%). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 vs. 11.5 days (p=0.0001), and higher maximum EVD outputs 1.9 vs. 1.5 mL/kg/hr (p=0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/hr p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72% vs. 82% of patients, p = 0.4). Conclusion In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age. PMID:24522759

  13. How Will a Pacemaker Affect My Lifestyle?

    MedlinePlus

    ... High-tension wires Metal detectors Industrial welders Electrical generators These devices can disrupt the electrical signaling of ... 2 feet away from industrial welders and electrical generators. Some medical procedures can disrupt your pacemaker. These ...

  14. Mathematical Models of Cardiac Pacemaking Function

    NASA Astrophysics Data System (ADS)

    Li, Pan; Lines, Glenn T.; Maleckar, Mary M.; Tveito, Aslak

    2013-10-01

    Over the past half century, there has been intense and fruitful interaction between experimental and computational investigations of cardiac function. This interaction has, for example, led to deep understanding of cardiac excitation-contraction coupling; how it works, as well as how it fails. However, many lines of inquiry remain unresolved, among them the initiation of each heartbeat. The sinoatrial node, a cluster of specialized pacemaking cells in the right atrium of the heart, spontaneously generates an electro-chemical wave that spreads through the atria and through the cardiac conduction system to the ventricles, initiating the contraction of cardiac muscle essential for pumping blood to the body. Despite the fundamental importance of this primary pacemaker, this process is still not fully understood, and ionic mechanisms underlying cardiac pacemaking function are currently under heated debate. Several mathematical models of sinoatrial node cell membrane electrophysiology have been constructed as based on different experimental data sets and hypotheses. As could be expected, these differing models offer diverse predictions about cardiac pacemaking activities. This paper aims to present the current state of debate over the origins of the pacemaking function of the sinoatrial node. Here, we will specifically review the state-of-the-art of cardiac pacemaker modeling, with a special emphasis on current discrepancies, limitations, and future challenges.

  15. The challenge of staphylococcal pacemaker endocarditis in a patient with transposition of the great arteries endocarditis in congenital heart disease

    SciTech Connect

    Ch'ng, Julie; Chan, William; Lee, Paul; Joshi, Subodh; Grigg, Leanne E.; Ajani, Andrew E

    2003-06-01

    Staphylococcus aureus is a leading cause of septicaemia and infective endocarditis. The overall incidence of staphylococcal bacteraemia is increasing, contributing to 16% of all hospital-acquired bacteraemias. The use of cardiac pacemakers has revolutionized the management of rhythm disturbances, yet this has also resulted in a group of patients at risk of pacemaker lead endocarditis and seeding in the range of 1% to 7%. We describe a 26-year-old man with transposition of the great arteries who had a pacemaker implanted and presented with S. aureus septicaemia 2 years postpacemaker implantation and went on to develop pacemaker lead endocarditis. This report illustrates the risk of endocarditis in the population with congenital heart disease and an intracardiac device.

  16. Emergent pacemaker placement in a patient with Lyme carditis-induced complete heart block and ventricular asystole.

    PubMed

    Brownstein, Adam J; Gautam, Samir; Bhatt, Paras; Nanna, Michael

    2016-01-01

    We report a case of a 31-year-old man who presented to the emergency department after four episodes of syncope within a 24 h time span. He was found to have symptomatic complete heart block associated with episodes of ventricular asystole lasting 5-6 s. He underwent emergent permanent pacemaker insertion during which he was found to have no underlying rhythm. He was later found to have positive serologies for Lyme disease despite no known exposure to ticks and neither signs nor symptoms of the disease. The pacemaker was ultimately removed due to resolution of his heart block with antibiotic therapy. PMID:27207985

  17. [Experiences with telemetry-supported pacemaker controls in patients with VVI pacemakers].

    PubMed

    Klein, H H; Hanh, B K; Hellberg, K; Ruschewski, W; de Vivie, E R; Kreuzer, H

    1985-09-20

    Investigations on telemetry-supported pacemaker control were carried out in 55 patients with the VVI-pacemaker Quantum (Intermedics). The investigations were done at least once during the 6-24 month period after implantation. The telemetry function was utilised for pacemaker programming, for clarifying pacemaker defects and for characterising the type of pacemaker electrode used. It could be shown that the Osypka spiral electrode VY (Dr. Osypka) had a lower impedance, and greater pulse width and charge threshold in comparison with the two other electrodes used (Encor, Cordis; Polyflex, Intermedics). In 38 of the 55 patients (69%) a pulse amplitude of 2.7 V could be chosen, whereas an amplitude of 5.4 V was programmed in the rest. Pacemaker sensing threshold was set to values between 2.4 and 3.0 mV. Pacemaker problems appeared in three patients; in one patient due to programming too economically and in the other two due to pacemaker defects. PMID:4028997

  18. Pacemakers and Implantable Defibrillators - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Multiple Languages → All Health Topics → Pacemakers and Implantable Defibrillators URL of this page: https://medlineplus.gov/languages/ ... List of All Topics All Pacemakers and Implantable Defibrillators - Multiple Languages To use the sharing features on ...

  19. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... electrode function tester. (a) Identification. A pacemaker electrode function tester is a device which is connected to an implanted pacemaker lead that supplies an accurately calibrated, variable pacing pulse...

  20. SU-E-T-585: Optically-Stimulated Luminescent Dosimeters for Monitoring Pacemaker Dose in Radiation Therapy

    SciTech Connect

    Apicello, L; Riegel, A; Jamshidi, A

    2015-06-15

    Purpose: A sufficient amount of ionizing radiation can cause failure to components of pacemakers. Studies have shown that permanent damage can occur after a dose of 10 Gy and minor damage to functionality occurs at doses as low as 2 Gy. Optically stimulated thermoluminescent dosimeters (OSLDs) can be used as in vivo dosimeters to predict dose to be deposited throughout the treatment. The purpose of this work is to determine the effectiveness of using OSLDs for in vivo dosimetry of pacemaker dose. Methods: As part of a clinical in vivo dosimetry experience, OSLDs were placed at the site of the pacemaker by the therapist for one fraction of the radiation treatment. OSLD measurements were extrapolated to the total dose to be received by the pacemaker during treatment. A total of 79 measurements were collected from November 2011 to December 2013 on six linacs. Sixty-six (66) patients treated in various anatomical sites had the dose of their pacemakers monitored. Results: Of the 79 measurements recorded, 76 measurements (96 %) were below 2 Gy. The mean and standard deviation were 50.12 ± 76.41 cGy. Of the 3 measurements that exceeded 2 Gy, 2 measurements matched the dose predicted in the treatment plan and 1 was repeated after an unexpectedly high Result. The repeated measurement yielded a total dose less than 2 Gy. Conclusion: This analysis suggests OSLDs may be used for in vivo monitoring of pacemaker dose. Further research should be performed to assess the effect of increased backscatter from the pacemaker device.

  1. A new method for diagramming pacemaker electrocardiograms.

    PubMed

    Hesselson, A B; Parsonnet, V

    1994-08-01

    Advancements in technology have made paced ECG interpretation increasingly difficult. A new method for depicting the complex pacemaker/heart interactions that eliminates the extensive use of symbols and repetitious use of refractory period and rate limit information of previous methods has been devised. The method uses a framework of parallel horizontal lines drawn on grid paper underneath the ECG. The lines are spaced apart by the actual programmed values (lower rate, AV, VA intervals) of the pacemaker in question. This framework allows the simultaneous use of the horizontal and vertical directions for the diagram of pacemaker timing intervals. Also, a single representation of refractory periods, upper rate intervals, and other variables can be labeled vertically and extrapolated horizontally across the entire diagram. Single chamber, dual chamber, and rate-modulated ECGs are readily represented. The diagram is easily plotted on standard ECG paper and flexible enough to represent complex ECGs. PMID:7526348

  2. 21 CFR 870.3690 - Pacemaker test magnet.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered...

  3. 21 CFR 870.3690 - Pacemaker test magnet.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered...

  4. 21 CFR 870.3690 - Pacemaker test magnet.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered...

  5. 21 CFR 870.3690 - Pacemaker test magnet.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered...

  6. 21 CFR 870.3690 - Pacemaker test magnet.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered...

  7. 21 CFR 870.3600 - External pacemaker pulse generator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has...

  8. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at...

  9. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at...

  10. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Implantable pacemaker pulse generator. 870.3610 Section 870.3610 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that...

  11. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Indirect pacemaker generator function analyzer. 870.3640 Section 870.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker...

  12. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implantable pacemaker pulse generator. 870.3610 Section 870.3610 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that...

  13. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker generator function analyzer. 870.3630... generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is connected to a pacemaker pulse generator to test any or all of the generator's parameters, including...

  14. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at...

  15. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Indirect pacemaker generator function analyzer. 870.3640 Section 870.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker...

  16. 21 CFR 870.3600 - External pacemaker pulse generator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has...

  17. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at...

  18. 21 CFR 870.3600 - External pacemaker pulse generator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has...

  19. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker generator function analyzer. 870.3630... generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is connected to a pacemaker pulse generator to test any or all of the generator's parameters, including...

  20. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker generator function analyzer. 870.3630... generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is connected to a pacemaker pulse generator to test any or all of the generator's parameters, including...

  1. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Indirect pacemaker generator function analyzer. 870.3640 Section 870.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker...

  2. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker generator function analyzer. 870.3630... generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is connected to a pacemaker pulse generator to test any or all of the generator's parameters, including...

  3. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker generator function analyzer. 870.3630... generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is connected to a pacemaker pulse generator to test any or all of the generator's parameters, including...

  4. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Indirect pacemaker generator function analyzer. 870.3640 Section 870.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker...

  5. 21 CFR 870.3600 - External pacemaker pulse generator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has...

  6. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at...

  7. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Implantable pacemaker pulse generator. 870.3610 Section 870.3610 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that...

  8. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Indirect pacemaker generator function analyzer. 870.3640 Section 870.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker...

  9. 21 CFR 870.3600 - External pacemaker pulse generator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has...

  10. Ventricular capture by anodal pacemaker stimulation.

    PubMed

    Occhetta, Eraldo; Bortnik, Miriam; Marino, Paolo

    2006-05-01

    This report describes the case of an 86-year-old male with syncopal paroxysmal 2:1 atrioventricular block and a single chamber VVI pacemaker programmed to bipolar sensing and unipolar pacing. After recurrence of syncope, a complete loss of ventricular capture with regular ventricular sensing was observed on ECG; fluoroscopic examination suggested perforation of the right ventricle by the helix of the implanted screw-in lead. Reprogramming the pacemaker to bipolar pacing/sensing resulted in regular ventricular capture and sensing, suggesting effective anodal stimulation from the ring electrode permitting complete non-invasive palliation. PMID:16636000

  11. Percutaneous extraction of inadvertently placed left-sided pacemaker leads with complete cerebral embolic protection.

    PubMed

    Bahadorani, John N; Schricker, Amir A; Pretorius, Victor G; Birgersdotter-Green, Ulrika; Dominguez, Arturo; Mahmud, Ehtisham

    2015-10-01

    Lead wire malposition is a known, but rare complication of permanent pacemaker or defibrillator implantation. The actual incidence and prevalence is unknown and management options for inadvertent left ventricular lead malposition have not been uniform. Current recommendations include systemic anticoagulation with warfarin or surgical lead removal with circulatory arrest for compelling clinical scenarios. Percutaneous left-sided lead extraction is contraindicated due to the potentially increased risk of thromboembolic complications associated with this procedure. To our knowledge, this is the first report of percutaneous extraction of inadvertently placed left ventricular and left atrial endocardial pacemaker leads with flow-preserving complete cerebral embolic protection. We also review the current literature regarding the incidence, management, and percutaneous extraction of left-sided cardiac leads. PMID:25581608

  12. Chronic fibrous sheath mistaken for retained pacemaker product.

    PubMed

    Nazir, Sheraz A; Hudsmith, Lucy; Newton, James D; Betts, Tim R

    2009-03-01

    A 71-year-old man underwent implantation of a single-chamber system in 1988 for sinoatrial disease, which was then upgraded to dual-chamber 7 years later following recurrent syncope. He presented with pacemaker erosion but without clinical or laboratory evidence of infective endocarditis. The pacemaker system was uneventfully extracted 5 days later via a transfemoral approach using a needle-eye snare. A post-procedure trans-thoracic echocardiogram was performed, which demonstrated an echogenic structure in the right atrium-this was initially felt to be a retained fragment of pacing lead. A short-axis view of the tricuspid valve with a bright linear echo crossing is shown in Figure 1. However, a post-procedural chest X-ray confirmed the absence of any retained intra-cardiac lead. The reverberant cast-like structure noted is a heavily calcified fibrous sheath as the pacing leads were confirmed to be intact at the time of removal. PMID:19147697

  13. The past, present, and future of pacemaker therapies.

    PubMed

    Boink, Gerard J J; Christoffels, Vincent M; Robinson, Richard B; Tan, Hanno L

    2015-11-01

    Since its introduction into clinical practice, electronic pacing has saved many lives. Despite continuous improvements, electronic pacemakers have important shortcomings, which stimulated the development of biological alternatives. Biological pacemakers generate the cardiac impulse using genes or cells to treat bradycardias. Over the past decade, significant improvements have been made in biological pacemakers, but issues remain in relation to long-term outcomes and safety. Concurrently, efforts to improve electronic pacemakers have also intensified. Whether new generations of electronic pacemakers will erase lingering concerns with regard to electronic pacing or whether biologicals will ultimately supplement or supplant electronics remains to be seen. PMID:26001958

  14. Optimal resources for implantable cardiac pacemakers.

    PubMed

    Parsonnet, V; Furman, S; Smyth, N P; Bilitch, M

    1983-07-01

    In this document, the 1974 Inter-Society Commission for Heart Disease Resources (ICHD) report, Implantable Cardiac Pacemakers, has been revised and updated to emphasize the increased complexity of present-day pacing, to propose realistic guidelines for various aspects of pacing practice, and to identify the resources needed for delivery of this important mode of health care. The first section of the report describes the several types of pacemakers currently available, how they function, and how and to what purpose they may be modified through noninvasive programming. Recommendations are given for a modified and updated version of the widely accepted ICHD code for identification of pacing modes. The emphasis of the second section of the report is on physical and personnel resources. Matters considered in some depth include the training and qualification of the various medical, technical, and paramedical specialists involved in an implantation procedure; requirements for, and methods of achieving, short- and long-term surveillance of pacemaker patients; and the role of the hospital, the manufacturers, and the FDA in this new era of complex dual-chamber, multiprogrammable pacemakers. PMID:6851049

  15. What Are the Risks of Pacemaker Surgery?

    MedlinePlus

    ... doctor about the benefits and risks of pacemaker surgery. Rate This Content: NEXT >> Updated: February 28, 2012 Twitter Facebook YouTube Google+ SITE INDEX ACCESSIBILITY PRIVACY STATEMENT FOIA OIG CONTACT US National Institutes of Health Department of Health and Human Services USA.gov

  16. Wandering atrial pacemaker (prevalence in French hornists).

    PubMed

    Nizet, P M; Borgi, J F; Horvath, S M

    1976-01-01

    Continuous electrocardiographic recordings were obtained in a group of French horn players during performance of identical pieces of music. Half of the musicians developed wandering atrial pacemaker. One example is illustrated. The causative mechanism is briefly discussed. This may represent an "occupational" hazard. PMID:1245812

  17. Generation of cardiac pacemaker cells by programming and differentiation.

    PubMed

    Husse, Britta; Franz, Wolfgang-Michael

    2016-07-01

    A number of diseases are caused by faulty function of the cardiac pacemaker and described as "sick sinus syndrome". The medical treatment of sick sinus syndrome with electrical pacemaker implants in the diseased heart includes risks. These problems may be overcome via "biological pacemaker" derived from different adult cardiac cells or pluripotent stem cells. The generation of cardiac pacemaker cells requires the understanding of the pacing automaticity. Two characteristic phenomena the "membrane-clock" and the "Ca(2+)-clock" are responsible for the modulation of the pacemaker activity. Processes in the "membrane-clock" generating the spontaneous pacemaker firing are based on the voltage-sensitive membrane ion channel activity starting with slow diastolic depolarization and discharging in the action potential. The influence of the intracellular Ca(2+) modulating the pacemaker activity is characterized by the "Ca(2+)-clock". The generation of pacemaker cells started with the reprogramming of adult cardiac cells by targeted induction of one pacemaker function like HCN1-4 overexpression and enclosed in an activation of single pacemaker specific transcription factors. Reprogramming of adult cardiac cells with the transcription factor Tbx18 created cardiac cells with characteristic features of cardiac pacemaker cells. Another key transcription factor is Tbx3 specifically expressed in the cardiac conduction system including the sinoatrial node and sufficient for the induction of the cardiac pacemaker gene program. For a successful cell therapeutic practice, the generated cells should have all regulating mechanisms of cardiac pacemaker cells. Otherwise, the generated pacemaker cells serve only as investigating model for the fundamental research or as drug testing model for new antiarrhythmics. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel

  18. Measuring pacemaker dose: a clinical perspective.

    PubMed

    Studenski, Matthew T; Xiao, Ying; Harrison, Amy S

    2012-01-01

    Recently in our clinic, we have seen an increased number of patients presenting with pacemakers and defibrillators. Precautions are taken to develop a treatment plan that minimizes the dose to the pacemaker because of the adverse effects of radiation on the electronics. Here we analyze different dosimeters to determine which is the most accurate in measuring pacemaker or defibrillator dose while at the same time not requiring a significant investment in time to maintain an efficient workflow in the clinic. The dosimeters analyzed here were ion chambers, diodes, metal-oxide-semiconductor field effect transistor (MOSFETs), and optically stimulated luminescence (OSL) dosimeters. A simple phantom was used to quantify the angular and energy dependence of each dosimeter. Next, 8 patients plans were delivered to a Rando phantom with all the dosimeters located where the pacemaker would be, and the measurements were compared with the predicted dose. A cone beam computed tomography (CBCT) image was obtained to determine the dosimeter response in the kilovoltage energy range. In terms of the angular and energy dependence of the dosimeters, the ion chamber and diode were the most stable. For the clinical cases, all the dosimeters match relatively well with the predicted dose, although the ideal dosimeter to use is case dependent. The dosimeters, especially the MOSFETS, tend to be less accurate for the plans, with many lateral beams. Because of their efficiency, we recommend using a MOSFET or a diode to measure the dose. If a discrepancy is observed between the measured and expected dose (especially when the pacemaker to field edge is <10 cm), we recommend analyzing the treatment plan to see whether there are many lateral beams. Follow-up with another dosimeter rather than repeating multiple times with the same type of dosimeter. All dosimeters should be placed after the CBCT has been acquired. PMID:21875785

  19. Measuring pacemaker dose: A clinical perspective

    SciTech Connect

    Studenski, Matthew T.; Xiao Ying; Harrison, Amy S.

    2012-07-01

    Recently in our clinic, we have seen an increased number of patients presenting with pacemakers and defibrillators. Precautions are taken to develop a treatment plan that minimizes the dose to the pacemaker because of the adverse effects of radiation on the electronics. Here we analyze different dosimeters to determine which is the most accurate in measuring pacemaker or defibrillator dose while at the same time not requiring a significant investment in time to maintain an efficient workflow in the clinic. The dosimeters analyzed here were ion chambers, diodes, metal-oxide-semiconductor field effect transistor (MOSFETs), and optically stimulated luminescence (OSL) dosimeters. A simple phantom was used to quantify the angular and energy dependence of each dosimeter. Next, 8 patients plans were delivered to a Rando phantom with all the dosimeters located where the pacemaker would be, and the measurements were compared with the predicted dose. A cone beam computed tomography (CBCT) image was obtained to determine the dosimeter response in the kilovoltage energy range. In terms of the angular and energy dependence of the dosimeters, the ion chamber and diode were the most stable. For the clinical cases, all the dosimeters match relatively well with the predicted dose, although the ideal dosimeter to use is case dependent. The dosimeters, especially the MOSFETS, tend to be less accurate for the plans, with many lateral beams. Because of their efficiency, we recommend using a MOSFET or a diode to measure the dose. If a discrepancy is observed between the measured and expected dose (especially when the pacemaker to field edge is <10 cm), we recommend analyzing the treatment plan to see whether there are many lateral beams. Follow-up with another dosimeter rather than repeating multiple times with the same type of dosimeter. All dosimeters should be placed after the CBCT has been acquired.

  20. Initial experience in the extraction of chronically implanted pacemaker leads using the Excimer laser sheath

    PubMed Central

    Levy, T; Walker, S; Paul, V

    1999-01-01

    OBJECTIVE—To assess the safety and efficiency of the Excimer laser sheath in extracting chronically implanted pacemaker leads.
PATIENTS—Eight patients were studied (one female, mean age 62 years, range 34 to 77) with 17 pacemaker leads (five atrial, 10 ventricular, two implantable defibrillator). The mean implantation time was 65 months (range 23 to 188). The indications for lead extraction were chronic infection (7), superior vena cava obstruction (4), lead malfunction (4), and pain (2).
METHODS—A prospective analysis of the use of the Excimer laser sheath in extracting chronically implanted pacemaker leads. Laser sheath extraction was undertaken if conventional extraction techniques with simple traction or traction with a locking stylet had failed. If laser sheath extraction was unsuccessful, basket retrieval of the lead from the groin was performed.
RESULTS—Complete lead removal was achieved in 16 leads (94%). In one case the electrode tip was left behind without complication. Extraction was achieved with the laser sheath alone in 16 leads. Basket retrieval was required in one case after laser failure. There were no complications.
CONCLUSIONS—The Excimer laser sheath appears to be an effective and safe technique for extracting chronically implanted pacemaker leads. It can be used in combination with the currently available techniques for successful lead extraction.


Keywords: Excimer laser sheath; lead extraction; pacing PMID:10377320

  1. Performance of re-used pacemakers and implantable cardioverter defibrillators compared with new devices at Groote Schuur Hospital in Cape Town, South Africa

    PubMed Central

    Jama, Zimasa V; Chin, Ashley; Mayosi, Bongani M; Badri, Motasim

    2015-01-01

    Objectives Little is known about the performance of re-used pacemakers and implantable cardioverter defibrillators (ICDs) in Africa. We sought to compare the risk of infection and the rate of malfunction of re-used pacemakers and ICDs with new devices implanted at Groote Schuur Hospital in Cape Town, South Africa. Methods This was a retrospective case comparison study of the performance of re-used pacemakers and ICDs in comparison with new devices implanted at Groote Schuur Hospital over a 10-year period. The outcomes were incidence of device infection, device malfunction, early battery depletion, and device removal due to infection, malfunction, or early battery depletion. Results Data for 126 devices implanted in 126 patients between 2003 and 2013 were analysed, of which 102 (81%) were pacemakers (51 re-used and 51 new) and 24 (19%) were ICDs (12 re-used and 12 new). There was no device infection, malfunction, early battery depletion or device removal in either the re-used or new pacemaker groups over the median follow up of 15.1 months [interquartile range (IQR), 1.3–36.24 months] for the re-used pacemakers, and 55.8 months (IQR, 20.3–77.8 months) for the new pacemakers. In the ICD group, no device infection occurred over a median follow up of 35.9 months (IQR, 17.0–70.9 months) for the re-used ICDs and 45.7 months (IQR, 37.6–53.7 months) for the new ICDs. One device delivered inappropriate shocks, which resolved without intervention and with no harm to the patient. This re-used ICD subsequently needed generator replacement 14 months later. In both the pacemaker and ICD groups, there were no procedure-non-related infections documented for the respective follow-up periods. Conclusion No significant differences were found in performance between re-used and new pacemakers and ICDs with regard to infection rates, device malfunction, battery life and device removal for complications. Pacemaker and ICD re-use is feasible and safe and is a viable option for

  2. [Does electromagnetic interference not occur to a bipolar pacemaker during TUR-P?].

    PubMed

    Takahashi, Tetsuya; Matsuoka, Nobuhiro; Ohshima, Takashi; Uchihashi, Yoshitaka; Satoh, Tetsuo

    2004-01-01

    It has been reported that a unipolar pacemaker is more sensitive to electromagnetic interference (EMI) than a bipolar pacemaker. However, we experienced cases in which electrosurgery device interfered with a bipolar pacemaker, but not with a unipolar pacemaker during TUR-P. It has been suggested that EMI occurs to a bipolar pacemaker depending on sensitivity and electric resistance of a patient. PMID:14968601

  3. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations.

    PubMed

    Rapsang, Amy G; Bhattacharyya, Prithwis

    2014-01-01

    A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary. PMID:24907883

  4. Modeling cardiac pacemakers with relaxation oscillators

    NASA Astrophysics Data System (ADS)

    Grudziński, Krzysztof; Żebrowski, Jan J.

    2004-05-01

    A modified van der Pol oscillator model was designed in order to reproduce the time series of the action potential generated by a natural pacemaker of the heart (i.e., the SA or the AV node). The main motivation was that the models published up to now were not altogether adequate for research on the heart. Based on either the classical van der Pol oscillator or other nonlinear oscillators, these models were interesting rather because of the physical phenomena that could be obtained (chaos and synchronization). However, they were unable to simulate many important physiological features of true physiological action potentials. We based our research on the experience of other groups which modeled neuronal oscillators. There complex nonlinear oscillators were used whose most important feature was a certain topology of the phase space. In our case, we modified the phase space of the classical van der Pol oscillator by adding two fixed points: a saddle and a node. In addition, a damping term asymmetric with respect to the voltage was introduced. Introduction of these new features into the van der Pol oscillator allowed to change the firing frequency of the pacemaker node without changing the length of the refractory period - an important physiological detail. We also show different ways of changing the pacemaker rhythm. A comparison of the properties of the signal obtained from our model with the features of the action potentials measured by other groups is made.

  5. Pacemakers and Implantable Defibrillators - Multiple Languages: MedlinePlus

    MedlinePlus

    ... العربية) Pacemaker (Arabic) العربية Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Pacemaker 心脏起搏器 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Pacemaker 心臟起搏器 - 繁體中文 (Chinese - Traditional) ...

  6. Gene therapy: Biological pacemaker created by gene transfer

    NASA Astrophysics Data System (ADS)

    Miake, Junichiro; Marbán, Eduardo; Nuss, H. Bradley

    2002-09-01

    The pacemaker cells of the heart initiate the heartbeat, sustain the circulation, and dictate the rate and rhythm of cardiac contraction. Circulatory collapse ensues when these specialized cells are damaged by disease, a situation that currently necessitates the implantation of an electronic pacemaker. Here we report the use of viral gene transfer to convert quiescent heart-muscle cells into pacemaker cells, and the successful generation of spontaneous, rhythmic electrical activity in the ventricle in vivo. Our results indicate that genetically engineered pacemakers could be developed as a possible alternative to implantable electronic devices.

  7. [A new dual-chamber pacemaker with an automatic antitachycardia system in the treatment of the bradycardia-tachycardia syndrome].

    PubMed

    Adornato, E; Polimeni, R M; Monea, P; Tassone, F; Pennisi, V

    1985-04-01

    A new dual-chamber pacemaker with automatic tachycardia terminating system was used in three patients with bradycardia-tachycardia syndrome. This pacemaker (Medtronic Symbios 7008) is a multiprogrammable, bipolar device with bidirectional telemetry and six permanent pacing modes (DDD-DVI-VVI-DOO-VOO-AOO). The antitachycardia system can be programmed in two different modes: underdrive dual demand and overdrive atrial burts (1 to 16 stimuli with selectable coupling interval from 135 to 360 msec). The pacing modes are automatically activated when five consecutive R-R cycles shorter than the tachycardia detection interval are sensed. The pacemaker may sense the ventricle (when set on VVI or DVI mode) or sense both the atrium and the ventricle (in DDD mode). The pacemaker was programmed on DVI mode in all three patients, and the overdrive atrial burst program was used for tachycardia termination, with promptly and costantly effective results. The underdrive dual demand program was tested after the implantation, but it did not show constant results because inefficacy or late termination of tachycardias. PMID:4043644

  8. Anticoagulation Management in Patients with Pacemaker-Detected Atrial Fibrillation

    PubMed Central

    Poposka, Lidija; Boskov, Vladimir; Risteski, Dejan; Taleski, Jane; Georgievska-Ismail, Ljubica

    2016-01-01

    INTRODUCTION: In patients with an implanted pacemaker, asymptomatic atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications. There is still no consensus which duration of episodes of atrial fibrillation should be taken as an indicator for inclusion of oral anticoagulation therapy (OAC). MATERIAL AND METHODS: A total of 104 patients who had no AF episodes in the past and have an indication for permanent pacing were included in the study. RESULTS: During an average follow-up of 18 months, 33 of the patients developed episodes of AF. Inclusion of OAC was performed in 17 patients, in whom AF was recorded, although in all patients CHA2DS2-VASc score was ≥ 1. The inclusion of OAC showed a statistically significant correlation with increasing duration of episodes of AF (r = 0.502, p = 0.003). During the follow-up period none of the patients developed thrombo-embolic complication. CONCLUSION: Considering that our group of patients had no thrombo-embolic events, we could conclude that dividing the AF episodes in less than 1% in 24 hours and longer than 1% within 24 hours could be an indicator for decision-making to include OAK if the CHA2DS2-VASc score is ≥ 1. PMID:27335594

  9. Permanent Peripheral Neuropathy

    PubMed Central

    Higgins, Elizabeth

    2014-01-01

    The health risks and side effects of fluoroquinolone use include the risk of tendon rupture and myasthenia gravis exacerbation, and on August 15, 2013, the Food and Drug Administration updated its warning to include the risk of permanent peripheral neuropathy. We present a case of fluoroquinolone-induced peripheral neuropathy in a patient treated for clinically diagnosed urinary tract infection with ciprofloxacin antibiotic. PMID:26425618

  10. Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach?

    PubMed

    Migliore, Federico; Curnis, Antonio; Bertaglia, Emanuele

    2016-04-01

    Different methods for venous access are used for permanent pacemaker or implantable cardioverter defibrillator (ICD), of which subclavian vein puncture technique is the most widely practised. Although this approach is relatively easy to learn, quick and offers high success rates, it may be associated with potential serious acute complications including pneumothorax, emopneumothorax, brachial plexus injury and longer-term complications such as lead fracture, loss of lead insulation and subclavian crush syndrome especially in young patients with ICD leads. Axillary vein approach seems to be a favourable technique not only for the prevention of acute complications but also to reduce lead failure including lead insulation and lead fracture prevention with a consequently better long-term lead survival compared with the classical subclavian approach. Although randomized studies are lacking, recent reports not only evaluated the safety and effectiveness of new fluoroscopic axillary venous puncture technique, but also compared it with the conventional intrathoracic subclavian venous puncture technique for the implantation of leads in permanent pacing. Various techniques of axillary vein puncture have been proposed ranging from a blind percutaneous puncture to the use of different tools such as contrast venography and ultrasound. In this article, we report a case of subclavian crush syndrome, the use of a modified Bellot's technique of axillary vein puncture that we currently use and the potential benefits of axillary vein puncture for pacemaker and ICD leads implantation compared with subclavian approach to avoid acute and long-term lead complications. PMID:25252042

  11. Medical treatment of a pacemaker endocarditis due to Candida albicans and to Candida glabrata.

    PubMed

    Roger, P M; Boissy, C; Gari-Toussaint, M; Foucher, R; Mondain, V; Vandenbos, F; le Fichoux, Y; Michiels, J F; Dellamonica, P

    2000-09-01

    We describe a case of pacemaker infection due to two fungal species: Candida albicans and C. glabrata. Transthoracic echocardiography showed a large vegetation on the intraventricular wires. Because of severe underlying diseases, surgery was believed to be contraindicated. The patient was treated using high dose of fluconazole, resulting in clinical improvement and negative blood cultures. However, 2 months later, the patient underwent a fatal stroke. At autopsy, a large vegetation was found only all along the wires. Postmortem culture of the infected material was positive for both C. albicans and C. glabrata. PMID:11023765

  12. A new symbolic language for diagramming pacemaker/heart interaction.

    PubMed

    Brownlee, R R; Shimmel-Golden, J B; Del Marco, C J; Furman, S

    1982-09-01

    A new symbolic language is presented that can be used to diagram pacemaker/heart interactions. The language symbolically indicates "normally" conducted and ectopic events; pacemaker stimuli; pacemaker capture of the chamber; triggered pacemaker stimuli by "normal" or ectopic events; as well as such anomalous pacemaker/heart interactions as failure to sense; "crosstalk" between electrodes; and "normal," ectopic, or paced events in one chamber sensed by the electrode in the other chamber. In addition, symbols are provided to represent antegrade and retrograde accessory pathway conduction, and electronic and physiological refractory intervals. A common baseline is used to separate symbols for atrial activity, above the baseline, from those for ventricular activity, below the baseline. Parallel baselines are used to plot refractory intervals. Thus, even complex dual-chamber pacemaker operating modes can be represented with intrinsic and stimulated cardiac response to pacemaker operation. The language can be sketched out informally for description of general concepts or drafted on millimeter grid paper to make precise timing notations. It is especially useful for interdisciplinary communication of ideas about complex pacemaker/heart interactions. PMID:6182542

  13. 21 CFR 870.3730 - Pacemaker service tools.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker service tools. 870.3730 Section 870.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen...

  14. 21 CFR 870.3730 - Pacemaker service tools.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker service tools. 870.3730 Section 870.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen...

  15. 21 CFR 870.3730 - Pacemaker service tools.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker service tools. 870.3730 Section 870.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen...

  16. 21 CFR 870.3730 - Pacemaker service tools.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker service tools. 870.3730 Section 870.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen...

  17. 21 CFR 870.3730 - Pacemaker service tools.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker service tools. 870.3730 Section 870.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen...

  18. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870.3650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker...

  19. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870.3650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker...

  20. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870.3650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker...

  1. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870.3650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker...

  2. 21 CFR 870.5550 - External transcutaneous cardiac pacemaker (noninvasive).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... § 870.5550 External transcutaneous cardiac pacemaker (noninvasive). (a) Identification. An external transcutaneous cardiac pacemaker (noninvasive) is a device used to supply a periodic electrical pulse intended to pace the heart. The pulse from the device is usually applied to the surface of the chest...

  3. 21 CFR 870.5550 - External transcutaneous cardiac pacemaker (noninvasive).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... § 870.5550 External transcutaneous cardiac pacemaker (noninvasive). (a) Identification. An external transcutaneous cardiac pacemaker (noninvasive) is a device used to supply a periodic electrical pulse intended to pace the heart. The pulse from the device is usually applied to the surface of the chest...

  4. 21 CFR 870.5550 - External transcutaneous cardiac pacemaker (noninvasive).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... § 870.5550 External transcutaneous cardiac pacemaker (noninvasive). (a) Identification. An external transcutaneous cardiac pacemaker (noninvasive) is a device used to supply a periodic electrical pulse intended to pace the heart. The pulse from the device is usually applied to the surface of the chest...

  5. 21 CFR 870.5550 - External transcutaneous cardiac pacemaker (noninvasive).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... § 870.5550 External transcutaneous cardiac pacemaker (noninvasive). (a) Identification. An external transcutaneous cardiac pacemaker (noninvasive) is a device used to supply a periodic electrical pulse intended to pace the heart. The pulse from the device is usually applied to the surface of the chest...

  6. Asynchronous response of coupled pacemaker neurons

    PubMed Central

    Dodla, Ramana; Wilson, Charles J.

    2009-01-01

    We study a network model of two conductance-based pacemaker neurons of differing natural frequency, coupled with either mutual excitation or inhibition, and receiving shared random inhibitory synaptic input. The networks may phase-lock spike-to-spike for strong mutual coupling. But the shared input can desynchronize the locked spike-pairs by selectively eliminating the lagging spike or modulating its timing with respect to the leading spike depending on their separation time window. Such loss of synchrony is also found in a large network of sparsely coupled heterogeneous spiking neurons receiving shared input. PMID:19257636

  7. Chaotic Response of the Pacemaker Neuron

    NASA Astrophysics Data System (ADS)

    Hayashi, Hatsuo; Ishizuka, Satoru; Hirakawa, Kazuyoshi

    1985-06-01

    Excitable membranes respond irregularly to a periodic stimulation with proper stimulus parameters. Because irregular firing is macroscopic, it seems that irregularity is caused by other factors besides microscopic membrane noise. The responses of the repetitively firing Onchidium pacemaker neuron to a sinusoidal current stimulation were investigated. The irregular responses are classified into three kinds of chaotic oscillation: chaos, intermittency and random alternation. 1/2- and 1/1-harmonic responses bifurcate to chaos via intermittency and random alternation respectively. Harmonic and chaotic responses alternate with each other with increasing frequency of stimulation and with smaller amplitude. Nonlinear factors, threshold and refractory period, are concerned with hyperbolicity of chaotic responses.

  8. Use of pacemaker programmers for disaster victim identification.

    PubMed

    Makinae, Haruka; Numata, Norio; Kitaoka, Hirofumi; Daimon, Masao; Yamamoto, Taira; Amano, Atsushi

    2013-12-01

    Disaster victim identification (DVI) presents a number of physical and legal challenges, involving the degeneration of human remains and legal obstacles to forensic examinations. One non-invasive method for positive identification may be the use of a pacemaker programmer to detect and obtain data from pacemakers recovered from unidentified remains. To test the usefulness of this method, this investigation examined the efficiency and utility of 5 different pacemaker programmers in the positive identification of victims of the March 2011 tsunami in Japan at 8 disaster sites in May 2011. On scanning 148 sets of remains, data were successfully obtained from 1 implant in 1 set of remains, allowing for the rapid positive identification of the individual. Scanning pacemakers with pacemaker programmers can be a non-invasive method of positive identification that meets Japanese legal and institutional requirements, but this method is ineffective without a preceding whole-body X-ray scan. PMID:23592022

  9. [Radiological picture in the diagnosis of various complications of permanent endocardial electrostimulation].

    PubMed

    Vanaria, D; Mangiameli, S; Circo, A; Fiscella, A; Bulla, V

    1977-09-30

    The close links between the implantation of permanent pacemakers and radiological examination are described with particular reference to position of the the right ventricle. Here radiological examination offers the best chance of diagnosis. The need for close cooperation between specialists is emphasised. PMID:917335

  10. Proton Beam Therapy Interference With Implanted Cardiac Pacemakers

    SciTech Connect

    Oshiro, Yoshiko Sugahara, Shinji; Noma, Mio; Sato, Masato; Sakakibara, Yuzuru; Sakae, Takeji; Hayashi, Yasutaka; Nakayama, Hidetsugu; Tsuboi, Koji; Fukumitsu, Nobuyoshi; Kanemoto, Ayae; Hashimoto, Takayuki; Tokuuye, Koichi

    2008-11-01

    Purpose: To investigate the effect of proton beam therapy (PBT) on implanted cardiac pacemaker function. Methods and Materials: After a phantom study confirmed the safety of PBT in patients with cardiac pacemakers, we treated 8 patients with implanted pacemakers using PBT to a total tumor dose of 33-77 gray equivalents (GyE) in dose fractions of 2.2-6.6 GyE. The combined total number of PBT sessions was 127. Although all pulse generators remained outside the treatment field, 4 patients had pacing leads in the radiation field. All patients were monitored by means of electrocardiogram during treatment, and pacemakers were routinely examined before and after PBT. Results: The phantom study showed no effect of neutron scatter on pacemaker generators. In the study, changes in heart rate occurred three times (2.4%) in 2 patients. However, these patients remained completely asymptomatic throughout the PBT course. Conclusions: PBT can result in pacemaker malfunctions that manifest as changes in pulse rate and pulse patterns. Therefore, patients with cardiac pacemakers should be monitored by means of electrocardiogram during PBT.

  11. Modern perspectives on numerical modeling of cardiac pacemaker cell.

    PubMed

    Maltsev, Victor A; Yaniv, Yael; Maltsev, Anna V; Stern, Michael D; Lakatta, Edward G

    2014-01-01

    Cardiac pacemaking is a complex phenomenon that is still not completely understood. Together with experimental studies, numerical modeling has been traditionally used to acquire mechanistic insights in this research area. This review summarizes the present state of numerical modeling of the cardiac pacemaker, including approaches to resolve present paradoxes and controversies. Specifically we discuss the requirement for realistic modeling to consider symmetrical importance of both intracellular and cell membrane processes (within a recent "coupled-clock" theory). Promising future developments of the complex pacemaker system models include the introduction of local calcium control, mitochondria function, and biochemical regulation of protein phosphorylation and cAMP production. Modern numerical and theoretical methods such as multi-parameter sensitivity analyses within extended populations of models and bifurcation analyses are also important for the definition of the most realistic parameters that describe a robust, yet simultaneously flexible operation of the coupled-clock pacemaker cell system. The systems approach to exploring cardiac pacemaker function will guide development of new therapies such as biological pacemakers for treating insufficient cardiac pacemaker function that becomes especially prevalent with advancing age. PMID:24748434

  12. Cardiovascular patients’ experiences of living with pacemaker: Qualitative study

    PubMed Central

    Ghojazadeh, Morteza; Azami-Aghdash, Saber; Sohrab-Navi, Zahra; Kolahdouzan, Kasra

    2015-01-01

    BACKGROUND A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. METHODS In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients’ statements were recorded with their consent and analyzed using content analysis method. RESULTS Participants’ experiences included three main themes: “Problems and limitations,” “feeling and dealing with pacemaker”, and “sources of comfort” and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. CONCLUSION Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker. PMID:26715933

  13. Modern Perspectives on Numerical Modeling of Cardiac Pacemaker Cell

    PubMed Central

    Maltsev, Victor A.; Yaniv, Yael; Maltsev, Anna V.; Stern, Michael D.; Lakatta, Edward G.

    2015-01-01

    Cardiac pacemaking is a complex phenomenon that is still not completely understood. Together with experimental studies, numerical modeling has been traditionally used to acquire mechanistic insights in this research area. This review summarizes the present state of numerical modeling of the cardiac pacemaker, including approaches to resolve present paradoxes and controversies. Specifically we discuss the requirement for realistic modeling to consider symmetrical importance of both intracellular and cell membrane processes (within a recent “coupled-clock” theory). Promising future developments of the complex pacemaker system models include the introduction of local calcium control, mitochondria function, and biochemical regulation of protein phosphorylation and cAMP production. Modern numerical and theoretical methods such as multi-parameter sensitivity analyses within extended populations of models and bifurcation analyses are also important for the definition of the most realistic parameters that describe a robust, yet simultaneously flexible operation of the coupled-clock pacemaker cell system. The systems approach to exploring cardiac pacemaker function will guide development of new therapies, such as biological pacemakers for treating insufficient cardiac pacemaker function that becomes especially prevalent with advancing age. PMID:24748434

  14. Endogenous pacemaker activity of rat tumour somatotrophs

    PubMed Central

    Kwiecien, Renata; Robert, Christophe; Cannon, Robert; Vigues, Stephan; Arnoux, Annie; Kordon, Claude; Hammond, Constance

    1998-01-01

    Cells derived from a rat pituitary tumour (GC cell line) that continuously release growth hormone behave as endogenous pacemakers. In simultaneous patch clamp recordings and cytosolic Ca2+ concentration ([Ca2+]i) imaging, they displayed rhythmic action potentials (44.7 ± 2.7 mV, 178 ± 40 ms, 0.30 ± 0.04 Hz) and concomitant [Ca2+]i transients (374 ± 57 nM, 1.0 ± 0.2 s, 0.27 ± 0.03 Hz). Action potentials and [Ca2+]i transients were reversibly blocked by removal of external Ca2+, addition of nifedipine (1 μM) or Ni2+ (40 μM), but were insensitive to TTX (1 μM). An L-type Ca2+ current activated at -33.6 ± 0.4 mV (holding potential (Vh), −40 mV), peaked at -1.8 ± 1.3 mV, was reduced by nifedipine and enhanced by S-(+)-SDZ 202 791. A T/R-type Ca2+ current activated at -41.7 ± 2.7 mV (Vh, -80 or -60 mV), peaked at -9.2 ± 3.0 mV, was reduced by low concentrations of Ni2+ (40 μM) or Cd2+ (10 μM) and was toxin resistant. Parallel experiments revealed the expression of the class E calcium channel α1-subunit mRNA. The K+ channel blockers TEA (25 mM) and charybdotoxin (10–100 nM) enhanced spike amplitude and/or duration. Apamin (100 nM) also strongly reduced the after-spike hyperpolarization. The outward K+ tail current evoked by a depolarizing step that mimicked an action potential reversed at −69.8 ± 0.3 mV, presented two components, lasted 2–3 s and was totally blocked by Cd2+ (400 μM). The slow pacemaker depolarization (3.5 ± 0.4 s) that separated consecutive spikes corresponded to a 2- to 3-fold increase in membrane resistance, was strongly Na+ sensitive but TTX insensitive. Computer simulations showed that pacemaker activity can be reproduced by a minimum of six currents: an L-type Ca2+ current underlies the rising phase of action potentials that are repolarized by a delayed rectifier and Ca2+-activated K+ currents. In between spikes, the decay of Ca2+-activated K+ currents and a persistent inward cationic current depolarize the membrane

  15. Artificial cardiac stimulation: a current view of physiologic pacemakers.

    PubMed Central

    Rosengarten, M. D.; Chiu, R. C.

    1983-01-01

    Artificial pacing of the heart has evolved rapidly over the last 20 years; the physician can now implant "physiologic" pacemakers that preserve the natural order of atrial and ventricular systole. The commonly used pacemakers that pace only the ventricle can induce dizziness, fatigue and syncope and increase congestive heart failure. Physiologic pacemakers can eliminate many of these side effects, but they are more expensive, can be less durable and may induce arrhythmias. Physiologic pacing can provide the greatest benefit and cost-effectiveness when the particular functions of the device are matched to the specific needs of the patient. PMID:6850463

  16. Of pacemakers and statistics: the actuarial method extended.

    PubMed

    Dussel, J; Wolbarst, A B; Scott-Millar, R N; Obel, I W

    1980-01-01

    Pacemakers cease functioning because of either natural battery exhaustion (nbe) or component failure (cf). A study of four series of pacemakers shows that a simple extension of the actuarial method, so as to incorporate Normal statistics, makes possible a quantitative differentiation between the two modes of failure. This involves the separation of the overall failure probability density function PDF(t) into constituent parts pdfnbe(t) and pdfcf(t). The approach should allow a meaningful comparison of the characteristics of different pacemaker types. PMID:6160497

  17. Preliminary experience with the use of a programmable pacemaker.

    PubMed

    Morse, D; Fernandez, J; Samuel, A; Lemole, G; Parsonnet, V

    1975-05-01

    One hundred sixty-four patients, in whom new externally programmable pacemakers had been inserted, were studied over a two year period, beginning July, 1972. Following implantation, the rate and current output of this pacemaker could be changed at any time by a non-invasive technique involving electromagnetic pulse trains emitted by an external "programmer". In 89 percent of the patients it was possible to reduce battery output by half, implying greater longevity of the pacer in these cases. In 15 percent of the patients, manipulative control of the pacemaker rate was employed and found beneficial. PMID:1126191

  18. Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study

    PubMed Central

    Ritter, Philippe; Duray, Gabor Z.; Steinwender, Clemens; Soejima, Kyoko; Omar, Razali; Mont, Lluís; Boersma, Lucas VA; Knops, Reinoud E.; Chinitz, Larry; Zhang, Shu; Narasimhan, Calambur; Hummel, John; Lloyd, Michael; Simmers, Timothy Alexander; Voigt, Andrew; Laager, Verla; Stromberg, Kurt; Bonner, Matthew D.; Sheldon, Todd J.; Reynolds, Dwight

    2015-01-01

    Aims Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker. Methods and results Patients having Class I or II indication for VVI pacing underwent implantation of a Micra transcatheter pacing system, from the femoral vein and fixated in the right ventricle using four protractible nitinol tines. Prespecified objectives were >85% freedom from unanticipated serious adverse device events (safety) and <2 V 3-month mean pacing capture threshold at 0.24 ms pulse width (efficacy). Patients were implanted (n = 140) from 23 centres in 11 countries (61% male, age 77.0 ± 10.2 years) for atrioventricular block (66%) or sinus node dysfunction (29%) indications. During mean follow-up of 1.9 ± 1.8 months, the safety endpoint was met with no unanticipated serious adverse device events. Thirty adverse events related to the system or procedure occurred, mostly due to transient dysrhythmias or femoral access complications. One pericardial effusion without tamponade occurred after 18 device deployments. In 60 patients followed to 3 months, mean pacing threshold was 0.51 ± 0.22 V, and no threshold was ≥2 V, meeting the efficacy endpoint (P < 0.001). Average R-wave was 16.1 ± 5.2 mV and impedance was 650.7 ± 130 ohms. Conclusion Early assessment shows the transcatheter pacemaker can safely and effectively be applied. Long-term safety and benefit of the pacemaker will further be evaluated in the trial. Clinical Trial Registration ClinicalTrials.gov ID NCT02004873. PMID:26045305

  19. Transcatheter leadless pacemaker implantation in a patient with a transvenous dual-chamber pacemaker already in place.

    PubMed

    Karjalainen, Pasi P; Nammas, Wail; Paana, Tuomas

    2016-01-01

    An 83-year-old lady had a DDDR pacemaker inserted in 1997 for symptomatic atrioventricular block. She underwent battery replacement in 2008. In 2010, she developed atrial fibrillation; the pacemaker was switched to VVIR mode. During the last 2years, ventricular lead threshold increased progressively. In December 2015, she presented for elective battery replacement. After successful battery replacement, the ventricular lead threshold remained high; therefore, we implanted a leadless transcatheter pacemaker, via femoral vein access, using a dedicated catheter delivery system. Electrical measurements at this stage revealed a pacing threshold of 0.28V at 0.24msec, and an impedance of 650Ω. PMID:27323664

  20. Real-time relationship between PKA biochemical signal network dynamics and increased action potential firing rate in heart pacemaker cells: Kinetics of PKA activation in heart pacemaker cells.

    PubMed

    Yaniv, Yael; Ganesan, Ambhighainath; Yang, Dongmei; Ziman, Bruce D; Lyashkov, Alexey E; Levchenko, Andre; Zhang, Jin; Lakatta, Edward G

    2015-09-01

    cAMP-PKA protein kinase is a key nodal signaling pathway that regulates a wide range of heart pacemaker cell functions. These functions are predicted to be involved in regulation of spontaneous action potential (AP) generation of these cells. Here we investigate if the kinetics and stoichiometry of increase in PKA activity match the increase in AP firing rate in response to β-adrenergic receptor (β-AR) stimulation or phosphodiesterase (PDE) inhibition, that alters the AP firing rate of heart sinoatrial pacemaker cells. In cultured adult rabbit pacemaker cells infected with an adenovirus expressing the FRET sensor AKAR3, the EC50 in response to graded increases in the intensity of β-AR stimulation (by Isoproterenol) the magnitude of the increases in PKA activity and the spontaneous AP firing rate were similar (0.4±0.1nM vs. 0.6±0.15nM, respectively). Moreover, the kinetics (t1/2) of the increases in PKA activity and spontaneous AP firing rate in response to β-AR stimulation or PDE inhibition were tightly linked. We characterized the system rate-limiting biochemical reactions by integrating these experimentally derived data into a mechanistic-computational model. Model simulations predicted that phospholamban phosphorylation is a potent target of the increase in PKA activity that links to increase in spontaneous AP firing rate. In summary, the kinetics and stoichiometry of increases in PKA activity in response to a physiological (β-AR stimulation) or pharmacological (PDE inhibitor) stimuli match those of changes in the AP firing rate. Thus Ca(2+)-cAMP/PKA-dependent phosphorylation limits the rate and magnitude of increase in spontaneous AP firing rate. PMID:26241846

  1. Engineered Biological Pacemakers | NCI Technology Transfer Center | TTC

    Cancer.gov

    The National Institute on Aging's Cellular Biophysics Section is seeking statements of capability or interest from parties interested in collaborative research to further develop, evaluate, or commercialize biological pacemakers.

  2. [Scientific results of the pacemaker register: possibilities and limits].

    PubMed

    Wiegand, U K H; Lemke, B; Nowak, B

    2010-09-01

    The German obligatory external quality assurance for pacemaker implantation generates a large database giving an almost complete review of in-patient pacemaker interventions since 2001. Publications on lead fixation, age and gender dependency of pacemaker indications, choice of pacing mode and complication rates as well as investigations into the causes of lead dysfunction prove that the database is basically suitable for health service research. In contrast to pacemaker registries of other European countries the focus on in-patient operations, missing product specifications and the absence of patient follow-up largely limits the scientific potential of the database. It is greatly hoped that these limitations will be overcome by cross-sectional and longitudinal quality assurance within the next years. PMID:20668867

  3. Sleep Apnea May Raise Heart Risks in People with Pacemakers

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_158688.html Sleep Apnea May Raise Heart Risks in People With ... 2016 (HealthDay News) -- People with heart pacemakers and sleep apnea are at much greater risk for a ...

  4. Magnetic Resonance Imaging Conditional Pacemakers: Rationale, Development and Future Directions

    PubMed Central

    Cronin, Edmond M; Wilkoff, Bruce L

    2012-01-01

    Pacemakers and other cardiac implantable electronic devices (CIEDs) have long been considered an absolute contraindication to magnetic resonance imaging (MRI), a crucial and growing imaging modality. In the last 20 years, protocols have been developed to allow MR scanning of CIED patients with a low complication rate. However, this practice has remained limited to a relatively small number of centers, and many pacemaker patients continue to be denied access to clinically indicated imaging. The introduction of MRI conditional pacemakers has provided a widely applicable and satisfactory solution to this problem. Here, the interactions of pacemakers with the MR environment, the results of MR scanning in patients with conventional CIEDs, the development and clinical experience with MRI conditional devices, and future directions are reviewed. PMID:23071382

  5. Sleep Apnea May Raise Heart Risks in People with Pacemakers

    MedlinePlus

    ... risk for a dangerous heart rhythm disorder called atrial fibrillation, a new study suggests. With sleep apnea, breathing ... sleep disorder is a known risk factor for atrial fibrillation, but the risk for pacemaker patients with sleep ...

  6. Donation of explanted pacemakers for reuse in underserved nations.

    PubMed

    Stanyon, Robert

    2010-01-01

    Some charitable organizations and physicians are willing to assist in the compassionate donation of explanted pacemakers for reuse in medically underserved nations. However, healthcare organizations must recognize that the Food and Drug Administration (FDA), device manufacturers, professional societies and many physicians advocate return of explanted pacemakers to the manufacturer to ensure an accurate performance database promoting improved device reliability and safety for the patient. PMID:20151371

  7. Emergency Care of Patients with Pacemakers and Defibrillators.

    PubMed

    Allison, Michael G; Mallemat, Haney A

    2015-08-01

    Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) are commonly inserted to treat unstable cardiac rhythm disturbances. Despite the benefits of these devices on mortality and morbidity rates, patients often present to the emergency department with complaints related to device insertion or malfunction. Emergency physicians must be able to rapidly identify potential life threats caused by pacemaker malfunction, ICD firing, and complications associated with implantation of the devices. PMID:26226872

  8. Pacemaker activity and ionic currents in mouse atrioventricular node cells

    PubMed Central

    Marger, Laurine; Mesirca, Pietro; Alig, Jacqueline; Torrente, Angelo; Dubel, Stefan; Engeland, Birgit; Kanani, Sandra; Fontanaud, Pierre; Striessnig, Jörg; Shin, Hee-Sup; Isbrandt, Dirk; Ehmke, Heimo; Nargeot, Joël

    2011-01-01

    It is well established that pacemaker activity of the sino-atrial node (SAN) initiates the heartbeat. However, the atrioventricular node (AVN) can generate viable pacemaker activity in case of SAN failure, but we have limited knowledge of the ionic bases of AVN automaticity. We characterized pacemaker activity and ionic currents in automatic myocytes of the mouse AVN. Pacemaking of AVN cells (AVNCs) was lower than that of SAN pacemaker cells (SANCs), both in control conditions and upon perfusion of isoproterenol (ISO). Block of INa by tetrodotoxin (TTX) or of ICa,L by isradipine abolished AVNCs pacemaker activity. TTX-resistant (INar) and TTX-sensitive (INas) Na+ currents were recorded in mouse AVNCs, as well as T-(ICa,T) and L-type (ICa,L) Ca2+ currents. ICa,L density was lower than in SANCs (51%). The density of the hyperpolarization-activated current, (If) and that of the fast component of the delayed rectifier current (IKr) were, respectively, lower (52%) and higher (53%) in AVNCs than in SANCs. Pharmacological inhibition of If by 3 µM ZD-7228 reduced pacemaker activity by 16%, suggesting a relevant role for If in AVNCs automaticity. Some AVNCs expressed also moderate densities of the transient outward K+ current (Ito). In contrast, no detectable slow component of the delayed rectifier current (IKs) could be recorded in AVNCs. The lower densities of If and ICa,L, as well as higher expression of IKr in AVNCs than in SANCs may contribute to the intrinsically slower AVNCs pacemaking than that of SANCs. PMID:21406959

  9. [Necrosis of the pouch due to nontraumatic rupture of the pile during permanent endocardial electrostimulation].

    PubMed

    Circo, A; Mangiameli, S; Vanaria, D; Lombardo, D; Evola, R

    1977-09-30

    Necrosis of the pouch containing the generator, due to non-traumatic breakage of the batteries, was observed in a patient with a permanent pacemaker, followed by rapid ingravescence. The cause of this complication is discussed. Chemical inflammation was noted soon after the pacemaker ceased to function. Initially this was similar to the not uncommon bacterial inflammation noted in such patients. Here, of course, the pacemaker usually continues to work, and its replacement is optional, whereas in the reported case is an emergency matter. In situations where tissue distress in the pouch is accompanied by inflammation, therefore, thought should be given to the possibility that, even if the batteries are still working, the cause may be chemical or electrochemical rather than septic, and than sudden breakdown of the generator may be expected. PMID:917334

  10. Essure Permanent Birth Control

    MedlinePlus

    ... Implants and Prosthetics Essure Permanent Birth Control Essure Permanent Birth Control Share Tweet Linkedin Pin it More sharing options ... evaluation of the Essure System Essure is a permanent birth control method for women (female sterilization). Implantation of Essure ...

  11. Nonphotic entrainment of the human circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Klerman, E. B.; Rimmer, D. W.; Dijk, D. J.; Kronauer, R. E.; Rizzo, J. F. 3rd; Czeisler, C. A.

    1998-01-01

    In organisms as diverse as single-celled algae and humans, light is the primary stimulus mediating entrainment of the circadian biological clock. Reports that some totally blind individuals appear entrained to the 24-h day have suggested that nonphotic stimuli may also be effective circadian synchronizers in humans, although the nonphotic stimuli are probably comparatively weak synchronizers, because the circadian rhythms of many totally blind individuals "free run" even when they maintain a 24-h activity-rest schedule. To investigate entrainment by nonphotic synchronizers, we studied the endogenous circadian melatonin and core body temperature rhythms of 15 totally blind subjects who lacked conscious light perception and exhibited no suppression of plasma melatonin in response to ocular bright-light exposure. Nine of these fifteen blind individuals were able to maintain synchronization to the 24-h day, albeit often at an atypical phase angle of entrainment. Nonphotic stimuli also synchronized the endogenous circadian rhythms of a totally blind individual to a non-24-h schedule while living in constant near darkness. We conclude that nonphotic stimuli can entrain the human circadian pacemaker in some individuals lacking ocular circadian photoreception.

  12. Biasing the pacemaker in the behavioral theory of timing

    PubMed Central

    Bizo, Lewis A.; White, K. Geoffrey

    1995-01-01

    In the behavioral theory of timing, pacemaker rate is determined by overall rate of reinforcement. A two-alternative free-operant psychophysical procedure was employed to investigate whether pacemaker period was also sensitive to the differential rate of reinforcement. Responding on a left key during the first 25 s and on a right key during the second 25 s of a 50-s trial was reinforced at variable intervals, and variable-interval schedule values during the two halves of the trials were varied systematically. Responding on the right key during the first 25 s and on the left key during the second 25 s was not reinforced. Estimates of pacemaker period were derived from fits of a function predicted by the behavioral theory of timing to right-key response proportions in consecutive 5-s bins of the 50-s trial. Estimates of pacemaker period were shortest when the differential reinforcer rate most strongly favored right-key responses, and were longest when the differential reinforcer rate most strongly favored left-key responses. The results were consistent with the conclusion that pacemaker rate is influenced by relative reinforcer rate. PMID:16812769

  13. The neurochemical basis of photic entrainment of the circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Rea, Michael A.; Buckley, Becky; Lutton, Lewis M.

    1992-01-01

    Circadian rhythmicity in mammals is controlled by the action of a light-entrainable hypothalamus, in association with two cell clusters known as the supra chiasmatic nuclei (SCN). In the absence of temporal environmental clues, this pacemaker continues to measure time by an endogenous mechanism (clock), driving biochemical, physiological, and behavioral rhythms that reflect the natural period of the pacemaker oscillation. This endogenous period usually differs slightly from 24 hours (i.e., circadian). When mammals are maintained under a 24 hour light-dark (LD) cycle, the pacemaker becomes entrained such that the period of the pacemaker oscillation matches that of the LD cycle. Potentially entraining photic information is conveyed to the SCN via a direct retinal projection, the retinohypothalamic tract (RHT). RHT neurotransmission is thought to be mediated by the release of excitatory amino acids (EAA) in the SCN. In support of this hypothesis, recent experiments using nocturnal rodents have shown that EAA antagonists block the effects of light on pacemaker-driven behavioral rhythms, and attenuate light induced gene expression in SCN cells. An understanding of the neurochemical basis of the photic entrainment process would facilitate the development of pharmacological strategies for maintaining synchrony among shift workers in environments, such as the Space Station, which provide unreliable or conflicting temporal photic clues.

  14. Factors associated with implantation of single- versus dual-chamber pacemakers in 1992.

    PubMed

    Daley, W R

    1998-08-01

    Characteristics of hospitalized patients receiving initial pacemaker implantation were determined using a multistate inpatient discharge database. Analysis revealed a significant association of pacemaker type with patient age and income level, even after controlling for diagnostic factors. PMID:9708676

  15. Aortic root infection in a prosthetic valve demonstrated by gallium-67 citrate SPECT.

    PubMed

    Thomson, L E J; Goodman, M P; Naqvi, T Z; Feldman, R; Buchbinder, N A; Waxman, A; D'Agnolo, A

    2005-04-01

    A 70-year-old man presented with 6 weeks of worsening low back pain, fever, sweating, and weight loss with known severe lumbosacral osteoarthritis. His history included CABG in 1992, porcine aortic valve replacement, and permanent pacemaker implantation in 2002. CT of the chest, abdomen, and pelvis did not demonstrate a cause for the symptoms. Blood cultures grew penicillin-sensitive enterococcus and he was referred for evaluation of possible osteodiskitis or epidural abscess. Gallium planar imaging demonstrated increased activity in the lumbar spine, suspicious for the presence of infection, and activity was noted in the mid mediastinum as well. SPECT clearly showed increased Ga-67 activity in the region of the aortic root, suspicious for infection. A perivalvular aortic root abscess was subsequently demonstrated by transesophageal echo. This case illustrates the value of Ga-67 chest SPECT in patients with prosthetic valves for detection of endocarditis. PMID:15764887

  16. Positional convulsant syncope in a pacemaker patient following insulation break of the right ventricular lead

    PubMed Central

    Ben Lassoued, Mehdi; Baatour, Makram; Haggui, Abdeddayem; Lamine, Khaled

    2014-01-01

    In spite of the advances made in the technology of pacemakers which resulted in a decrease in the incidence of pacemaker lead fracture, the latter remains a potential complication of implanted pacemakers manufactured in the early days. In this report, we present a case of fracture of the unipolar electrode diagnosed by an emergency physician in a patient on a pacemaker for 10 years who presented to the emergency department with positional convulsant syncopes. PMID:24827652

  17. Positional convulsant syncope in a pacemaker patient following insulation break of the right ventricular lead.

    PubMed

    Ben Lassoued, Mehdi; Baatour, Makram; Haggui, Abdeddayem; Lamine, Khaled

    2014-01-01

    In spite of the advances made in the technology of pacemakers which resulted in a decrease in the incidence of pacemaker lead fracture, the latter remains a potential complication of implanted pacemakers manufactured in the early days. In this report, we present a case of fracture of the unipolar electrode diagnosed by an emergency physician in a patient on a pacemaker for 10 years who presented to the emergency department with positional convulsant syncopes. PMID:24827652

  18. [Development and research of temporary demand pacemaker with electrocardiosignal display].

    PubMed

    Fan, Shounian; Jiang, Chenxi; Cai, Yunchang; Pan, Yangzhong; Yang, Tianhe; Wu, Qiang; Zheng, Yaxi; Liu, Xiaoqiao; Li, Shiying

    2004-08-01

    A temporary demand pacemaker with electrocardiosignal display is introduced in this paper. Double way low-noise electrocardiosignal preamplifier, amplitude limiter, high and low pass filter, 50 Hz notch filter, TTL level generator and stimulating pulse formation circuit are components of the hardware electrocircuit. The demand pacing and the electrocardiosignal display are separately controlled by the software in which the double microcontrollers communications technique is used. In this study, liquid crystal display is firstly used in body surface electrocardiosignal display or intracardial electrophysiologic signal display when the temporary demand pacemaker is installed and put into use. The machine has proven clinically useful and can be of wide appliation. PMID:15357453

  19. [Electromagnetic interference of electrical dental equipment with cardiac pacemakers].

    PubMed

    Brand, H S; van der Hoeff, E V; Schrama, T A M; Entjes, M L; van Nieuw, Amerongen A

    2007-09-01

    Eight different electrical dental appliances were tested at different intervals for their ability to interfere with the function of a contemporary cardiac pacemaker. The normal atrial and ventricular pacing was inhibited by an ultrasonic bath cleaner at a distance of less than 15 cm. In contrast, a dental chair, an electrosurgical unit, an ultrasonic tooth scaler, 2 handpieces, and 2 amalgamators failed to produce electromagnetic interference at the minimum distance of 2.5 cm. In conclusion, the results suggest that normal clinical use of dental electrical equipment does not have any significant effect on the cardiac pacemaker tested. PMID:17937372

  20. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues.

    PubMed

    Korantzopoulos, Panagiotis; Sideris, Skevos; Dilaveris, Polychronis; Gatzoulis, Konstantinos; Goudevenos, John A

    2016-04-01

    A significant increase in the implantation of cardiac implantable electronic devices (CIEDs) is evident over the past years, while there is evidence for a disproportionate increase in CIED-related infections. The cumulative probability of device infection seems to be higher in implantable cardioverter defibrillator and in cardiac resynchronization therapy patients compared with permanent pacemaker patients. Given that more than a half of CIED infections are possibly related to the operative procedure, there is a need for effective periprocedural infection control. However, many of the current recommendations are empirical and not evidence-based, while questions, unresolved issues, and conflicting evidence arise. The perioperative systemic use of antibiotics confers significant benefit in prevention of CIED infections. However, there are no conclusive data regarding the specific value of each agent in different clinical settings, the value of post-operative antibiotic treatment as well as the optimal duration of therapy. The merit of local pocket irrigation with antibiotic and/or antiseptic agents remains unproved. Of note, recent evidence indicates that the application of antibacterial envelopes into the device pocket markedly decreases the infection risk. In addition, limited reports on strict integrated infection control protocols show a dramatic reduction in infection rates in this setting and therefore deserve further attention. Finally, the relative impact of particular factors on the infection risk, including the type of the CIED, patients' individual characteristics and comorbidities, should be further examined since it may facilitate the development of tailored prophylactic interventions for each patient. PMID:26516219

  1. 76 FR 53851 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ... a proposed rule that appeared in the Federal Register of August 8, 2011 (76 FR 48058). The document..., Silver Spring, MD 20993-0002, 301-796-6216. SUPPLEMENTARY INFORMATION: In FR Doc. 2011-19959, appearing... read ``1. Geiger, D.R., ``FY 2003 and 2004 Unit Costs for the Process of Medical Device...

  2. 76 FR 48058 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-08

    ... the cost of PMA at approximately $1,000,000 (see, for example, 73 FR 7501, February 8, 2008), and we... set at $236,298 for a premarket application (PMA or PDP) (75 FR 45632 at 45643), so user fees would... classification of this device along with information submitted in response to the 515(i) order (74 FR...

  3. 77 FR 39924 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-06

    ... cost of a PMA at approximately $1,000,000 (see, for example, 73 FR 7501, February 8, 2008), and we... application (PMA or PDP) (75 FR 45643), so user fees will likely cover $4.3 million (= 18 x $236,298) to $5.4... premarket approval. In the Federal Register of May 6, 1994 (59 FR 23731) (the May 6, 1994, notice),...

  4. [Practical questions around individual with a pacemaker or an implantable cardioverter defibrillator].

    PubMed

    Manaouil, Cécile; Fantoni, Sophie; Montpellier, Dominique; Tordjman, Eric; Jarde, Olivier

    2012-07-01

    An individual with a pacemaker can ask his GP for information about potential problems associated with the device. Should a pacemaker continue to be used by end-of-life patients? Should a pacemaker be stopped in a limited care situation? What precautions should be taken when treating a patient with a pacemaker? Pacemakers and implantable defibrillators are sensitive to electromagnetic interference (EMI). Medically, MRIs are theoretically contraindicated, even though examinations could be performed without a major problem, and special precautions should be taken when using an electrosurgical cutter or radiotherapy. In case of death, a doctor or embalmer must remove the patient's pacemaker due to its risk of explosion during cremation. Doctors who sign cremation forms have a legal obligation to provide such information. It may affect an employee's ability to work. Are there some professions that are not well suited for individuals with a pacemaker? PMID:22138293

  5. Hardware-in-the-loop simulation and energy optimization of cardiac pacemakers.

    PubMed

    Barker, Chris; Kwiatkowska, Marta; Mereacre, Alexandru; Paoletti, Nicola; Patane, Andrea

    2015-08-01

    Implantable cardiac pacemakers are medical devices that can monitor and correct abnormal heart rhythms. To provide the necessary safety assurance for pacemaker software, both testing and verification of the code, as well as testing the entire pacemaker hardware in the loop, is necessary. In this paper, we present a hardware testbed that enables detailed hardware-in-the-loop simulation and energy optimisation of pacemaker algorithms with respect to a heart model. Both the heart and the pacemaker models are encoded in Simulink/Stateflow™ and translated into executable code, with the pacemaker executed directly on the microcontroller. We evaluate the usefulness of the testbed by developing a parameter synthesis algorithm which optimises the timing parameters based on power measurements acquired in real-time. The experiments performed on real measurements successfully demonstrate that the testbed is capable of energy minimisation in real-time and obtains safe pacemaker timing parameters. PMID:26737950

  6. Very-late proarrhythmia of a migrant pacemaker lead.

    PubMed

    Stein, Andreas; Mazzitelli, Domenico; Kolb, Christof

    2011-01-01

    The report is on a 49-year-old patient who experienced life-threatening ventricular tachyarrhythmias caused by a pacemaker lead that was abandoned 26 years ago, migrated with its proximal ending to the main pulmonary artery and remained there asymptomatically for at least 3 years. PMID:20888005

  7. Factors defining a pacemaker region for synchrony in the hippocampus

    PubMed Central

    Wittner, Lucia; Miles, Richard

    2007-01-01

    Synchronous activities of neuronal populations are often initiated in a pacemaker region and spread to recruit other regions. Here we examine factors that define a pacemaker site. The CA3a region acts as the pacemaker for disinhibition induced synchrony in guinea pig hippocampal slices and CA3b is a follower region. We found CA3a pyramidal cells were more excitable and fired in bursts more frequently than CA3b cells. CA3a cells had more complex dendritic arbors than CA3b cells especially in zones targetted by recurrent synapses. The product of the density of pyramidal cell axon terminals and dendritic lengths in innervated zones predicted a higher recurrent synaptic connectivity in the CA3a than in the CA3b region. We show that some CA3a cells but few CA3b cells behave as pacemaker cells by firing early during population events and by recruiting follower cells to fire. With a greater excitability and enhanced synaptic connectivity these CA3a cells may also possess initiating functions for other hippocampal ensemble activities initiated in this region. PMID:17823211

  8. Circadian organization is governed by extra-SCN pacemakers.

    PubMed

    Pezuk, Pinar; Mohawk, Jennifer A; Yoshikawa, Tomoko; Sellix, Michael T; Menaker, Michael

    2010-12-01

    In mammals, a pacemaker in the suprachiasmatic nucleus (SCN) is thought to be required for behavioral, physiological, and molecular circadian rhythms. However, there is considerable evidence that temporal food restriction (restricted feedisng [RF]) and chronic methamphetamine (MA) can drive circadian rhythms of locomotor activity, body temperature, and endocrine function in the absence of SCN. This indicates the existence of extra-SCN pacemakers: the Food Entrainable Oscillator (FEO) and Methamphetamine Sensitive Circadian Oscillator (MASCO). Here, we show that these extra-SCN pacemakers control the phases of peripheral oscillators in intact as well as in SCN-ablated PER2::LUC mice. MA administration shifted the phases of SCN, cornea, pineal, pituitary, kidney, and salivary glands in intact animals. When the SCN was ablated, disrupted phase relationships among peripheral oscillators were reinstated by MA treatment. When intact animals were subjected to restricted feeding, the phases of cornea, pineal, kidney, salivary gland, lung, and liver were shifted. In SCN-lesioned restricted-fed mice, phases of all of the tissues shifted such that they aligned with the time of the meal. Taken together, these data show that FEO and MASCO are strong circadian pacemakers able to regulate the phases of peripheral oscillators. PMID:21135159

  9. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker repair or replacement material. 870.3710 Section 870.3710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710...

  10. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker repair or replacement material. 870.3710 Section 870.3710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710...

  11. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker electrode function tester. 870.3720 Section 870.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3720...

  12. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker electrode function tester. 870.3720 Section 870.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3720...

  13. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker repair or replacement material. 870.3710 Section 870.3710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710...

  14. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker electrode function tester. 870.3720 Section 870.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3720...

  15. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker repair or replacement material. 870.3710 Section 870.3710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710...

  16. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker electrode function tester. 870.3720 Section 870.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3720...

  17. Generation of murine cardiac pacemaker cell aggregates based on ES-cell-programming in combination with Myh6-promoter-selection.

    PubMed

    Rimmbach, Christian; Jung, Julia J; David, Robert

    2015-01-01

    Treatment of the "sick sinus syndrome" is based on artificial pacemakers. These bear hazards such as battery failure and infections. Moreover, they lack hormone responsiveness and the overall procedure is cost-intensive. "Biological pacemakers" generated from PSCs may become an alternative, yet the typical content of pacemaker cells in Embryoid Bodies (EBs) is extremely low. The described protocol combines "forward programming" of murine PSCs via the sinus node inducer TBX3 with Myh6-promoter based antibiotic selection. This yields cardiomyocyte aggregates consistent of >80% physiologically functional pacemaker cells. These "induced-sinoatrial-bodies" ("iSABs") are spontaneously contracting at yet unreached frequencies (400-500 bpm) corresponding to nodal cells isolated from mouse hearts and are able to pace murine myocardium ex vivo. Using the described protocol highly pure sinus nodal single cells can be generated which e.g. can be used for in vitro drug testing. Furthermore, the iSABs generated according to this protocol may become a crucial step towards heart tissue engineering. PMID:25742394

  18. [Behavior of various activity-controlled cardiac pacemakers in treadmill stress tests with variable slopes].

    PubMed

    Matula, M; Hölzer, K; Zitzmann, E; Schön, H; Alt, E

    1993-02-01

    New activity pacemaker systems with the principle of sensing low-frequency acceleration in the anterior-posterior axis are currently under clinical evaluation. We compared the pacemaker system Relay, which represents this new generation of accelerometer controlled devices, with conventional activity systems sensing pressure and vibration. Ten pacemaker patients with implanted Activitrax, Sensolog or Relay pacemakers and 10 healthy volunteers with externally strapped-on pacemakers were studied. The aim was to evaluate the systems' ability to distinguish different workloads during graded treadmill testing with changes in speed and/or slope. The rate adaption of the new acceleration sensing pacemakers was found to be more adequate compared to vibration and pressure-sensing pacemakers when only the slope of the treadmill was varied. The acceleration-sensing pacemaker adjusted its rate according to the workload largely independent from the type of stress (n.s.). With the vibration and pressure-sensing pacemakers, however, significant differences (p < 0.05) were seen between rate adaption in the two stress test modes. The new generation of acceleration-sensing pacemakers has certain advantages over conventional vibration-sensitive systems in terms of a higher sensitivity to varying workloads and higher specificity to the type of exercise performed. PMID:8465563

  19. Rare earth permanent magnets

    SciTech Connect

    Major-Sosias, M.A.

    1993-10-01

    Permanent magnets were discovered centuries ago from what was known as {open_quotes}lodestone{close_quotes}, a rock containing large quantities of the iron-bearing mineral magnetite (Fe{sub 3}O{sub 4}). The compass was the first technological use for permanent magnetic materials; it was used extensively for navigational purposes by the fifteenth century. During the twentieth century, as new applications for permanent magnets were developed, interest and research in permanent magnetic materials soared. Four major types of permanent magnets have been developed since the turn of the century.

  20. Feasibility of spinal cord stimulation in angina pectoris in patients with chronic pacemaker treatment for cardiac arrhythmias.

    PubMed

    Ekre, Olof; Börjesson, Mats; Edvardsson, Nils; Eliasson, Tore; Mannheimer, Clas

    2003-11-01

    Spinal cord stimulation (SCS) has been used since 1985 as additional symptom-relieving treatment for patients with severe angina pectoris despite optimal conventional medical and invasive treatment. SCS has antiischemic effects and is safe and effective in long-term use. Several patients with coronary artery disease also suffer from disorders that necessitate the use of a cardiac permanent pacemaker (PPM). The combination of SCS and PPM has previously been considered hazardous because of possible false inhibition of the PPM. To assess if thoracic SCS and PPM can be safely combined in patients with refractory angina pectoris, 18 patients treated with both SCS and PPM were tested. The PPM settings were temporarily modified to increase the probability of interference, while the SCS intensity (used in bipolar mode) was increased to the maximum level tolerated by the patient. Any sign of inhibition of the ventricular pacing was recorded by continuous ECG monitoring. With the aid of a questionnaire, symptoms of interference during long-term treatment were evaluated. No patient had signs of inhibition during the tests. Reprogramming of the pacemaker because of the test results was not needed in any of the patients. The long-term follow-up data revealed no serious events. This study indicates that bipolar SCS and PPM can be safely combined in patients with refractory angina pectoris. However, individual testing is mandatory to ascertain safety in each patient. A testing procedure for patients in need of SCS and PPM is suggested in this article. PMID:14622316

  1. Absent right and persistent left superior vena cava: troubleshooting during a challenging pacemaker implant: a case report

    PubMed Central

    2014-01-01

    Background Venous anomalies of the thorax can occur in isolation or in association with complex congenital heart disease. The incidence of an absent right superior vena cava in the setting of a persistent left superior vena cava is very rare in the general population with only a dozen cases documented in the medical literature. Such venous anomalies can make for very challenging electronic cardiac device implantation. We report our challenging dual chamber pacemaker implant in a patient with such complex anatomy and focus on our implantation technique that helped achieve adequate lead positioning. Case presentation A 73-year-old Caucasian female with degenerative complete heart block presented for dual chamber permanent pacemaker implant. Lead implantation was very challenging due to abnormal and rare vena cava anatomy; a persistent left superior vena cava drained directly into the coronary sinus and the right brachiocephalic vein drained directly into the left persistent superior vena cava as the patient had an absent right superior vena cava . Adequate right ventricular lead positioning was achieved following numerous lead-stylet manipulations and careful looping in the atria to redirect its trajectory to the ventricular apex. Conclusion Abnormal superior vena cava development is uncommon and can lead to technical challenges when venous access is required during various interventional procedures. Pre-operative imaging can help identify such challenging anatomy allowing appropriate operative planning; careful patient selection is warranted for venography given the risk of contrast nephrotoxicity. PMID:25047923

  2. Design and Testing of a Percutaneously Implantable Fetal Pacemaker

    PubMed Central

    Loeb, Gerald E.; Zhou, Li; Zheng, Kaihui; Nicholson, Adriana; Peck, Raymond A.; Krishnan, Anjana; Silka, Michael; Pruetz, Jay; Chmait, Ramen; Bar-Cohen, Yaniv

    2012-01-01

    We are developing a cardiac pacemaker with a small, cylindrical shape that permits percutaneous implantation into a fetus to treat complete heart block and consequent hydrops fetalis, which can otherwise be fatal. The device uses off-the-shelf components including a rechargeable lithium cell and a highly efficient relaxation oscillator encapsulated in epoxy and glass. A corkscrew electrode made from activated iridium can be screwed into the myocardium, followed by release of the pacemaker and a short, flexible lead entirely within the chest of the fetus to avoid dislodgement from fetal movement. Acute tests in adult rabbits demonstrated the range of electrical parameters required for successful pacing and the feasibility of successfully implanting the device percutaneously under ultrasonic imaging guidance. The lithium cell can be recharged inductively as needed, as indicated by a small decline in the pulsing rate. PMID:22855119

  3. [Elemental research on intelligent non-invasive temporary pacemakers].

    PubMed

    Nie, Bang-ji; Xu, Long; Xin, Xue-gang; Wang, Cheng-lai; Wu, Min-shan

    2005-01-01

    Some research on intelligent non-invasive temporary pacemakers is introduced in this paper. An industrial computer, some IC chips and other elements are used to construct its hardware, and its software is in C++ language. The experimental device has some intelligent functions of recognizing some arrhythmia. The system has a pacemaker module and an ECG monitor module. Its software includes a main program, a RS-232C communication program, a printer VxD, a pacing control VxD and ECG signal pretreatment and recognizing program and so on. The pacing-generating circuit is employed to make the precision control of pacing current. The communication between industrial-computer system and ECG module is completed through the DLL. The real time processing of ECG signals is based on filter method for a higher recognizing ratio. The system calculates several parameters to recognize certain arrhythmia and uses MIT/BIH database to validate the reliability of ECG recognition. PMID:15875682

  4. [Representations, myths, and behaviors among Chagas disease patients with pacemakers].

    PubMed

    Magnani, Claudia; Oliveira, Bruna Guimarães; Gontijo, Eliane Dias

    2007-07-01

    This anthropological study aimed to evaluate the incorporation of pacemakers into the lives of individuals with Chagas disease. An ethnographic methodology was used, based on an open interview focusing on the personal perceptions of 15 patients with chronic Chagas cardiopathy who had required pacemaker implants at the Federal University Hospital in Belo Horizonte, Minas Gerais State, Brazil. As part of a broader quality of life analysis, the study investigated the cultural, physical, and psychological resources used by patients to confront, explain, and accept the disease process, including mental representations on the cultural perception of the illness and definition of social relations. The study was intended to contribute to comprehensive patient care by health professionals, including psychosocial aspects. Decoded and integrated orientation in the cultural sphere assumes an important role in order to prevent disinformation from perpetuating the dissemination of popular myths as active elements in patient stigmatization. PMID:17572811

  5. Percutaneously Inject able Fetal Pacemaker: Electrodes, Mechanical Design and Implantation*

    PubMed Central

    Zhou, Li; Chmait, Ramen; Bar-Cohen, Yaniv; Peck, Raymond A.; Loeb, Gerald E.

    2015-01-01

    We are developing a self-contained cardiac pacemaker with a small, cylindrical shape (~3×20mm) that permits it to be implanted percutaneously into a fetus to treat complete heart block and consequent hydrops fetalis, which is otherwise fatal. The device uses off-the-shelf components including a rechargeable lithium cell and a highly efficient relaxation oscillator encapsulated in epoxy and glass. A corkscrew electrode made from activated iridium can be screwed into the myocardium, followed by release of the pacemaker and a short, flexible lead entirely within the chest of the fetus to avoid dislodgement from fetal movement. The feasibility of implanting the device percutaneously under ultrasonic imaging guidance was demonstrated in acute adult rabbit experiments. PMID:23367442

  6. Transient apical dyskinesia with a pacemaker: Electrocardiographic features.

    PubMed

    Núñez-Gil, Iván J; Feltes, Gisela I; Mejía-Rentería, Hernán D; Biagioni, Corina; De Agustín, J Alberto; Vivas, David; Fernández-Ortiz, Antonio

    2015-04-01

    Transient apical dyskinesia syndromes present features similar to acute coronary syndromes, but with normal coronary arteries and rapid complete resolution of wall motion alterations. We report the case of a 73-year-old woman who was admitted to hospital because of typical chest pain at rest after her brother's death. She had had a pacemaker implanted in 2001. Troponin levels were elevated and apical hypokinesia was shown by ventriculography and echocardiography, with normal coronary arteries. Evolving ECG alterations were observed in spite of the continued pacing rhythm. All these alterations were fully resolved after discharge. This case shows that, even in the presence of a pacemaker, evolving ECG alterations can be observed in Takotsubo syndrome. PMID:25840647

  7. Temporary transvenous pacemaker placement in the Emergency Department.

    PubMed

    Harrigan, Richard A; Chan, Theodore C; Moonblatt, Steven; Vilke, Gary M; Ufberg, Jacob W

    2007-01-01

    Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure. PMID:17239740

  8. A Computer-Aided Large Scale Pacemaker Surveillance System*

    PubMed Central

    Covvey, H.D.; MacGregor, D.C.; Noble, E.J.; Goldman, B.S.; Wigle, E.D.

    1980-01-01

    Beginning in 1972 with a small PDP-8 based system, our Pacemaker Center has continued a commitment to the implementation of computer-based systems to reduce the cost and increase the safety of patient follow-up. Recently we brought into operation a new version of our patient surveillance system on our shared database management computer, the Sperry-Univac V-76. A complete set of optical mark readable forms has been developed to capture pacemaker data. A variety of operational support reports are produced. Pre-clinic and pre-telephone follow-up reports summarize patient status and serve as a basis for comparing the patient's current state to his history of encounters. Post-clinic and post-transtelephone reports document the encounter and are used as reports to the referring physician and for inclusion in the patient's chart. The surgical form set is used to generate a detailed operative note.

  9. Permanent cardiac pacing in pediatric patients.

    PubMed

    Lotfy, Wael; Hegazy, Ranya; AbdElAziz, Osama; Sobhy, Rodina; Hasanein, Hossam; Shaltout, Fawzan

    2013-02-01

    Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow

  10. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data.

    PubMed

    Loupa, C; Mavroidi, N; Boutsikakis, I; Paniara, O; Deligarou, O; Manoli, H; Saroglou, G

    2004-06-01

    The epidemiology, and clinical and microbiological spectrum, of infective endocarditis (IE) in Greece was analysed in a prospective 4-year study in a tertiary hospital and a heart surgery centre in Athens. In total, 101 cases of IE (71 men, 30 women, aged 54.4 +/- 17.1 years) were studied, with a follow-up period of 3 months. Seventy-seven cases were definite and 24 possible; 59 involved native valves (native valve endocarditis; NVE), 31 prosthetic valves (prosthetic valve endocarditis; PVE), of which nine were early and 22 late, and 11 permanent pacemakers (pacemaker endocarditis; PME). There was a predominant involvement of aortic (48/101) and mitral (40/101) valves. Seven patients had rheumatic valvular disease, two had mitral valve prolapse, and eight had a previous history of IE. Thirteen and six patients had undergone dental and endoscopic procedures, respectively. In 13 patients, intravenous catheters were used within the 3 months before diagnosis of IE. There were three intravenous drug users among the patients. Staphylococcus aureus was the most important pathogen, isolated in 22% of cases, followed by viridans streptococci (19%) and coagulase-negative staphylococci (16%). Enterococcus spp. were responsible for 3%, HACEK group for 2%, and fungi for 6% of cases. Viridans streptococci were the leading cause of NVE (29%), Staphylococcus epidermidis of PVE (16%), and S. aureus of PME (54.5%). Six of 22 S. aureus and ten of 16 S. epidermidis isolates were methicillin-resistant. Surgical intervention, including total pacemaker removal, was performed in 51.5% of patients. Overall mortality was 16%, but was 29% with PVE, and was significantly higher with medical than with combined surgical and medical therapy (24.5% vs. 8%). Compared with previous studies, there were changing trends in the epidemiology, microbiology, treatment and prognosis of IE in Greece. PMID:15191385

  11. Plethyzmography in assessment of hemodynamic results of pacemaker functions programming

    NASA Astrophysics Data System (ADS)

    Wojciechowski, Dariusz; Sionek, Piotr; Peczalski, Kazimierz; Janusek, Dariusz

    2011-01-01

    The paper presents potential role of plethyzmography in optimization of heart hemodynamic function during pacemaker programming. The assessment of optimal stroke volume in patients, with implanted dual chamber pacemaker (DDD), by plethyzmography was a goal of the study. The data were collected during pacing rhythm. 20 patients (8 female and 12 male, average 77.4+/-4.6 years) with dual chamber pacemaker (DDD) and with pacing rhythm during routine pacemaker control and study tests were incorporated in the study group. Hemodynamic parameters were assessed during modification of atrio-ventricular delay (AVD) for pacing rhythm of 70 bpm and 90 bpm. The time of atrioventricular was programmed with 20 ms steps within range 100-200 ms and data were recorded with two minutes delay between two consecutive measurements. Stroke volume (SV) and cardiac output (CO) were calculated from plethyzmographic signal by using Beatscope software (TNO Holand). Highest SV calculated for given pacing rhythm was named optimal stroke volume (OSV) and consequently highest cardiac output was named maximal cardiac output (MCO). The time of atrio-ventricular delay for OSV was named optimal atrioventricular delay (OAVD). The results have showed: mean values of OAVD for 70 bpm - 152+/-33 ms and for 90 bpm -149+/-35 ms, shortening of the mean OAVD time caused by increase of pacing rate from 70 bpm to 90 bpm what resulted in statistically significant decrease of OSV with not statistically significant increase of MCO. The analysis of consecutive patients revealed three types of response to increase of pacing rhythm: 1. typical-shortening of OAVD, 2. neutral-no change of OAVD and 3.atypical-lengthening of OAVD.

  12. Integrative Modeling of Electrical Properties of Pacemaker Cardiac Cells

    NASA Astrophysics Data System (ADS)

    Grigoriev, M.; Babich, L.

    2016-06-01

    This work represents modeling of electrical properties of pacemaker (sinus) cardiac cells. Special attention is paid to electrical potential arising from transmembrane current of Na+, K+ and Ca2+ ions. This potential is calculated using the NaCaX model. In this respect, molar concentration of ions in the intercellular space which is calculated on the basis of the GENTEX model is essential. Combined use of two different models allows referring this approach to integrative modeling.

  13. Physiological effects of light on the human circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Shanahan, T. L.; Czeisler, C. A.

    2000-01-01

    The physiology of the human circadian pacemaker and its influence and on the daily organization of sleep, endocrine and behavioral processes is an emerging interest in science and medicine. Understanding the development, organization and fundamental properties underlying the circadian timing system may provide insight for the application of circadian principles to the practice of clinical medicine, both diagnostically (interpretation of certain clinical tests are dependent on time of day) and therapeutically (certain pharmacological responses vary with the time of day). The light-dark cycle is the most powerful external influence acting upon the human circadian pacemaker. It has been shown that timed exposure to light can both synchronize and reset the phase of the circadian pacemaker in a predictable manner. The emergence of detectable circadian rhythmicity in the neonatal period is under investigation (as described elsewhere in this issue). Therefore, the pattern of light exposure provided in the neonatal intensive care setting has implications. One recent study identified differences in both amount of sleep time and weight gain in infants maintained in a neonatal intensive care environment that controlled the light-dark cycle. Unfortunately, neither circadian phase nor the time of day has been considered in most clinical investigations. Further studies with knowledge of principles characterizing the human circadian timing system, which governs a wide array of physiological processes, are required to integrate these findings with the practice of clinical medicine.

  14. [When do you implant a pacemaker in myotonic dystrophy?].

    PubMed

    Babuty, Dominique; Lallemand, Bénédicte; Laurent, Valérie; Clémenty, Nicolas; Pierre, Bertrand; Fauchier, Laurent; Raynaud, Martine; Pellieux, Sybille

    2011-01-01

    Myotonic dystrophy is the most frequent adult form of hereditary muscular dystrophy caused by a mutation on the DMPK gene. Myotonic dystrophy leads to multiple systemic complications related to weakness, respiratory failure, cardiac arrhythmias and cardiac conduction disturbances. Age of death is earlier in myotonic dystrophy patients than in general population with a high frequency of sudden death. Several mechanisms are involved in sudden death: atrio-ventricular block, severe ventricular arrhythmias or non-cardiac mechanism. The high degree of atrio-ventricular block is a well-recognized indication of pacemaker implantation but the prophylactic implantation of pacemaker should be considered to prevent sudden death in asymptomatic myotonic dystrophy patients. A careful clinical evaluation needs to be done for the identification of patients at high risk of sudden death. The resting ECG and SA ECG are non-invasive tools useful to select the patients who need an electrophysiologic study. In presence of prolonged HV interval more than or equal to 70 ms one can discuss the implantation of a prophylactic pacemaker. The choice of an implantable cardiac defibrillator is preferred in presence of spontaneous ventricular tachycardia or an alteration of the left ventricular ejection fraction. PMID:21549556

  15. Isolating Neural Correlates of the Pacemaker for Food Anticipation

    PubMed Central

    Blum, Ian David; Waddington Lamont, Elaine; Rodrigues, Trevor; Abizaid, Alfonso

    2012-01-01

    Mice fed a single daily meal at intervals within the circadian range exhibit food anticipatory activity. Previous investigations strongly suggest that this behaviour is regulated by a circadian pacemaker entrained to the timing of fasting/refeeding. The neural correlate(s) of this pacemaker, the food entrainable oscillator (FEO), whether found in a neural network or a single locus, remain unknown. This study used a canonical property of circadian pacemakers, the ability to continue oscillating after removal of the entraining stimulus, to isolate activation within the neural correlates of food entrainable oscillator from all other mechanisms driving food anticipatory activity. It was hypothesized that continued anticipatory activation of central nuclei, after restricted feeding and a return to ad libitum feeding, would elucidate a neural representation of the signaling circuits responsible for the timekeeping component of the food entrainable oscillator. Animals were entrained to a temporally constrained meal then placed back on ad libitum feeding for several days until food anticipatory activity was abolished. Activation of nuclei throughout the brain was quantified using stereological analysis of c-FOS expressing cells and compared against both ad libitum fed and food entrained controls. Several hypothalamic and brainstem nuclei remained activated at the previous time of food anticipation, implicating them in the timekeeping mechanism necessary to track previous meal presentation. This study also provides a proof of concept for an experimental paradigm useful to further investigate the anatomical and molecular substrates of the FEO. PMID:22558352

  16. Gold-coated pacemaker implantation for a patient with type IV allergy to titanium

    PubMed Central

    Kypta, Alexander; Blessberger, Hermann; Lichtenauer, Michael; Lambert, Thomas; Kammler, Juergen; Steinwender, Clemens

    2016-01-01

    A 65-year-old man was scheduled for pacemaker implantation for symptomatic sick-sinus-syndrome (SSS). He suffered from multiple drug-allergies and allergies to several metals like quicksilver and titanium. Gold-coated pacemaker generators and polyurethane leads are effective in avoiding allergic reactions to pacing system components. Therefore, we decided to implant a custom-made gold-coated DDDR-pacemaker generator and polyurethane leads. PMID:27479204

  17. Gold-coated pacemaker implantation for a patient with type IV allergy to titanium.

    PubMed

    Kypta, Alexander; Blessberger, Hermann; Lichtenauer, Michael; Lambert, Thomas; Kammler, Juergen; Steinwender, Clemens

    2015-01-01

    A 65-year-old man was scheduled for pacemaker implantation for symptomatic sick-sinus-syndrome (SSS). He suffered from multiple drug-allergies and allergies to several metals like quicksilver and titanium. Gold-coated pacemaker generators and polyurethane leads are effective in avoiding allergic reactions to pacing system components. Therefore, we decided to implant a custom-made gold-coated DDDR-pacemaker generator and polyurethane leads. PMID:27479204

  18. Permanent contraception for women.

    PubMed

    Micks, Elizabeth A; Jensen, Jeffrey T

    2015-11-01

    Permanent methods of contraception are used by an estimated 220 million couples worldwide, and are often selected due to convenience, ease of use and lack of side effects. A variety of tubal occlusion techniques are available for female permanent contraception, and procedures can be performed using a transcervical or transabdominal approach. This article reviews currently available techniques for female permanent contraception and discusses considerations when helping patients choose a contraceptive method and tubal occlusion technique. PMID:26626698

  19. Interference of implanted cardiac pacemakers with TASER X26 dart mode application.

    PubMed

    Leitgeb, Norbert; Niedermayr, Florian; Neubauer, Robert

    2012-06-01

    The prevalence of pacemaker patients among the general population and of conducted energy devices for law enforcement and self-defence is increasing. Consequently, the question on whether cardiac pacemaker patients are at particular risk becomes increasingly important, in particular, as the widespread use of such devices is planned in Europe. The risk of pacemaker patients has been investigated by numerical simulation at detailed anatomical models of patients with cardiac pacemakers implanted in left pectoral, right pectoral, and abdominal positions, with the monopolar electrode placed at the ventricular apex. The induced cardiac pacemaker interference voltages have been assessed for distant application of TASER X26 devices with dart electrodes propelled towards a subject. It could be shown that interference voltages are highest in abdominal pacemaker implantation, while they are about 20% lower in left or right pectoral sites. They remain below the immunity threshold level as defined by safety standards of implanted cardiac pacemakers and of implanted cardioverter defibrillators to prevent persisting malfunction or damage. However, induced voltages are high enough to be sensed by the pacemaker and to capture pacemaker function in case of hits at thorax and abdomen, frontal as well as dorsal. PMID:22691428

  20. Testing of Common Electromagnetic Environments for Risk of Interference with Cardiac Pacemaker Function

    PubMed Central

    Tiikkaja, Maria; Aro, Aapo L.; Alanko, Tommi; Lindholm, Harri; Sistonen, Heli; Hartikainen, Juha E.K.; Toivonen, Lauri; Juutilainen, Jukka; Hietanen, Maila

    2013-01-01

    Background Cardiac pacemakers are known to be susceptible to strong electromagnetic fields (EMFs). This in vivo study investigated occurrence of electromagnetic interference with pacemakers caused by common environmental sources of EMFs. Methods Eleven volunteers with a pacemaker were exposed to EMFs produced by two mobile phone base stations, an electrically powered commuter train, and an overhead high voltage transmission lines. All the pacemakers were programmed in normal clinically selected settings with bipolar sensing and pacing configurations. Results None of the pacemakers experienced interference in any of these exposure situations. However, often it is not clear whether or not strong EMFs exist in various work environments, and hence an individual risk assessment is needed. Conclusions Modern pacemakers are well shielded against external EMFs, and workers with a pacemaker can most often return to their previous work after having a pacemaker implanted. However, an appropriate risk assessment is still necessary after the implantation of a pacemaker, a change of its generator, or major modification of its programming settings. PMID:24106646

  1. Powering pacemakers from heartbeat vibrations using linear and nonlinear energy harvesters

    NASA Astrophysics Data System (ADS)

    Amin Karami, M.; Inman, Daniel J.

    2012-01-01

    Linear and nonlinear piezoelectric devices are introduced to continuously recharge the batteries of the pacemakers by converting the vibrations from the heartbeats to electrical energy. The power requirement of a pacemaker is very low. However, after few years, patients require another surgical operation just to replace their pacemaker battery. Linear low frequency and nonlinear mono-stable and bi-stable energy harvesters are designed according to the especial signature of heart vibrations. The proposed energy harvesters are robust to variation of heart rate and can meet the power requirement of pacemakers.

  2. Oscillating Permanent Magnets.

    ERIC Educational Resources Information Center

    Michaelis, M. M.; Haines, C. M.

    1989-01-01

    Describes several ways to partially levitate permanent magnets. Computes field line geometries and oscillation frequencies. Provides several diagrams illustrating the mechanism of the oscillation. (YP)

  3. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review.

    PubMed

    Zaremba, Tomas; Jakobsen, Annette Ross; Søgaard, Mette; Thøgersen, Anna Margrethe; Riahi, Sam

    2016-04-01

    An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field. PMID:26041870

  4. Permanent magnet assembly

    DOEpatents

    Chell, Jeremy; Zimm, Carl B.

    2006-12-12

    A permanent magnet assembly is disclosed that is adapted to provide a magnetic field across an arc-shaped gap. Such a permanent magnet assembly can be used, for example, to provide a time-varying magnetic field to an annular region for use in a magnetic refrigerator.

  5. A Novel Way Of Repair Of Insulation Breaks During Pacemaker Generator Replacement

    PubMed Central

    Manzoor Ali, Syed; Iqbal, Khurshid; Tramboo, Nisar A; Lone, Aijaz A; Kaul, Suresh; Kaul, Neelam; Hafiz, Imran

    2009-01-01

    Minor abrasions can occur while mobilising old lead during pacemaker generator replacement necesittating placement of additional lead adding to the financial burden and junk in heart. We describe a novel way of repair of old pacemaker lead preventing additional lead placement. PMID:19763196

  6. Electrical stimulation of primary neonatal rat ventricular cardiomyocytes using pacemakers.

    PubMed

    Martherus, Ruben S R M; Zeijlemaker, Volkert A; Ayoubi, Torik A Y

    2010-01-01

    The study of gene regulation in cardiac myocytes requires a reliable in vitro model. However, monolayer cultures used for this purpose are typically not exposed to electrical stimulation, though this has been shown to strongly affect cardiomyocyte gene expression. Based on pacemakers for clinical use, we developed an easy-to-use portable system that allows the user to perform electro-stimulation of cardiomyocyte cultures in standard tissue incubators without the need for bulky equipment. In addition, we present a refined protocol for culturing high-purity cardiomyocyte cultures with excellent contractile properties for a wide variety of applications. PMID:20078430

  7. Synchronous Drosophila circadian pacemakers display nonsynchronous Ca²⁺ rhythms in vivo.

    PubMed

    Liang, Xitong; Holy, Timothy E; Taghert, Paul H

    2016-02-26

    In Drosophila, molecular clocks control circadian rhythmic behavior through a network of ~150 pacemaker neurons. To explain how the network's neuronal properties encode time, we performed brainwide calcium imaging of groups of pacemaker neurons in vivo for 24 hours. Pacemakers exhibited daily rhythmic changes in intracellular Ca(2+) that were entrained by environmental cues and timed by molecular clocks. However, these rhythms were not synchronous, as each group exhibited its own phase of activation. Ca(2+) rhythms displayed by pacemaker groups that were associated with the morning or evening locomotor activities occurred ~4 hours before their respective behaviors. Loss of the receptor for the neuropeptide PDF promoted synchrony of Ca(2+) waves. Thus, neuropeptide modulation is required to sequentially time outputs from a network of synchronous molecular pacemakers. PMID:26917772

  8. Popeye domain containing proteins and stress-mediated modulation of cardiac pacemaking

    PubMed Central

    Simrick, Subreena; Schindler, Roland; Poon, Kar-Lai; Brand, Thomas

    2016-01-01

    An intricate network of ion channels and pumps are involved in generating a diastolic pacemaker potential, which is transmitted to the working myocardium with the help of the cardiac conduction system. The principles of cardiac pacemaking are reasonably well understood, however, the mechanism by which the heart increases its beating frequency in response to adrenergic stimulation has not been fully worked out. The Popeye domain containing (Popdc) genes encode plasma membrane-localized proteins that are able to bind cAMP with high affinity and mice with null mutations in Popdc1 or -2 have a stress-induced pacemaker dysfunction. The phenotype in both mutants develops in an age-dependent manner and thus may model pacemaker dysfunction in man, as well as providing novel mechanistic insights into the process of pacemaker adaptation to stress. PMID:23562093

  9. Synchronous Drosophila circadian pacemakers display non-synchronous Ca2+ rhythms in vivo

    PubMed Central

    Liang, Xitong; Holy, Timothy E.; Taghert, Paul H.

    2016-01-01

    In Drosophila, molecular clocks control circadian rhythmic behavior through a network of ~150 pacemaker neurons. To explain how the network’s neuronal properties encode time, we performed brain-wide calcium imaging of groups of pacemaker neurons in vivo for 24 hours. Pacemakers exhibited daily rhythmic changes in intracellular Ca2+ that were entrained by environmental cues and timed by molecular clocks. However, these rhythms were not synchronous, as each group exhibited its own phase of activation. Ca2+ rhythms displayed by pacemaker groups that were associated with the morning or evening locomotor activities occurred ~4 hours before their respective behaviors. Loss of receptor for neuropeptide PDF promoted synchrony of Ca2+ waves. Thus neuropeptide modulation is required to sequentially time outputs from a network of synchronous molecular pacemakers. PMID:26917772

  10. Pacemaker failures characterized by continuous direct current leakage.

    PubMed

    Fisher, J D; Furman, S; Parker, B; Escher, D J

    1976-06-01

    Pulse generator failure caused by continuous leakage of direct current through an output capacitor has not previously been appreciated. Routine post-explant electronic evaluation has identified the defect in six implanted and one external pulse generator. The constant direct current in the implantable units, 0.14 to 0.26 milliamperes, is in the range that produces ventricular arrhythmias in dogs although this did not occur in our patients. Evidence of local myocardial damage existed in four cases and of electrode deterioration in three. The implant failures occurred without warning and in four cases within 2 weeks of demonstrated normal function, blunting the predictive benefits of pacemaker monitoring programs. Capacitor discharge circuits used in many pacers are inherently capable of developing direct current leakage in the event of output capacitor short circuit. In one model of pacemakers such continuous direct current leakage caused 8.3 percent (3 of 36) of pulse generator failures, widely scattered in time at 23, 27 and 46 months after implant. Capacitor short circuit causing constant direct current leakage can masquerade as primary battery failure and should be suspected when cessation of pacer function is associated with increased threshold or poor myocardial electrogram without evidence of wire break or displacement. PMID:1274862

  11. The behavioral theory of timing: Reinforcer rate determines pacemaker rate

    PubMed Central

    Bizo, Lewis A.; White, K. Geoffrey

    1994-01-01

    In the behavioral theory of timing, pulses from a hypothetical Poisson pacemaker produce transitions between states that are correlated with adjunctive behavior. The adjunctive behavior serves as a discriminative stimulus for temporal discriminations. The present experiments tested the assumption that the average interpulse time of the pacemaker is proportional to interreinforcer interval. Responses on a left key were reinforced at variable intervals for the first 25 s since the beginning of a 50-s trial, and right-key responses were reinforced at variable intervals during the second 25 s. Psychometric functions relating proportion of right-key responses to time since trial onset, in 5-s intervals across the 50-s trial, were sigmoidal in form. Average interpulse times derived by fitting quantitative predictions from the behavioral theory of timing to obtained psychometric functions decreased when the interreinforcer interval was decreased and increased when the interreinforcer interval was increased, as predicted by the theory. In a second experiment, average interpulse times estimated from trials without reinforcement followed global changes in interreinforcer interval, as predicted by the theory. Changes in temporal discrimination as a function of interreinforcer interval were therefore not influenced by the discrimination of reinforcer occurrence. The present data support the assumption of the behavioral theory of timing that interpulse time is determined by interreinforcer interval. PMID:16812723

  12. PP2 prevents isoproterenol stimulation of cardiac pacemaker activity.

    PubMed

    Huang, Jianying; Lin, Yen-Chang; Hileman, Stan; Martin, Karen H; Hull, Robert; Yu, Han-Gang

    2015-02-01

    Increasing evidence has demonstrated the potential risks of cardiac arrhythmias (such as prolonged QT interval) using tyrosine kinase inhibitors for cancer therapy. We report here that a widely used selective inhibitor of Src tyrosine kinases, PP2, can inhibit and prevent isoproterenol stimulation of cardiac pacemaker activity. In dissected rat sinus node, PP2 inhibited and prevented isoproterenol stimulation of spontaneous beating rate. In isolated sinus node myocytes, PP2 suppressed the hyperpolarization-activated "funny" current (If) by negatively shifting the activation curve and decelerating activation kinetics, associated with decreased cell surface expression and reduced tyrosine phosphorylation of hyperpolarization-activated cyclic nucleotide-modulated channel 4 (HCN4) channel proteins. In human embryonic kidney 293 cells overexpressing recombinant human HCN4 channels, PP2 reversed isoproterenol stimulation of HCN4 and inhibited HCN4-573x, a cAMP-insensitive human HCN4 mutant. Isoprotenrenol had little effects on HCN4-573x. These results demonstrated that inhibition of presumably tyrosine Src kinase activity in heart by PP2 decreased and prevented the potential β-adrenergic stimulation of cardiac pacemaker activity. These effects are mediated, at least partially, by a cAMP-independent attenuation of channel activity and cell surface expression of HCN4, the key channel protein that controls the heart rate. PMID:25658311

  13. Phase shifting two coupled circadian pacemakers - Implications for jet lag

    NASA Technical Reports Server (NTRS)

    Gander, P. H.; Kronauer, R. E.; Graeber, R. C.

    1985-01-01

    Two Van der Pol oscillators with reciprocal linear velocity coupling are utilized to model the response of the human circadian timing system to abrupt displacements of the environmental time cues (zeitgebers). The core temperature rhythm and sleep-wake cycle simulated by the model are examined. The relationship between the masking of circadian rhythms by environmental variables and behavioral and physiological events and the rates of resynchronization is studied. The effects of zeitgeber phase shifts and zeitgeber strength on the resynchronization rates are analyzed. The influence of intrinsic pacemakers periods and coupling strength on resynchronization are investigated. The simulated data reveal that: resynchronization after a time zone shift depends on the magnitude of the shift; the time of day of the shift has little influence on resynchronization; the strength of zeitgebers affects the rate and direction of the resynchronization; the intrinsic pacemaker periods have a significant effect on resynchronization; and increasing the coupling between the oscillators results in an increase in the rate of resynchronization. The model data are compared to transmeridian flight studies data and similar resynchronization patterns are observed.

  14. Excitation model of pacemaker cardiomyocytes of cardiac conduction system

    NASA Astrophysics Data System (ADS)

    Grigoriev, M.; Babich, L.

    2015-11-01

    Myocardium includes typical and atypical cardiomyocytes - pacemakers, which form the cardiac conduction system. Excitation from the atrioventricular node in normal conditions is possible only in one direction. Retrograde direction of pulses is impossible. The most important prerequisite for the work of cardiomyocytes is the anatomical integrity of the conduction system. Changes in contractile force of the cardiomyocytes, which appear periodically, are due to two mechanisms of self-regulation - heterometric and homeometric. Graphic course of the excitation pulse propagation along the heart muscle more accurately reveals the understanding of the arrhythmia mechanism. These models have the ability to visualize the essence of excitation dynamics. However, they do not have the proper forecasting function for result estimation. Integrative mathematical model enables further investigation of general laws of the myocardium active behavior, allows for determination of the violation mechanism of electrical and contractile function of cardiomyocytes. Currently, there is no full understanding of the topography of pacemakers and ionic mechanisms. There is a need for the development of direction of mathematical modeling and comparative studies of the electrophysiological arrangement of cells of atrioventricular connection and ventricular conduction system.

  15. The vicissitudes of the pacemaker current I (Kdd) of cardiac purkinje fibers.

    PubMed

    Vassalle, Mario

    2007-11-01

    The mechanisms underlying the pacemaker current in cardiac tissues is not agreed upon. The pacemaker potential in Purkinje fibers has been attributed to the decay of the potassium current I (Kdd). An alternative proposal is that the hyperpolarization-activated current I (f) underlies the pacemaker potential in all cardiac pacemakers. The aim of this review is to retrace the experimental development related to the pacemaker mechanism in Purkinje fibers with reference to findings about the pacemaker mechanism in the SAN as warranted. Experimental data and their interpretation are critically reviewed. Major findings were attributed to K(+) depletion in narrow extracellular spaces which would result in a time dependent decay of the inward rectifier current I (K1). In turn, this decay would be responsible for a "fake" reversal of the pacemaker current. In order to avoid such a postulated depletion, Ba(2+) was used to block the decay of I (K1). In the presence of Ba(2+) the time-dependent current no longer reversed and instead increased with time and more so at potentials as negative as -120 mV. In this regard, the distinct possibility needs to be considered that Ba(2+) had blocked I (Kdd) (and not only I (K1)). That indeed this was the case was demonstrated by studying single Purkinje cells in the absence and in the presence of Ba(2+). In the absence of Ba(2+), I (Kdd) was present in the pacemaker potential range and reversed at E (K). In the presence of Ba(2+), I (Kdd) was blocked and I (f) appeared at potentials negative to the pacemaker range. The pacemaker potential behaves in a manner consistent with the underlying I (Kdd) but not with I (f). The fact that I (f) is activated on hyperpolarization at potential negative to the pacemaker range makes it suitable as a safety factor to prevent the inhibitory action of more negative potentials on pacemaker discharge. It is concluded that the large body of evidence reviewed proves the pacemaker role of I (Kdd) (but not of I

  16. Antidepressants and food restriction cycles: evidence for multiple pacemakers in rodents.

    PubMed

    McEachron, D L

    1987-01-01

    Studies involving the suprachiasmatic nuclei (SCN) provide insufficient evidence to support the SCN as master pacemaker(s) in the rodent circadian system. Restricted feeding (RF) cycles act as strong zeitgebers for activity and corticosterone rhythms and provide support for the existence of important secondary pacemakers. These proposed pacemakers show anticipatory behavior, a limited range of entertainment for RF cycles, and prolonged free runs under certain circumstances. Additional evidence supporting a multiple pacemaker model of rodent circadian organization comes from studies involving antidepressants. Lithium treatment lengthens the free-running tau of rat activity rhythms and shifts the range of entrainment towards longer zeitgeber cycles. Lithium also phase delays many rodent rhythms but does not appear to affect the SCN-pineal axis. These data are difficult to explain without involving more than one pacemaker. Models of the rodent system can be developed incorporating multiple pacemakers. To test these models, a multivariate approach will be required. Combining the labeled 2-deoxyglucose method for metabolic mapping and the procedures of fractional desynchronization with antidepressant psychopharmacology and RF cycles may prove to be an important multivariate approach. PMID:3306700

  17. A randomized comparison of fluoroscopic techniques for implanting pacemaker lead on the right ventricular outflow tract septum.

    PubMed

    Chen, Dongli; Wei, Huiqiang; Tang, Jiaojiao; Liu, Lie; Wu, Shulin; Lin, Chunying; Zhang, Qianhuan; Liang, Yuanhong; Chen, Silin

    2016-05-01

    Right ventricular outflow tract (RVOT) septal pacing is commonly performed under the standard fluoroscopic positions during procedure. The aim of the prospective, randomized study was to evaluate the accuracy of the combination of standard fluoroscopic and left lateral (LL) fluoroscopic views for determination of RVOT septal position compared with standard fluoroscopic views alone. We prospectively enrolled patients who had indications for implantation of a permanent pacemaker. Patients were randomly assigned into two groups based on intraoperative fluoroscopic views as follows: LL group (three standard fluoroscopic views + LL fluoroscopic view) or standard group (three standard fluoroscopic views). Transthoracic echocardiography (TTE) determination of pacing sites was applied in all patients 3 days after pacemaker implantation. The implantation success rate of RVOT septal pacing was compared between groups. A total of 143 patients (59 males, mean age 57.6 ± 16.3 years) with symptomatic bradyarrhythmia were studied, of whom, 72 patients were randomized to LL group and 71 to standard group. TTE determination of pacing sites was compared with two groups. In the LL group, 60 patients (83 %) were achieved in RVOT septal position. In the standard group, however, the position of RVOT septum was only observed in 48 patients (68 %). The success rate of RVOT septal position in LL group was significantly higher than standard group (p = 0.029). Comparing to traditional views, combining LL view in the procedure will approve the accuracy of RVOT septal pacing site. PMID:26797500

  18. Influence of D-net (EUROPEAN GSM-standard) cellular telephones on implanted pacemakers in children.

    PubMed

    Elshershari, Huda; Celiker, Alpay; Ozer, Sema; Ozme, Sencan

    2002-09-01

    This study was designed to evaluate possible interactions between digital cellular telephones and implanted pacemakers in children. The study comprised 95 patients (53 males and 42 females) with a mean age of 11.5 +/- 4.6 years (range 1-22 years). The average time from pacemaker implantation was 2.5 years (range 1 month-12 years). Fourteen (15%) devices were dual chamber and the remaining were single chamber pacemakers. The following companies manufactured the pacemakers tested: Medtronic (n = 42), Telectronics (n = 9), Vitatron (n = 16), Pacesetter (n = 19), CPI (n = 8), and Biotronik (n = 1). All the patients were tested in the supine position during continuous ECG monitoring. After completion of the routine pacemaker check, the effects of the European Global system for mobile communication (GSM) was tested using two cellular telephone models (Ericsson GA 628 and Siemens S 25, 2-W power). For this purpose, atrial and ventricular sensitivity settings were programmed to the most sensitive values, and the tests were carried out in the unipolar and bipolar sensing modes. The evaluation was performed during ringing, switching on/off, and conversation phase with the cellular telephone positioned over the pulse generator and around the pacemaker pocket. A malfunction of the pacemaker was not observed in any patient. Only 1 (1%) of 95 patients showed a brief oversensing problem during calls with the cellular telephone. In this case, an AAIR pacemaker was implanted transvenously in a subcutaneous pocket and the sensing defect occurred only with the unipolar sensing mode and was not reproducible. Once the source of interference was removed, no sensing defect was detected and the patient remained asymptomatic. No symptoms were experienced in this study. The authors believe that pacemaker dependent patients with nonprotected pulse generators manufactured at the beginning of 1990s may be tested by their physicians for possible interferences before they use a digital cellular

  19. Permanent versus disconnectable FPSOs

    NASA Astrophysics Data System (ADS)

    Luo, Yong; Wang, Hong-Wei

    2009-06-01

    Floating production storage and offloading (FPSO) vessels offer a cost-effective field development solution, especially in deepwater areas lacking an adequate pipeline network. Most FPSOs are permanently moored, i.e. the complete system is designed to withstand any kind of extreme environment at the field location. FPSOs that can be quickly disconnected from their moorings and risers have also been designed and deployed. The key feature of this type of disconnectable FPSO is that it can be disconnect and so avoid dangerous environmental conditions such as icebergs, hurricanes in the Gulf of Mexico and typhoons in the South China Sea. In this paper, the concept of disconnectable FPSOs for deepwater field development is presented. Key technologies and their engineering analyses are highlighted. The merits and demerits of disconnectable vs permanent FPSOs are then evaluated. The paper concludes that both permanent and disconnectable FPSOs are versatile floating systems and their selection depends on safety, technological, cost and operational considerations.

  20. In vitro investigation of eddy current effect on pacemaker operation generated by low frequency magnetic field.

    PubMed

    Babouri, A; Hedjeidj, A

    2007-01-01

    This paper presents in vitro investigation of the eddy current induction effects to the cardiac pacemaker exposed to low frequency magnetic fields. The method used in this study is based to the interaction by inductive coupling through the loop formed by the pacemaker and its leads and the surrounding medium. This interaction results in an induced electromotive force between the terminals of the pacemaker which can potentially disturb the operation of this last. In this article we present experimental results, analytical calculations and numerical simulations using the finite element method. PMID:18003302

  1. [Permanent endocardiac electrostimulation. Considerations on 511 implantations and reimplantations in 7 years of practice].

    PubMed

    Mangiameli, S; Circo, A; Vanaria, D; Lombardo, D; Scalisi, A; Genovese, G; Galassi, A

    1977-06-30

    Permanent pacemakers were implanted and reimplanted in a total of 511 patients (mostly men) during a period of about 7 yr. Mean age was 67.9 yr. The cephalic route was used in nearly every case, with subclavicular implantation of the generator. Mean hospital stay was 7.6 days. Ventricular inhibition pacemakers were used in over 84% and fixed-frequency models in 7%. Mean pacemaker life was 24.1 months, with longer periods in the last months of the period of observation. The evaluation of battery run-down and recent and long-term complications is discussed, together with a particular type of decubitus of electrolytic origin. Hospital mortality was 2%. Survival was 91% at 1 yr and 54% at 6 yr. Emphasis is placed on the fact that subjects continue to be heart patients. Their well-being depends on psychological and general medical care, together with help from their, families and society, quite apart from cardiological attention. PMID:876509

  2. Infection.

    PubMed

    Saigal, Gaurav; Nagornaya, Natalya; Post, M Judith D

    2016-01-01

    Imaging is useful in the diagnosis and management of infections of the central nervous system. Typically, imaging findings at the outset of the disease are subtle and nonspecific, but they often evolve to more definite imaging patterns in a few days, with less rapidity than for stroke but faster than for neoplastic lesions. This timing is similar to that of noninfectious inflammatory brain disease, such as multiple sclerosis. Fortunately, imaging patterns help to distinguish the two kinds of processes. Other than for sarcoidosis, the meninges are seldom involved in noninfectious inflammation; in contrast, many infectious processes involve the meninges, which then enhance with contrast on computed tomography (CT) or magnetic resonance imaging (MRI). However, brain infection causes a vast array of imaging patterns. Although CT is useful when hemorrhage or calcification is suspected or bony detail needs to be determined, MRI is the imaging modality of choice in the investigation of intracranial infections. Imaging sequences such as diffusion-weighted imaging help in accurately depicting the location and characterizing pyogenic infections and are particularly useful in differentiating bacterial infections from other etiologies. Susceptibility-weighted imaging is extremely useful for the detection of hemorrhage. Although MR spectroscopy findings can frequently be nonspecific, certain conditions such as bacterial abscesses show a relatively specific spectral pattern and are useful in diagnosing and constituting immediate therapy. In this chapter we review first the imaging patterns associated with involvement of various brain structures, such as the epidural and subdural spaces, the meninges, the brain parenchyma, and the ventricles. Involvement of these regions is illustrated with bacterial infections. Next we illustrate the patterns associated with viral and prion diseases, followed by mycobacterial and fungal infections, to conclude with a review of imaging findings

  3. A Comparative Survey of Pacemaker Implantation in Trinidad and Tobago in 2005 and 2009

    PubMed Central

    Henry, R; Dookie, T; Primus, E

    2014-01-01

    ABSTRACT Objective: The indications for permanent pacemaker implantations in Trinidad have expanded from initially symptomatic bradycardia to now include complex devices. A retrospective review of the available data was conducted to better understand the evolving trends in device implantation in Trinidad and Tobago. Methods: Data were collated from the two major implanting teams in Trinidad for the years 2005 and 2009. The two implanting centres were the Advanced Cardiovascular Institute (ACI) at Westshore Medical Centre and the Catheterization Laboratory of the Eric Williams Medical Sciences Complex (EWMSC). Data were based on retrospective collation using the implantation records. Results: The implantation rate for new devices increased from 39 per million to 103 per million population. The most common indications for new device implants in 2009 were high degree atrioventricular (AV) block (53%) and sick sinus syndrome (22%), with the notable appearance of congestive cardiomyopathy (13%) which was not present in the earlier cohort. Of particular note, 23 high-end devices were implanted in 2009. These were five cardiac-resynchronization therapy (CRT-P) devices, 14 automatic implantable cardio-defibrillator (AICD) devices and four combined cardiac-resynchronization therapy with defibrillator (CRT-D) devices versus none in 2005. Conclusions: In summary, over the period 2005 to 2009, a substantial increase in device implantation rates has occurred which now include high-end complex devices. Absolute rates, however, remain far below that of developed countries, indicating that the true need remains underserved. Furthermore, adjustment for gross domestic product suggests that the relatively buoyant economy of Trinidad and Tobago is capable of servicing a greater proportion of this need than is currently met. PMID:26108119

  4. Deactivation of Pacemakers and Implantable Cardioverter-Defibrillators

    PubMed Central

    Kramer, Daniel B.; Mitchell, Susan L.; Brock, Dan W.

    2013-01-01

    Cardiac implantable electrical devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs), are the most effective treatment for life-threatening arrhythmias. Patients or their surrogates may request device deactivation to avoid prolongation of the dying process or in other settings, such as after device-related complications or with changes in their health care goals. Despite published guidelines outlining theoretical and practical aspects of this common clinical scenario, significant uncertainty remains for both patients and health care providers regarding the ethical and legal status of CIED deactivation. This review outlines the ethical and legal principles supporting CIED deactivation at patients’ request, centered upon patient autonomy and authority over their own medical treatment. The empirical literature describing stakeholder views and experiences surrounding CIED deactivation is described, along with lessons for future research and practice guidance surrounding the care of patients with CIEDs. PMID:23217433

  5. Safety Of Mris In Patients With Pacemakers And Defibrillators

    PubMed Central

    Baher, Alex; Shah, Dipan

    2013-01-01

    With a burgeoning population, increases in life expectancy, and expanding indications, the number of patients with cardiac devices such as pacemakers and implantable cardioverter defibrillators continues to increase each year. A majority of these patients will develop an indication for magnetic resonance imaging (MRI) in their lifetime. MRIs have established themselves as one of the most powerful imaging tools for a variety of conditions. However, given the historic safety concerns, many physicians are reluctant to use MRIs in this patient population. In this paper, we discuss the potential adverse effects of MRIs in patients with cardiac devices, review key studies that have addressed strategies to limit adverse effects, and provide our cardiovascular MRI laboratory’s protocol for imaging patients with implanted cardiac devices. PMID:24066196

  6. Pacemaker activity resulting from the coupling with nonexcitable cells

    NASA Astrophysics Data System (ADS)

    Jacquemet, Vincent

    2006-07-01

    Fibroblasts are nonexcitable cells that are sometimes coupled with excitable cells (cardiomyocytes). Due to a higher resting potential, these cells may act as a current source or sink and therefore disturb the electrical activity of the surrounding excitable cells. The possible occurrence of spontaneous pacemaker activity resulting from these electrotonic interactions was investigated in a theoretical model of two coupled cells as well as in a multicellular fiber model based on the Courtemanche kinetics. The results indicate that repeated spontaneous activations can be observed after an alteration in the activation and recovery properties of the sodium current (changes in excitability properties), provided that the difference in the resting potential as well as the coupling between the excitable and nonexcitable cells is sufficiently high. This may constitute a mechanism of focal sources triggering arrhythmias such as atrial fibrillation.

  7. The dromotropic pacemaker: system analysis and design considerations.

    PubMed

    Hexamer, M; Meine, M; Kloppe, C; Kloppe, A; Mügge, A; Werner, J

    2004-11-01

    Patients suffering from chronotropic incompetence are generally treated with a rate-responsive pacemaker that stimulates the heart at a rate derived from a strain related sensor signal. The pacemaker concept described here uses a well-defined time interval in the electrogram as sensor parameter (AVCT: atrio-ventricular conduction time). AVCT is directly controlled by the autonomic nervous system. The design of the new algorithm was based on a thorough experimental analysis of AVCT subject to variations of the exercise rate and the pacing frequency. There it was demonstrated that AVCT is disturbed by the respiratory activity. The new rate-responsive algorithm which uses the internal model control principle explicitly takes into account the closed-loop nature of the underlying system. The major design objectives were: a) extended range of the individual heart rate, b) effective attenuation of the respiratory related disturbance and c) dynamic stability. Seven patients undergoing an incremental exercise test were paced with the new AVCT-based algorithm. When paced with this algorithm the paced heart rate was 126 +/- 12 min(-1) whereas the peak intrinsic heart rate was only 100 +/- 20 min(-1). The increase which was significant (26 +/- 13 min(-1); 15.53 min(-1)) clearly demonstrated the potential of this concept to restore chronotropic competence. A reanalysis of the experiments was undertaken in order to facilitate the individual parameterization in clinical practice. It could be demonstrated that a rather simple screening test is sufficient to gain the knowledge necessary for the individual parameterisation. PMID:15624866

  8. The Immunoendocrine Thymus as a Pacemaker of Lifespan.

    PubMed

    Csaba, György

    2016-06-01

    The thymus develops from an endocrine area of the foregut, and retains the ancient potencies of this region. However, later it is populated by bone marrow originated lymphatic elements and forms a combined organ, which is a central part of the immune system as well as an influential element of the endocrine orchestra. Thymus produces self-hormones (thymulin, thymosin, thymopentin, and thymus humoral factor), which are participating in the regulation of immune cell transformation and selection, and also synthesizes hormones similar to that of the other endocrine glands such as melatonin, neuropeptides, and insulin, which are transported by the immune cells to the sites of requests (packed transport). Thymic (epithelial and immune) cells also have receptors for hormones which regulate them. This combined organ, which is continuously changing from birth to senescence seems to be a pacemaker of life. This function is basically regulated by the selection of self-responsive thymocytes as their complete destruction helps the development (up to puberty) and their gradual release in case of weakened control (after puberty) causes the erosion of cells and intercellular material, named aging. This means that during aging, self-destructive and non-protective immune activities are manifested under the guidance of the involuting thymus, causing the continuous irritation of cells and organs. Possibly the pineal body is the main regulator of the pacemaker, the neonatal removal of which results in atrophy of thymus and wasting disease and its later corrosion causes the insufficiency of thymus. The co-involution of pineal and thymus could determine the aging and the time of death without external intervention; however, external factors can negatively influence both of them. PMID:27352969

  9. Alkaline "Permanent" Paper.

    ERIC Educational Resources Information Center

    Pacey, Antony

    1991-01-01

    Discussion of paper manufacturing processes and their effects on library materials focuses on the promotion of alkaline "permanent" paper, with less acid, by Canadian library preservation specialists. Standards for paper acidity are explained; advantages of alkaline paper are described, including decreased manufacturing costs; and recyclability is…

  10. [Optimalization of rate adaptation using Holter functions in DDD/R pacemakers].

    PubMed

    Novotný, T; Dvorák, R; Kozák, M; Vlasínová, J

    1998-06-01

    Introduction of the pacing rate adaptation according to the momentary metabolic needs added other programmable parametres which demand physician's attention during the initial postimplantation programmation and also in follow-up of pacemaker patients. The parametres setting is strictly individual with a need of feedback control. In some devices it is enabled by Holter functions as a part of pacemaker software. These methods were used to set the rate adaptive parametres in the group of 23 patients with implanted DDD/R pacemaker. The walking stress test was used. Model follow-up situations are presented in 3 case reports. Using Holter functions enables the physician to put patient's subjective complains in relation with actual heart rate--this is used to optimize the parametres of rate adaptation. The authors consider the Holter functions a necessary part of rate adaptive pacemaker software. PMID:9820057

  11. A Sodium Leak Current Regulates Pacemaker Activity of Adult Central Pattern Generator Neurons in Lymnaea Stagnalis

    PubMed Central

    Lu, Tom Z.; Feng, Zhong-Ping

    2011-01-01

    The resting membrane potential of the pacemaker neurons is one of the essential mechanisms underlying rhythm generation. In this study, we described the biophysical properties of an uncharacterized channel (U-type channel) and investigated the role of the channel in the rhythmic activity of a respiratory pacemaker neuron and the respiratory behaviour in adult freshwater snail Lymnaea stagnalis. Our results show that the channel conducts an inward leak current carried by Na+ (ILeak-Na). The ILeak-Na contributed to the resting membrane potential and was required for maintaining rhythmic action potential bursting activity of the identified pacemaker RPeD1 neurons. Partial knockdown of the U-type channel suppressed the aerial respiratory behaviour of the adult snail in vivo. These findings identified the Na+ leak conductance via the U-type channel, likely a NALCN-like channel, as one of the fundamental mechanisms regulating rhythm activity of pacemaker neurons and respiratory behaviour in adult animals. PMID:21526173

  12. Interference of apex locator, pulp tester and diathermy on pacemaker function

    PubMed Central

    Sriman, Narayanan; Prabhakar, V.; Bhuvaneswaran, J.S.; Subha, N.

    2015-01-01

    Aim: The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Materials and Methods: Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial number: PLE734632S). Directly connecting the pacemaker lead with the EAL/EPT/diathermy operating on a flat bench top, the telemetry wand was held directly over the pacemaker to monitor the pacing pattern for a period of 30 s. Pacemaker activity was continuously recorded on the telemetric programmer and electro gram (EGM) readings examined for pacer inhibition, noise reversion or inappropriate pacemaker pulses. Results: All the three apex locators showed no pacing interference or background noise during its function or at rest. The EGM readings of EPT showed varying levels of background noise in between pacing however, this did not affect the normal pacing pattern and the pacing interval remained constant. EGM readings of diathermy showed an increase in the pacing interval (irregular pacing pattern) followed by complete inhibition of the pacing system. Conclusion: The tested EALs do not interfere with cardiac pacemaker function. The tested EPT showed varying levels of background noise but does not interfere with cardiac pacemaker function. Use of Diathermy interfered with the normal pacing, leading to complete inhibition of the pacing system. PMID:25657520

  13. Laser extraction of pacemaker lead traversing a patent foramen ovale and the mitral valve.

    PubMed

    Anastacio, Melissa M; Castillo-Sang, Mario; Lawton, Jennifer S

    2012-12-01

    Left ventricular lead misplacement is an infrequent complication of pacemaker or defibrillator lead insertion. It most commonly occurs through defects in the interatrial septum. Although patients may remain asymptomatic, the most common clinical complication is a thromboembolic event. Percutaneous technology has been described to safely remove misplaced leads. We present a case of a patient with a pacemaker lead in the left ventricle through a patent foramen ovale that was successfully extracted using excimer laser technology. PMID:23176932

  14. Biological pacemaker created by minimally invasive somatic reprogramming in pigs with complete heart block

    PubMed Central

    Hu, Yu-Feng; Dawkins, James Frederick; Cho, Hee Cheol; Marbán, Eduardo; Cingolani, Eugenio

    2016-01-01

    Somatic reprogramming by reexpression of the embryonic transcription factor T-box 18 (TBX18) converts cardiomyocytes into pacemaker cells. We hypothesized that this could be a viable therapeutic avenue for pacemaker-dependent patients afflicted with device-related complications, and therefore tested whether adenoviral TBX18 gene transfer could create biological pacemaker activity in vivo in a large-animal model of complete heart block. Biological pacemaker activity, originating from the intramyocardial injection site, was evident in TBX18-transduced animals starting at day 2 and persisted for the duration of the study (14 days) with minimal backup electronic pacemaker use. Relative to controls transduced with a reporter gene, TBX18-transduced animals exhibited enhanced autonomic responses and physiologically superior chronotropic support of physical activity. Induced sinoatrial node cells could be identified by their distinctive morphology at the site of injection in TBX18-transduced animals, but not in controls. No local or systemic safety concerns arose. Thus, minimally invasive TBX18 gene transfer creates physiologically relevant pacemaker activity in complete heart block, providing evidence for therapeutic somatic reprogramming in a clinically relevant disease model. PMID:25031269

  15. Sphingosine and FTY720 Modulate Pacemaking Activity in Interstitial Cells of Cajal from Mouse Small Intestine

    PubMed Central

    Nam, Joo Hyun; Kim, Woo Kyung; Kim, Byung Joo

    2013-01-01

    Interstitial cells of Cajal (ICCs) are the pacemakers of the gastrointestinal tract, and transient receptor potential melastatin type 7 (TRPM7) and Ca2+ activated Cl− channels (ANO1) are candidate the generators of pacemaker potentials in ICCs. The effects of D-erythro-sphingosine (SPH) and structural analogues of SPH, that is, N,N-dimethyl-Derythro-sphingosine (N,N-DMS), FTY720, and FTY720-P on the pacemaking activities of ICCs were examined using the whole cell patch clamp technique. SPH, N,N-DMS, and FTY720 decreased the amplitudes of pacemaker potentials in ICC clusters, but resting membrane potentials displayed little change. Also, perfusing SPH, N,N-DMS, or FTY720 in the bath reduced both inward and outward TRPM7-like currents in single ICCs, and inhibited ANO1 currents. The another structural analogue of SPH, FTY720-P was ineffective at the pacemaker potentials in ICC clusters and the TRPM7-like currents in single ICCs. Furthermore, FTY720- P had no effect on ANO1. These results suggest that SPH, N,N-DMS, and FTY720 modulate the pacemaker activities of ICCs, and that TRPM7 and ANO1 channels affect intestinal motility. PMID:23912597

  16. The East Asian Summer Monsoon in pacemaker experiments driven by ENSO

    NASA Astrophysics Data System (ADS)

    Ding, Hui; Greatbatch, Richard J.; Lu, Jian; Cash, Ben

    2015-03-01

    The variability of the East Asian summer monsoon (EASM) is studied using a pacemaker technique driven by ENSO in an atmospheric general circulation model (AGCM) coupled to a slab mixed layer model. In the pacemaker experiments, sea surface temperature (SST) is constrained to observations in the eastern equatorial Pacific through a q- flux that measures the contribution of ocean dynamics to SST variability, while the AGCM is coupled to the slab model. An ensemble of pacemaker experiments is analyzed using a multivariate EOF analysis to identify the two major modes of variability of the EASM. The results show that the pacemaker experiments simulate a substantial amount (around 45 %) of the variability of the first mode (the Pacific-Japan pattern) in ERA40 from 1979 to 1999. Different from previous work, the pacemaker experiments also simulate a large part (25 %) of the variability of the second mode, related to rainfall variability over northern China. Furthermore, we find that the lower (850 hPa) and the upper (200 hPa) tropospheric circulation of the first mode display the same degree of reproducibility whereas only the lower part of the second mode is reproducible. The basis for the success of the pacemaker experiments is the ability of the experiments to reproduce the observed relationship between El Niño Southern Oscillation (ENSO) and the EASM.

  17. Using the Virtual Heart Model to validate the mode-switch pacemaker operation.

    PubMed

    Jiang, Zhihao; Connolly, Allison; Mangharam, Rahul

    2010-01-01

    Artificial pacemakers are one of the most widely-used implantable devices today, with millions implanted worldwide. The main purpose of an artificial pacemaker is to treat bradycardia, or slow heart beats, by pacing the atrium and ventricles at a faster rate. While the basic functionality of the device is fairly simple, there are many documented cases of death and injury due to device malfunctions. The frequency of malfunctions due to firmware problems will only increase as the pacemaker operations become more complex in an attempt to expand the use of the device. One reason these malfunctions arise is that there is currently no methodology for formal validation and verification of medical device software, as there are in the safety-critical domains of avionics and industrial control automation. We have developed a timed-automata based Virtual Heart Model (VHM) to act as platform for medical device software validation and verification. Through a case study involving multiple arrhythmias, this investigation shows how the VHM can be used with closed-loop operation of a pacemaker to validate the necessity and functionality of the complex mode-switch pacemaker operation. We demonstrate the correct pacemaker operation, to switch from one rhythm management mode to another, in patients with supraventricular tachycardias. (1). PMID:21096077

  18. Development of pacemaker properties and rhythmogenic mechanisms in the mouse embryonic respiratory network

    PubMed Central

    Chevalier, Marc; Toporikova, Natalia; Simmers, John; Thoby-Brisson, Muriel

    2016-01-01

    Breathing is a vital rhythmic behavior generated by hindbrain neuronal circuitry, including the preBötzinger complex network (preBötC) that controls inspiration. The emergence of preBötC network activity during prenatal development has been described, but little is known regarding inspiratory neurons expressing pacemaker properties at embryonic stages. Here, we combined calcium imaging and electrophysiological recordings in mouse embryo brainstem slices together with computational modeling to reveal the existence of heterogeneous pacemaker oscillatory properties relying on distinct combinations of burst-generating INaP and ICAN conductances. The respective proportion of the different inspiratory pacemaker subtypes changes during prenatal development. Concomitantly, network rhythmogenesis switches from a purely INaP/ICAN-dependent mechanism at E16.5 to a combined pacemaker/network-driven process at E18.5. Our results provide the first description of pacemaker bursting properties in embryonic preBötC neurons and indicate that network rhythmogenesis undergoes important changes during prenatal development through alterations in both circuit properties and the biophysical characteristics of pacemaker neurons. DOI: http://dx.doi.org/10.7554/eLife.16125.001 PMID:27434668

  19. Variable Permanent Magnet Quadrupole

    SciTech Connect

    Mihara, T.; Iwashita, Y.; Kumada, M.; Spencer, C.M.; /SLAC

    2007-05-23

    A permanent magnet quadrupole (PMQ) is one of the candidates for the final focus lens in a linear collider. An over 120 T/m strong variable permanent magnet quadrupole is achieved by the introduction of saturated iron and a 'double ring structure'. A fabricated PMQ achieved 24 T integrated gradient with 20 mm bore diameter, 100 mm magnet diameter and 20 cm pole length. The strength of the PMQ is adjustable in 1.4 T steps, due to its 'double ring structure': the PMQ is split into two nested rings; the outer ring is sliced along the beam line into four parts and is rotated to change the strength. This paper describes the variable PMQ from fabrication to recent adjustments.

  20. Permanent magnet design methodology

    NASA Technical Reports Server (NTRS)

    Leupold, Herbert A.

    1991-01-01

    Design techniques developed for the exploitation of high energy magnetically rigid materials such as Sm-Co and Nd-Fe-B have resulted in a revolution in kind rather than in degree in the design of a variety of electron guidance structures for ballistic and aerospace applications. Salient examples are listed. Several prototype models were developed. These structures are discussed in some detail: permanent magnet solenoids, transverse field sources, periodic structures, and very high field structures.

  1. Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite{sup Registered-Sign} treatment

    SciTech Connect

    Sung, Wonmo; Kim, Siyong; Kim, Jung-in; Lee, Jae-gi; Shin, Young-Joo; Jung, Jae-Yong; Ye, Sung-Joon

    2012-10-15

    Purpose: To investigate dose perturbations for pacemaker-implanted patients in partial breast irradiation using high dose rate (HDR) balloon brachytherapy. Methods: Monte Carlo (MC) simulations were performed to calculate dose distributions involving a pacemaker in Ir-192 HDR balloon brachytherapy. Dose perturbations by varying balloon-to-pacemaker distances (BPD = 50 or 100 mm) and concentrations of iodine contrast medium (2.5%, 5.0%, 7.5%, and 10.0% by volume) in the balloon were investigated for separate parts of the pacemaker (i.e., battery and substrate). Relative measurements using an ion-chamber were also performed to confirm MC results. Results: The MC and measured results in homogeneous media without a pacemaker agreed with published data within 2% from the balloon surface to 100 mm BPD. Further their dose distributions with a pacemaker were in a comparable agreement. The MC results showed that doses over the battery were increased by a factor of 3, compared to doses without a pacemaker. However, there was no significant dose perturbation in the middle of substrate but up to 70% dose increase in the substrate interface with the titanium capsule. The attenuation by iodine contrast medium lessened doses delivered to the pacemaker by up to 9%. Conclusions: Due to inhomogeneity of pacemaker and contrast medium as well as low-energy photons in Ir-192 HDR balloon brachytherapy, the actual dose received in a pacemaker is different from the homogeneous medium-based dose and the external beam-based dose. Therefore, the dose perturbations should be considered for pacemaker-implanted patients when evaluating a safe clinical distance between the balloon and pacemaker.

  2. Propagation of pacemaker activity in the guinea-pig antrum

    PubMed Central

    Hennig, G W; Hirst, G D S; Park, K J; Smith, C B; Sanders, K M; Ward, S M; Smith, T K

    2004-01-01

    Cyclical periods of depolarization (slow waves) underlie peristaltic contractions involved in mixing and emptying of contents in the gastric antrum. Slow waves originate from a myenteric network of interstitial cells of Cajal (ICC-MY). In this study we have visualized the sequence and propagation of Ca2+ transients associated with pacemaker potentials in the ICC network and longitudinal (LM) and circular muscle (CM) layers of the isolated guinea-pig gastric antrum. Gastric antrum was dissected to reveal the ICC-MY network, loaded with Fluo-4 AM and activity was monitored at 37°C. Ca2+ waves propagated throughout the ICC-MY network at an average velocity of 3.24 ± 0.12 mm s−1 at a frequency of 4.87 ± 0.16 cycles min−1 (n = 4). The propagation of the Ca2+ wave often appeared ‘step-like’, with separate regions of the network being activated after variable delays. The direction of propagation was highly variable (Δ angle of propagation 44.3 ± 10.9 deg per cycle) and was not confined to the axes of the longitudinal or circular muscle. Ca2+ waves appeared to spread out radially from the site of initiation. The initiating Ca2+ wave in ICC-MY was correlated to secondary Ca2+ waves in intramuscular interstial cells of Cajal, ICC-IM, and smooth muscle cells, and the local distortion (contraction) in a field of view. TTX (1 μm) had little effect on slow wave or pacemaker potential activity, but 2-APB (50 μm) blocked all Ca2+ waves, indicating a pivotal role for intracellular Ca2+ stores. Nicardipine (2 μm) eliminated the Ca2+ transient generated by smooth muscle, but did not affect the fast upstroke associated with ICC-MY. These results indicate that slow waves follow a sequence of activation, beginning with the ICC-MY and ICC-IM network, followed later by a sustained Ca2+ transient in the muscle layers that is responsible for contraction. PMID:14754999

  3. Is metabolic rate a universal 'pacemaker' for biological processes?

    PubMed

    Glazier, Douglas S

    2015-05-01

    A common, long-held belief is that metabolic rate drives the rates of various biological, ecological and evolutionary processes. Although this metabolic pacemaker view (as assumed by the recent, influential 'metabolic theory of ecology') may be true in at least some situations (e.g. those involving moderate temperature effects or physiological processes closely linked to metabolism, such as heartbeat and breathing rate), it suffers from several major limitations, including: (i) it is supported chiefly by indirect, correlational evidence (e.g. similarities between the body-size and temperature scaling of metabolic rate and that of other biological processes, which are not always observed) - direct, mechanistic or experimental support is scarce and much needed; (ii) it is contradicted by abundant evidence showing that various intrinsic and extrinsic factors (e.g. hormonal action and temperature changes) can dissociate the rates of metabolism, growth, development and other biological processes; (iii) there are many examples where metabolic rate appears to respond to, rather than drive the rates of various other biological processes (e.g. ontogenetic growth, food intake and locomotor activity); (iv) there are additional examples where metabolic rate appears to be unrelated to the rate of a biological process (e.g. ageing, circadian rhythms, and molecular evolution); and (v) the theoretical foundation for the metabolic pacemaker view focuses only on the energetic control of biological processes, while ignoring the importance of informational control, as mediated by various genetic, cellular, and neuroendocrine regulatory systems. I argue that a comprehensive understanding of the pace of life must include how biological activities depend on both energy and information and their environmentally sensitive interaction. This conclusion is supported by extensive evidence showing that hormones and other regulatory factors and signalling systems coordinate the processes of

  4. [The termination of auricular flutter by noninvasive programmed electrical stimulation using a permanent AAI-mode pacemaker].

    PubMed

    Saucedo, J; Iturralde, P; Attie, F; Colín, L; Kershenovich, S; González Hermosillo, J A

    1993-01-01

    We describe a case of a 15-year-old boy with an atrial septal defect who three years after the direct closure of the defect presented with atrial flutter type I according to Wells's classification. He was then electrically cardioverted but presented immediately sinus bradycardia and a ventricular escape rhythm that required epicardial pacing (Intermedics 292-03 DASH) in the AAI mode. We report here the successful termination of a new episode of atrial flutter into sinus rhythm with a noninvasive programmed stimulation using his previously implanted pacing system. PMID:8215704

  5. Dynamics of PKA phosphorylation and gain of function in cardiac pacemaker cells: a computational model analysis.

    PubMed

    Behar, Joachim; Yaniv, Yael

    2016-05-01

    Cardiac pacemaker cell function is regulated by a coupled-clock system that integrates molecular cues on the cell-membrane surface (i.e., membrane clock) and on the sarcoplasmic reticulum (SR) (i.e., Ca(2+) clock). A recent study has shown that cotransfection of spontaneous beating cells (HEK293 cells and neonatal rat myocytes) with R524Q-mutant human hyperpolarization-activated cyclic nucleotide-gated molecules (the dominant component of funny channels) increases the funny channel's sensitivity to cAMP and leads to a decrease in spontaneous action potential (AP) cycle length (i.e., tachycardia). We hypothesize that in rabbit pacemaker cells, the same behavior is expected, and because of the coupled-clock system, the resultant steady-state decrease in AP cycle length will embody contributions from both clocks: the initial decrease in the spontaneous AP beating interval, arising from increased sensitivity of the f-channel to cAMP, will be accompanied by an increase in the adenylyl cyclase (AC)-cAMP-PKA-dependent phosphorylation activity, which will further decrease this interval. To test our hypothesis, we used the recently developed Yaniv-Lakatta pacemaker cell numerical model. This model predicts the cAMP signaling dynamics, as well as the kinetics and magnitude of protein phosphorylation in both normal and mutant pacemaker cells. We found that R524Q-mutant pacemaker cells have a shorter AP firing rate than that of wild-type cells and that gain in pacemaker function is the net effect of the R514Q mutation on the functioning of the coupled-clock system. Specifically, our results directly support the hypothesis that changes in Ca(2+)-activated AC-cAMP-PKA signaling are involved in the development of tachycardia in R524Q-mutant pacemaker cells. PMID:26945074

  6. Architecture of retinal projections to the central circadian pacemaker.

    PubMed

    Fernandez, Diego Carlos; Chang, Yi-Ting; Hattar, Samer; Chen, Shih-Kuo

    2016-05-24

    The suprachiasmatic nucleus (SCN) receives direct retinal input from the intrinsically photosensitive retinal ganglion cells (ipRGCs) for circadian photoentrainment. Interestingly, the SCN is the only brain region that receives equal inputs from the left and right eyes. Despite morphological assessments showing that axonal fibers originating from ipRGCs cover the entire SCN, physiological evidence suggests that only vasoactive intestinal polypeptide (VIP)/gastrin-releasing peptide (GRP) cells located ventrally in the SCN receive retinal input. It is still unclear, therefore, which subpopulation of SCN neurons receives synaptic input from the retina and how the SCN receives equal inputs from both eyes. Here, using single ipRGC axonal tracing and a confocal microscopic analysis in mice, we show that ipRGCs have elaborate innervation patterns throughout the entire SCN. Unlike conventional retinal ganglion cells (RGCs) that innervate visual targets either ipsilaterally or contralaterally, a single ipRGC can bilaterally innervate the SCN. ipRGCs form synaptic contacts with major peptidergic cells of the SCN, including VIP, GRP, and arginine vasopressin (AVP) neurons, with each ipRGC innervating specific subdomains of the SCN. Furthermore, a single SCN-projecting ipRGC can send collateral inputs to many other brain regions. However, the size and complexity of the axonal arborizations in non-SCN regions are less elaborate than those in the SCN. Our results provide a better understanding of how retinal neurons connect to the central circadian pacemaker to synchronize endogenous circadian clocks with the solar day. PMID:27162356

  7. Computed tomography in patients with cardiac pacemakers: difficulties and solutions.

    PubMed

    Mlynarski, Rafal; Sosnowski, Maciej; Mlynarska, Agnieszka; Tendera, Michał

    2012-05-01

    The presence of cardiac pacemaker systems may significantly limit interpretation of multi-slice computed tomography (MSCT) images. In 80 patients (45 men; aged 69.5 ± 13.4) with previously implanted anti-arrhythmic devices, a 64-slice CT (Aquilion-64) was performed. In 61 patients (76.3%), ECG gating was used (coronaries visualization) and in 19 patients (23.7%) without ECG gating (not coronaries visualization). In all 19 patients without ECG gating MSCT images were diagnostic. In 37 (60.6%) patients of 61, there was no problem with gating process and image quality was diagnostic. In 24 (39.4%) with visible spikes in the ECG-gating group, there were difficulties in differentiating the R spike from an artificial spike (unipolar pacing) by MSCT software. In 15 patients (24.6%) after reprogramming, it was possible to obtain good quality images. In nine (14.7%) patients, it was not possible to reprogram devices due to old unipolar leads, but in two cases (3.3%), ECG gating was corrected manually and good image quality was obtained. In seven (11.5%) patients, it was not possible to perform ECG gating. The ECG gating process was identified as the main cause of the imaging problems. Bipolar leads working as bipolar pacing seem to be necessary to perform MSCT with ECG gating. A unipolar system lead may cause serious problems with reconstructions. PMID:21505855

  8. Pacemaker-induced transient asynchrony suppresses heart failure progression.

    PubMed

    Kirk, Jonathan A; Chakir, Khalid; Lee, Kyoung Hwan; Karst, Edward; Holewinski, Ronald J; Pironti, Gianluigi; Tunin, Richard S; Pozios, Iraklis; Abraham, Theodore P; de Tombe, Pieter; Rockman, Howard A; Van Eyk, Jennifer E; Craig, Roger; Farazi, Taraneh G; Kass, David A

    2015-12-23

    Uncoordinated contraction from electromechanical delay worsens heart failure pathophysiology and prognosis, but restoring coordination with biventricular pacing, known as cardiac resynchronization therapy (CRT), improves both. However, not every patient qualifies for CRT. We show that heart failure with synchronous contraction is improved by inducing dyssynchrony for 6 hours daily by right ventricular pacing using an intracardiac pacing device, in a process we call pacemaker-induced transient asynchrony (PITA). In dogs with heart failure induced by 6 weeks of atrial tachypacing, PITA (starting on week 3) suppressed progressive cardiac dilation as well as chamber and myocyte dysfunction. PITA enhanced β-adrenergic responsiveness in vivo and normalized it in myocytes. Myofilament calcium response declined in dogs with synchronous heart failure, which was accompanied by sarcomere disarray and generation of myofibers with severely reduced function, and these changes were absent in PITA-treated hearts. The benefits of PITA were not replicated when the same number of right ventricular paced beats was randomly distributed throughout the day, indicating that continuity of dyssynchrony exposure is necessary to trigger the beneficial biological response upon resynchronization. These results suggest that PITA could bring the benefits of CRT to the many heart failure patients with synchronous contraction who are not CRT candidates. PMID:26702095

  9. Piezoelectric energy harvesting from heartbeat vibrations for leadless pacemakers

    NASA Astrophysics Data System (ADS)

    Ansari, M. H.; Karami, M. Amin

    2015-12-01

    This paper studies energy harvesting from heartbeat vibrations using fan-folded piezoelectric beams. The generated energy from the heartbeat can be used to power a leadless pacemaker. In order to utilize the available 3 dimensional space to the energy harvester, we chose the fan-folded design. The proposed device consists of several piezoelectric beams stacked on top of each other. The size for this energy harvester is 2 cm by 0.5 cm by 1 cm, which makes the natural frequency very high. High natural frequency is one major concern about the micro-scaled energy harvesters. By utilizing the fan-folded geometry and adding tip mass and link mass to the configuration, this natural frequency is reduced to the desired range. This fan-folded design makes it possible to generate more than 10 μW of power. The proposed device does not incorporate magnets and is thus Magnetic resonance imaging (MRI) compatible. Although our device is a linear energy harvester, it is shown that the device is relatively insensitive to the heartrate. The natural frequencies and the mode shapes of the device are calculated. An analytical solution is presented and the method is verified by experimental investigation. We use a closed loop shaker controller and a shaker to simulate the heartbeat vibrations. The developed analytical model is verified through comparison of theoretical and experimental tip displacement and acceleration frequency response functions.

  10. Pacemaker-Induced Transient Asynchrony Suppresses Heart Failure Progression

    PubMed Central

    Kirk, Jonathan A.; Chakir, Khalid; Lee, Kyoung Hwan; Karst, Edward; Holewinski, Ronald J.; Pironti, Gianluigi; Tunin, Richard S.; Pozios, Iraklis; Abraham, Theodore P.; de Tombe, Pieter; Rockman, Howard A.; Van Eyk, Jennifer E.; Craig, Roger; Farazi, Taraneh G.; Kass, David A.

    2016-01-01

    Uncoordinated contraction from electromechanical delay worsens heart failure pathophysiology and prognosis, but restoring coordination with bi-ventricular pacing, known as cardiac resynchronization therapy (CRT) improves both. Not every patient, however, qualifies for CRT. Here we show that heart failure with synchronous contraction is improved by inducing dyssynchrony for 6 hours daily by right-ventricular pacing using an intracardiac pacing device, in a process we call pacemaker-induced transient asynchrony (PITA). In dogs with heart failure induced by 6 weeks of atrial tachypacing, PITA (starting on week 3) suppressed progressive cardiac dilation as well as chamber and myocyte dysfunction. PITA enhanced β-adrenergic responsiveness in vivo and normalized it in myocytes. Myofilament calcium response declined in dogs with synchronous heart failure, which was accompanied by sarcomere disarray and generation of myofibers with severely reduced function, and these changes were absent in PITA-treated hearts. The benefits of PITA were not replicated when the same number of RV-paced beats was randomly distributed throughout the day, indicating that continuity of dyssynchrony exposure is necessary to trigger the beneficial biological response upon resynchronization. These results suggest PITA could bring the benefits of CRT to the many heart failure patients with synchronous contraction that are not CRT candidates. PMID:26702095

  11. Possible Influences of Spark Discharges on Cardiac Pacemakers.

    PubMed

    Korpinen, Leena; Kuisti, Harri; Tarao, Hiroo; Virtanen, Vesa; Pääkkönen, Rauno; Dovan, Thanh; Kavet, Robert

    2016-01-01

    Exposure to spark discharges may occur beneath high voltage transmission lines when contact is initiated with a conductive object (such as a motor vehicle) with the spark discharge mediated by the ambient electric field from the line. The objective of this study was to assess whether such exposures could interfere with the normal functioning of implanted cardiac pacemakers (PMs). The experiment consisted of PMs implanted in a human-sized phantom and then exposed to spark discharge through an upper extremity. A circuit was designed that produced spark discharges between two spherical electrodes fed to the phantom's left hand. The circuit was set to deliver a single discharge per half cycle (every 10 ms) about 10 μs in duration with a peak current of 1.2-1.3 A, thus simulating conditions under a 400-kV power line operating at 50 Hz. Of 29 PMs acquired, all were tested in unipolar configuration and 20 in bipolar configuration with exposure consisting of 2 min of continuous exposure (one unit was exposed for 1 min). No interference was observed in bipolar configuration. One unit in unipolar configuration incorrectly identified ventricular extra systoles (more than 400 beats min(-1)) for 2 s. The use of unipolar configuration in new implants is extremely rare, thus further minimizing the risk of interference with the passage of time. Replication of this study and, if safety for human subjects can be assured, future testing of human subjects is also advisable. PMID:26606060

  12. Management of radiation therapy patients with cardiac defibrillator or pacemaker.

    PubMed

    Salerno, Francesca; Gomellini, Sara; Caruso, Cristina; Barbara, Raffaele; Musio, Daniela; Coppi, Tamara; Cardinale, Mario; Tombolini, Vincenzo; de Paula, Ugo

    2016-06-01

    The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary. PMID:26706454

  13. Right Ventricular Anatomy Can Accommodate Multiple Micra Transcatheter Pacemakers

    PubMed Central

    EGGEN, MICHAEL D.; BONNER, MATTHEW D.; IAIZZO, PAUL A.; WIKA, KENT

    2016-01-01

    Background The introduction of transcatheter pacemaker technology has the potential to significantly reduce if not eliminate a number of complications associated with a traditional leaded pacing system. However, this technology raises new questions regarding how to manage the device at end of service, the number of devices the right ventricle (RV) can accommodate, and what patient age is appropriate for this therapy. In this study, six human cadaver hearts and one reanimated human heart (not deemed viable for transplant) were each implanted with three Micra devices in traditional pacing locations via fluoroscopic imaging. Methods A total of six human cadaver hearts were obtained from the University of Minnesota Anatomy Bequest Program; the seventh heart was a heart not deemed viable for transplant obtained from LifeSource and then reanimated using Visible Heart® methodologies. Each heart was implanted with multiple Micras using imaging and proper delivery tools; in these, the right ventricular volumes were measured and recorded. The hearts were subsequently dissected to view the right ventricular anatomies and the positions and spacing between devices. Results Multiple Micra devices could be placed in each heart in traditional, clinically accepted pacing implant locations within the RV and in each case without physical device interactions. This was true even in a human heart considered to be relatively small. Conclusions Although this technology is new, it was demonstrated here that within the human heart's RV, three Micra devices could be accommodated within traditional pacing locations: with the potential in some, for even more. PMID:26710918

  14. Liquids with permanent porosity.

    PubMed

    Giri, Nicola; Del Pópolo, Mario G; Melaugh, Gavin; Greenaway, Rebecca L; Rätzke, Klaus; Koschine, Tönjes; Pison, Laure; Gomes, Margarida F Costa; Cooper, Andrew I; James, Stuart L

    2015-11-12

    Porous solids such as zeolites and metal-organic frameworks are useful in molecular separation and in catalysis, but their solid nature can impose limitations. For example, liquid solvents, rather than porous solids, are the most mature technology for post-combustion capture of carbon dioxide because liquid circulation systems are more easily retrofitted to existing plants. Solid porous adsorbents offer major benefits, such as lower energy penalties in adsorption-desorption cycles, but they are difficult to implement in conventional flow processes. Materials that combine the properties of fluidity and permanent porosity could therefore offer technological advantages, but permanent porosity is not associated with conventional liquids. Here we report free-flowing liquids whose bulk properties are determined by their permanent porosity. To achieve this, we designed cage molecules that provide a well-defined pore space and that are highly soluble in solvents whose molecules are too large to enter the pores. The concentration of unoccupied cages can thus be around 500 times greater than in other molecular solutions that contain cavities, resulting in a marked change in bulk properties, such as an eightfold increase in the solubility of methane gas. Our results provide the basis for development of a new class of functional porous materials for chemical processes, and we present a one-step, multigram scale-up route for highly soluble 'scrambled' porous cages prepared from a mixture of commercially available reagents. The unifying design principle for these materials is the avoidance of functional groups that can penetrate into the molecular cage cavities. PMID:26560299

  15. Liquids with permanent porosity

    NASA Astrophysics Data System (ADS)

    Giri, Nicola; Del Pópolo, Mario G.; Melaugh, Gavin; Greenaway, Rebecca L.; Rätzke, Klaus; Koschine, Tönjes; Pison, Laure; Gomes, Margarida F. Costa; Cooper, Andrew I.; James, Stuart L.

    2015-11-01

    Porous solids such as zeolites and metal-organic frameworks are useful in molecular separation and in catalysis, but their solid nature can impose limitations. For example, liquid solvents, rather than porous solids, are the most mature technology for post-combustion capture of carbon dioxide because liquid circulation systems are more easily retrofitted to existing plants. Solid porous adsorbents offer major benefits, such as lower energy penalties in adsorption-desorption cycles, but they are difficult to implement in conventional flow processes. Materials that combine the properties of fluidity and permanent porosity could therefore offer technological advantages, but permanent porosity is not associated with conventional liquids. Here we report free-flowing liquids whose bulk properties are determined by their permanent porosity. To achieve this, we designed cage molecules that provide a well-defined pore space and that are highly soluble in solvents whose molecules are too large to enter the pores. The concentration of unoccupied cages can thus be around 500 times greater than in other molecular solutions that contain cavities, resulting in a marked change in bulk properties, such as an eightfold increase in the solubility of methane gas. Our results provide the basis for development of a new class of functional porous materials for chemical processes, and we present a one-step, multigram scale-up route for highly soluble ‘scrambled’ porous cages prepared from a mixture of commercially available reagents. The unifying design principle for these materials is the avoidance of functional groups that can penetrate into the molecular cage cavities.

  16. Permanent Turbidity-Standards

    PubMed Central

    Roessler, William G.; Brewer, Carl R.

    1967-01-01

    Permanent turbidity reference standards suitable for measurement of microbial suspensions were prepared by suspending finely divided titanium dioxide in aryl sulfonamide-formaldehyde or methylstyrene resins. Turbidities of these standards, adjusted to a useful range for microbiological and immunological studies, were compared with other reference standards in use today. Tube holders for a Coleman Photonephelometer and a Nepho-Colorimeter were modified to eliminate the water well and to allow use of optically standardized 10-, 16-, or 18-mm test tubes. The standards and the tube holders have been used satisfactorily for more than 12 years. Images Fig. 5 Fig. 6 PMID:6077410

  17. Cryogenic Permanent Magnet Undulators

    SciTech Connect

    Chavanne, J.; Lebec, G.; Penel, C.; Revol, F.; Kitegi, C.

    2010-06-23

    For an in-vacuum undulator operated at small gaps the permanent magnet material needs to be highly resistant to possible electron beam exposure. At room temperature, one generally uses Sm{sub 2}Co{sub 17} or high coercivity NdFeB magnets at the expense of a limited field performance. In a cryogenic permanent magnet undulator (CPMU), at a temperature of around 150 K, any NdFeB grade reveals a coercivity large enough to be radiation resistant. In particular, very high remanence NdFeB material can be used to build undulators with enhanced field and X-ray brilliance at high photon energy provided that the pre-baking of the undulator above 100 deg. C can be eliminated. The ESRF has developed a full scale 2 m long CPMU with a period of 18 mm. This prototype has been in operation on the ID6 test beamline since January 2008. A significant effort was put into the characterization of NdFeB material at low temperature, the development of dedicated magnetic measurement systems and cooling methods. The measured heat budget with beam is found to be larger than expected without compromising the smooth operation of the device. Leading on from this first experience, new CPMUs are currently being considered for the upgrade of the ESRF.

  18. Ionic Mechanisms of Pacemaker Activity in Spontaneously-contracting Atrial HL-1 Cells

    PubMed Central

    Yang, Zhenjiang; Murray, Katherine T.

    2010-01-01

    Although normally absent, spontaneous pacemaker activity can develop in human atrium to promote tachyarrhythmias. HL-1 cells are immortalized atrial cardiomyocytes that contract spontaneously in culture, providing a model system of atrial cell automaticity. Using electrophysiologic recordings and selective pharmacologic blockers, we investigated the ionic basis of automaticity in atrial HL-1 cells. Both the sarcoplasmic reticulum (SR) Ca++ release channel inhibitor ryanodine and the SR Ca++ ATPase inhibitor thapsigargin slowed automaticity, supporting a role for intracellular Ca++ release in pacemaker activity. Additional experiments were performed to examine the effects of ionic currents activating in the voltage range of diastolic depolarization. Inhibition of the hyperpolarization-activated pacemaker current, If, by ivabradine significantly suppressed diastolic depolarization, with modest slowing of automaticity. Block of inward Na+ currents also reduced automaticity, while inhibition of T- and L-type Ca++ currents caused milder effects to slow beat rate. The major outward current in HL-1 cells is the rapidly activating delayed rectifier, IKr. Inhibition of IKr using dofetilide caused marked prolongation of APD and thus spontaneous cycle length. These results demonstrate a mutual role for both intracellular Ca++ release and sarcolemmal ionic currents in controlling automaticity in atrial HL-1 cells. Given that similar internal and membrane-based mechanisms also play a role in sinoatrial nodal cell pacemaker activity, our findings provide evidence for generalized conservation of pacemaker mechanisms among different types of cardiomyocytes. PMID:20881602

  19. Calcium transient and sodium-calcium exchange current in human versus rabbit sinoatrial node pacemaker cells.

    PubMed

    Verkerk, Arie O; van Borren, Marcel M G J; Wilders, Ronald

    2013-01-01

    There is an ongoing debate on the mechanism underlying the pacemaker activity of sinoatrial node (SAN) cells, focusing on the relative importance of the "membrane clock" and the "Ca(2+) clock" in the generation of the small net membrane current that depolarizes the cell towards the action potential threshold. Specifically, the debate centers around the question whether the membrane clock-driven hyperpolarization-activated current, I f , which is also known as the "funny current" or "pacemaker current," or the Ca(2+) clock-driven sodium-calcium exchange current, I NaCa, is the main contributor to diastolic depolarization. In our contribution to this journal's "Special Issue on Cardiac Electrophysiology," we present a numerical reconstruction of I f and I NaCa in isolated rabbit and human SAN pacemaker cells based on experimental data on action potentials, I f , and intracellular calcium concentration ([Ca(2+)] i ) that we have acquired from these cells. The human SAN pacemaker cells have a smaller I f , a weaker [Ca(2+)] i transient, and a smaller I NaCa than the rabbit cells. However, when compared to the diastolic net membrane current, I NaCa is of similar size in human and rabbit SAN pacemaker cells, whereas I f is smaller in human than in rabbit cells. PMID:23606816

  20. The six-minute walk--an adequate exercise test for pacemaker patients?

    PubMed

    Langenfeld, H; Schneider, B; Grimm, W; Beer, M; Knoche, M; Riegger, G; Kochsiek, K

    1990-12-01

    In many pacemaker patients bicycle and treadmill ergometry are not practicable. As an alternative, we performed a 6-minute walk on a 20-m corridor in 97 pacemaker patients, who were asked to walk as far as possible determining their speed by themselves. Results were compared with those of bicycle ergometry in 42 of these patients and with treadmill exercise of a group of 92 other pacemaker patients. In the 6-minute walk, performance and maximal heart rate were slightly lower (49 +/- 18 W; 96 +/- 23 beats/min) than in bicycle (57 +/- 16 W; 110 +/- 26 beats/min) and treadmill ergometry (50 +/- 37 W; 102 +/- 35 beats/min). A good correlation was found between walking and bicycling (r = 0.74) and in subgroups of patients with different pacemaker indications. All patients preferred the walk to bicycle ergometry considering it to be more related to daily physical activity. In conclusion, a 6-minute walk is a simple and physiological exercise test for nearly all pacemaker patients with good correlation to other types of exercise. It seems to be preferable to other tests because of its better acceptance and practicability. PMID:1704537

  1. Ionic mechanisms of pacemaker activity in spontaneously contracting atrial HL-1 cells.

    PubMed

    Yang, Zhenjiang; Murray, Katherine T

    2011-01-01

    Although normally absent, spontaneous pacemaker activity can develop in human atrium to promote tachyarrhythmias. HL-1 cells are immortalized atrial cardiomyocytes that contract spontaneously in culture, providing a model system of atrial cell automaticity. Using electrophysiologic recordings and selective pharmacologic blockers, we investigated the ionic basis of automaticity in atrial HL-1 cells. Both the sarcoplasmic reticulum Ca release channel inhibitor ryanodine and the sarcoplasmic reticulum Ca ATPase inhibitor thapsigargin slowed automaticity, supporting a role for intracellular Ca release in pacemaker activity. Additional experiments were performed to examine the effects of ionic currents activating in the voltage range of diastolic depolarization. Inhibition of the hyperpolarization-activated pacemaker current, If, by ivabradine significantly suppressed diastolic depolarization, with modest slowing of automaticity. Block of inward Na currents also reduced automaticity, whereas inhibition of T- and L-type Ca currents caused milder effects to slow beat rate. The major outward current in HL-1 cells is the rapidly activating delayed rectifier, IKr. Inhibition of IKr using dofetilide caused marked prolongation of action potential duration and thus spontaneous cycle length. These results demonstrate a mutual role for both intracellular Ca release and sarcolemmal ionic currents in controlling automaticity in atrial HL-1 cells. Given that similar internal and membrane-based mechanisms also play a role in sinoatrial nodal cell pacemaker activity, our findings provide evidence for generalized conservation of pacemaker mechanisms among different types of cardiomyocytes. PMID:20881602

  2. Successful Treatment of Occipital Neuralgia with Implantable Peripheral Nerve Stimulation in a Pacemaker-Dependent Patient

    PubMed Central

    Chaiban, Gassan; Tolba, Reda; Eissa, Hazem; Lirette, Lesley Smallwood; Almualim, Mohammed; Malaty, Adham; Atallah, Joseph

    2014-01-01

    Background Peripheral nerve stimulation has been used to treat patients with occipital nerve–related chronic headaches who have been unsuccessful with less invasive therapeutic approaches. Patients with pacemaker-dependent cardiac conduction abnormalities require unique consideration prior to the implantation of peripheral nerve stimulators because the placement of the devices may lead to failure of the systems secondary to electromagnetic interference or crosstalk between the devices. Case Report An 86-year-old female who suffered from chronic right-sided cervicogenic headaches and neck pain had received only temporary relief from previous treatments. Additional comorbidities included longstanding pacemaker-dependent atrioventricular node conduction disease. Because the extent to which nerve stimulators electrically interact with pacemakers is unclear, we tunneled the leads to the lumbar region of the back and placed the generator on the contralateral side to the pacemaker to minimize the chance that the 2 devices would interfere. The patient has remained pain free for 1 year since implantation. Conclusion Although no current published trials evaluate the degree of interference between medical devices, case reports increasingly suggest that simultaneous implantation of a spinal cord stimulator and pacemaker is safe as long as precautions are taken and the devices are checked periodically, particularly when the devices are adjusted. PMID:24688344

  3. Modeling and experimental verification of a fan-folded vibration energy harvester for leadless pacemakers

    NASA Astrophysics Data System (ADS)

    Ansari, M. H.; Karami, M. Amin

    2016-03-01

    This paper studies energy harvesting from heartbeat vibrations for powering leadless pacemakers. Unlike traditional pacemakers, leadless pacemakers are implanted inside the heart and the pacemaker is in direct contact with the myocardium. A leadless pacemaker is in the shape of a cylinder. Thus, in order to utilize the available 3-dimensional space for the energy harvester, we choose a fan-folded 3D energy harvester. The proposed device consists of several piezoelectric beams stacked on top of each other. The volume of the energy harvester is 1 cm3 and its dimensions are 2 cm × 0.5 cm × 1 cm. Although high natural frequency is generally a major concern with micro-scale energy harvesters, by utilizing the fan-folded geometry and adding tip mass and link mass to the configuration, we reduced the natural frequency to the desired range. This fan-folded design makes it possible to generate more than 10 μ W of power per cubic centimeter. The proposed device is compatible with Magnetic Resonance Imaging. Although the proposed device is a linear energy harvester, it is relatively insensitive to the heart rate. The natural frequencies and the mode shapes of the device are calculated analytically. The accuracy of the analytical model is verified by experimental investigations. We use a closed loop shaker system to precisely replicate heartbeat vibrations in vitro.

  4. Chlamydia Infections

    MedlinePlus

    ... PID). PID can cause permanent damage to your reproductive system. This can lead to long-term pelvic pain, infertility, and ectopic pregnancy. Women who have had chlamydia infections more than once are at higher risk of serious reproductive health complications. Men often don't have health ...

  5. Electrophysiological Evidence for Intrinsic Pacemaker Currents in Crayfish Parasol Cells.

    PubMed

    Mellon, DeForest

    2016-01-01

    I used sharp intracellular electrodes to record from parasol cells in the semi-isolated crayfish brain to investigate pacemaker currents. Evidence for the presence of the hyperpolarization-activated inward rectifier potassium current was obtained in about half of the parasol cells examined, where strong, prolonged hyperpolarizing currents generated a slowly-rising voltage sag, and a post-hyperpolarization rebound. The amplitudes of both the sag voltage and the depolarizing rebound were dependent upon the strength of the hyperpolarizing current. The voltage sag showed a definite threshold and was non-inactivating. The voltage sag and rebound depolarization evoked by hyperpolarization were blocked by the presence of 5-10 mM Cs2+ ions, 10 mM tetraethyl ammonium chloride, and 10 mM cobalt chloride in the bathing medium, but not by the drug ZD 7288. Cs+ ions in normal saline in some cells caused a slight increase in mean resting potential and a reduction in spontaneous burst frequency. Many of the neurons expressing the hyperpolarization-activated inward potassium current also provided evidence for the presence of the transient potassium current IA, which was inferred from experimental observations of an increased latency of post-hyperpolarization response to a depolarizing step, compared to the response latency to the depolarization alone. The latency increase was reduced in the presence of 4-aminopyridine (4-AP), a specific blocker of IA. The presence of 4-AP in normal saline also induced spontaneous bursting in parasol cells. It is conjectured that, under normal physiological conditions, these two potassium currents help to regulate burst generation in parasol cells, respectively, by helping to maintain the resting membrane potential near a threshold level for burst generation, and by regulating the rate of rise of membrane depolarizing events leading to burst generation. The presence of post-burst hyperpolarization may depend upon IA channels in parasol cells. PMID

  6. Setups for in vitro assessment of RFID interference on pacemakers

    NASA Astrophysics Data System (ADS)

    Mattei, E.; Censi, F.; Delogu, A.; Ferrara, A.; Calcagnini, G.

    2013-08-01

    The aim of this study is to propose setups for in vitro assessment of RFID (radiofrequency identification) interference on pacemakers (PM). The voltage induced at the input stage of the PM by low-frequency (LF) and high-frequency (HF) RFID transmitters has been used to quantify the amount of the interference. A commercial PM was modified in order to measure the voltage at its input stage when exposed to a sinusoidal signal at 125 kHz and 13.56 MHz. At both frequencies, two antennas with different dimensions (diameter = 10 cm and 30 cm, respectively) were used to generate the interfering field, and the induced voltage was measured between the lead tip and the PM case (unipolar voltage), and between the tip and ring electrodes (bipolar voltage). The typical lead configurations adopted in similar studies or proposed by international standards, as well as lead paths closer to actual physiological implants were tested. At 125 kHz, the worst-case condition differs for the two antennas: the 10 cm antenna induced the highest voltage in the two-loop spiral configuration, whereas the 30 cm antenna in the 225 cm2 loop configuration. At 13.56 MHz, the highest voltage was observed for both the antennas in the 225 cm2 loop configuration. Bipolar voltages were found to be lower than the unipolar voltages induced in the same configurations, this difference being not as high as one could expect from theoretical considerations. The worst-case scenario, in terms of the induced voltage at the PM input stage, has been identified both for LF and HF readers, and for two sizes of transmitting antennas. These findings may provide the basis for the definition of a standard implant configuration and a lead path to test the EMI effects of LF and HF RFID transmitters on active implantable devices.

  7. Electrophysiological Evidence for Intrinsic Pacemaker Currents in Crayfish Parasol Cells

    PubMed Central

    Mellon, DeForest

    2016-01-01

    I used sharp intracellular electrodes to record from parasol cells in the semi-isolated crayfish brain to investigate pacemaker currents. Evidence for the presence of the hyperpolarization-activated inward rectifier potassium current was obtained in about half of the parasol cells examined, where strong, prolonged hyperpolarizing currents generated a slowly-rising voltage sag, and a post-hyperpolarization rebound. The amplitudes of both the sag voltage and the depolarizing rebound were dependent upon the strength of the hyperpolarizing current. The voltage sag showed a definite threshold and was non-inactivating. The voltage sag and rebound depolarization evoked by hyperpolarization were blocked by the presence of 5–10 mM Cs2+ ions, 10 mM tetraethyl ammonium chloride, and 10 mM cobalt chloride in the bathing medium, but not by the drug ZD 7288. Cs+ ions in normal saline in some cells caused a slight increase in mean resting potential and a reduction in spontaneous burst frequency. Many of the neurons expressing the hyperpolarization-activated inward potassium current also provided evidence for the presence of the transient potassium current IA, which was inferred from experimental observations of an increased latency of post-hyperpolarization response to a depolarizing step, compared to the response latency to the depolarization alone. The latency increase was reduced in the presence of 4-aminopyridine (4-AP), a specific blocker of IA. The presence of 4-AP in normal saline also induced spontaneous bursting in parasol cells. It is conjectured that, under normal physiological conditions, these two potassium currents help to regulate burst generation in parasol cells, respectively, by helping to maintain the resting membrane potential near a threshold level for burst generation, and by regulating the rate of rise of membrane depolarizing events leading to burst generation. The presence of post-burst hyperpolarization may depend upon IA channels in parasol cells

  8. Graded permanent magnets

    NASA Astrophysics Data System (ADS)

    Skomski, R.; Hadjipanayis, G. C.; Sellmyer, D. J.

    2009-04-01

    The effect of semihard magnetic phases and interfaces on the performance of nanostructured two-phase permanent magnets is investigated by model calculations. In addition to the trivial coercivity increase due to the replacement of soft regions by semihard regions, there is a coercivity enhancement even if the volume-averaged anisotropy is kept constant during the introduction of the semihard phase. A variational approach is used to derive analytical results for representative anisotropy profiles. The improvement is operative on length scales slightly larger than that of the soft phase in hard-soft composites, but the main challenge is to find semihard light or heavy transition metal phases with a high magnetization. There are several Fe- and Co-based phases, but most are thin-film systems and difficult to use in bulk magnets. Very hard nanostructured magnets may also be created from soft phases with negative but large anisotropy constants (hard-magnetic soft-soft magnets).

  9. Right ventricle bipolar pacing may prevent appropriate biventricular pacing from two pacemakers. Case report.

    PubMed

    Kranidis, Athanasios I; Andrikopoulos, George K; Kappos, Kostas G; Bouki, Tania P; Dedehlias, Panos N

    2004-10-01

    This article reports on practical problems and possible solutions that may occur in case of upgrading a dual-chamber pacemaker by implanting a second left ventricular ventricular pacing, ventricular sensing, ventricular triggering (VVT) pacemaker. This therapeutic strategy was considered appropriate in the case of a 73-year-old patient with severe heart failure, who was scheduled to undergo coronary artery bypass surgery. A right-sided, dual-chamber pacemaker had been already implanted to the patient. The duration of the paced QRS complex was 220 ms and inter- and intraventricular dyssynchrony was documented in the echocardiographic study. We describe the methodological problems and possible solutions related to biventricular pacing following the abovementioned strategy. PMID:15484162

  10. Experimental Evaluation of SAR around an Implanted Cardiac Pacemaker Caused by Mobile Radio Terminal

    NASA Astrophysics Data System (ADS)

    Endo, Yuta; Saito, Kazuyuki; Watanabe, Soichi; Takahashi, Masaharu; Ito, Koichi

    Although the effect of electromagnetic interference on an implanted cardiac pacemaker due to a nearby mobile phone has been investigated, there have been few studies on the enhancement of the specific absorption rate (SAR) around an implanted cardiac pacemaker due to a nearby mobile phone. In this study, the SAR distribution around a pacemaker model embedded in a parallelepiped torso phantom when a mobile phone was nearby was numerically calculated and experimentally measured. The results of both investigations showed a characteristic SAR distribution. The system presented can be used to estimate the effects of electromagnetic interference on implanted electric circuits and thus could lead to the development of guidelines for the safe use of mobile radio terminals near people with medical implants.

  11. Superior vena cava occlusion and/or syndrome related to pacemaker leads.

    PubMed

    Mazzetti, H; Dussaut, A; Tentori, C; Dussaut, E; Lazzari, J O

    1993-03-01

    Four cases of pacemaker-related SVC obstruction or syndrome are reported. While two of them lacked any symptom suggestive of SVC obstruction, the other two presented with mild symptoms. None of them received any treatment. One died from a cause unrelated to SVC obstruction, while the others presented no change in their clinical status. A review of the literature suggests that neither thrombotic nor fibrotic obstruction in patients with pacemaker leads is strictly related to the number of abandoned leads, the presence of severed leads, or the time elapsing from pacemaker implant. The diagnosis is clinically made and is confirmed by venography. Only one of the reported deaths is attributable to SVC obstruction. The remaining cases from the literature responded to treatment with heparin, thrombolytic agents, angioplasty, or surgery. PMID:8438712

  12. In search of the pathways for light-induced pacemaker resetting in the suprachiasmatic nucleus.

    PubMed

    Meijer, Johanna H; Schwartz, William J

    2003-06-01

    Within the suprachiasmatic nucleus (SCN) of the mammalian hypothalamus is a circadian pacemaker that functions as a clock. Its endogenous period is adjusted to the external 24-h light-dark cycle, primarily by light-induced phase shifts that reset the pacemaker's oscillation. Evidence using a wide variety of neurobiological and molecular genetic tools has elucidated key elements that comprise the visual input pathway for SCN photoentrainment in rodents. Important questions remain regarding the intracellular signals that reset the autoregulatory molecular loop within photoresponsive cells in the SCN's retino-recipient subdivision, as well as the intercellular coupling mechanisms that enable SCN tissue to generate phase shifts of overt behavioral and physiological circadian rhythms such as locomotion and SCN neuronal firing rate. Multiple neurotransmitters, protein kinases, and photoinducible genes add to system complexity, and we still do not fully understand how dawn and dusk light pulses ultimately produce bidirectional, advancing and delaying phase shifts for pacemaker entrainment. PMID:12828281

  13. [Verification of irradiation conditions of X-rays that influence implantable cardiac pacemakers].

    PubMed

    Umezawa, Naoki; Hirose, Minoru; Shinbo, Toshihiro

    2008-07-20

    Originally, it was thought that X-rays did not influence implantable cardiac pacemakers. In general, radiological technologists did not take proper care of these devises at the time of X-Ray examinations. However, 11 cases in which pacemakers malfunctioned (for example partial electrical reset) during CT examinations have been reported in recent years. At the time, we tended to attribute such problems to the peculiarities of multi-detector CT (MDCT). However, on logical grounds this explanation seemed weak. To better explain the problem, we attempted various tests in which pacemakers were exposed to CT and X-ray photography equipment. We analyzed some ECG results to clarify the matter and took measurements to examine these problems. PMID:18719296

  14. Effects of lubiprostone on pacemaker activity of interstitial cells of cajal from the mouse colon.

    PubMed

    Jiao, Han-Yi; Kim, Dong Hyun; Ki, Jung Suk; Ryu, Kwon Ho; Choi, Seok; Jun, Jae Yeoul

    2014-08-01

    Lubiprostone is a chloride (Cl(-)) channel activator derived from prostaglandin E1 and used for managing constipation. In addition, lubiprostone affects the activity of gastrointestinal smooth muscles. Interstitial cells of Cajal (ICCs) are pacemaker cells that generate slow-wave activity in smooth muscles. We studied the effects of lubiprostone on the pacemaker potentials of colonic ICCs. We used the whole-cell patch-clamp technique to determine the pacemaker activity in cultured colonic ICCs obtained from mice. Lubiprostone hyperpolarized the membrane and inhibited the generation of pacemaker potentials. Prostanoid EP1, EP2, EP3, and EP4 antagonists (SC-19220, PF-04418948, 6-methoxypyridine-2-boronc acid N-phenyldiethanolamine ester, and GW627368, respectively) did not block the response to lubiprostone. L-NG-nitroarginine methyl ester (L-NAME, an inhibitor of nitric oxide synthase) and 1H-[1,2,4]oxadiazolo[4,3,-a]quinoxalin-1-one (ODQ, an inhibitor of guanylate cyclase) did not block the response to lubiprostone. In addition, tetraethylammonium (TEA, a voltage-dependent potassium [K(+)] channel blocker) and apamin (a calcium [Ca(2+)]-dependent K(+) channel blocker) did not block the response to lubiprostone. However, glibenclamide (an ATP-sensitive K(+) channel blocker) blocked the response to lubiprostone. Similar to lubiprostone, pinacidil (an opener of ATP-sensitive K(+) channel) hyperpolarized the membrane and inhibited the generation of pacemaker potentials, and these effects were inhibited by glibenclamide. These results suggest that lubiprostone can modulate the pacemaker potentials of colonic ICCs via activation of ATP-sensitive K(+) channel through a prostanoid EP receptor-independent mechanism. PMID:25177167

  15. Autaptic pacemaker mediated propagation of weak rhythmic activity across small-world neuronal networks

    NASA Astrophysics Data System (ADS)

    Yilmaz, Ergin; Baysal, Veli; Ozer, Mahmut; Perc, Matjaž

    2016-02-01

    We study the effects of an autapse, which is mathematically described as a self-feedback loop, on the propagation of weak, localized pacemaker activity across a Newman-Watts small-world network consisting of stochastic Hodgkin-Huxley neurons. We consider that only the pacemaker neuron, which is stimulated by a subthreshold periodic signal, has an electrical autapse that is characterized by a coupling strength and a delay time. We focus on the impact of the coupling strength, the network structure, the properties of the weak periodic stimulus, and the properties of the autapse on the transmission of localized pacemaker activity. Obtained results indicate the existence of optimal channel noise intensity for the propagation of the localized rhythm. Under optimal conditions, the autapse can significantly improve the propagation of pacemaker activity, but only for a specific range of the autaptic coupling strength. Moreover, the autaptic delay time has to be equal to the intrinsic oscillation period of the Hodgkin-Huxley neuron or its integer multiples. We analyze the inter-spike interval histogram and show that the autapse enhances or suppresses the propagation of the localized rhythm by increasing or decreasing the phase locking between the spiking of the pacemaker neuron and the weak periodic signal. In particular, when the autaptic delay time is equal to the intrinsic period of oscillations an optimal phase locking takes place, resulting in a dominant time scale of the spiking activity. We also investigate the effects of the network structure and the coupling strength on the propagation of pacemaker activity. We find that there exist an optimal coupling strength and an optimal network structure that together warrant an optimal propagation of the localized rhythm.

  16. Achieving permanency for LGBTQ youth.

    PubMed

    Jacobs, Jill; Freundlich, Madelyn

    2006-01-01

    This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family connection before leaving the child welfare system; however, LGBTQ youth are not routinely included in the permanency discussions. At the same time, efforts in addressing the needs of LGBTQ youth have increased, but permanency is rarely mentioned as a need. This article offers models of permanence and practices to facilitate permanence with LGBTQ youth and their families. It also offers a youth-driven, individualized process, using youth development principles to achieve relational, physical, and legal permanence. Reunification efforts are discussed, including services, supports, and education required for youth to return to their family of origin. For those who cannot return home, other family resources are explored. The article also discusses cultural issues as they affect permanence for LGBTQ youth, and, finally, addresses the need for ongoing support services to sustain and support permanency. PMID:16846117

  17. Treatment of paroxysmal nodal tachycardia by dual demand pacemaker in the coronary sinus.

    PubMed Central

    O'Keeffe, D B; Curry, P V; Sowton, E

    1981-01-01

    A patient with refractory paroxysmal atrioventricular nodal re-entrant tachycardia had required direct current cardioversion to terminate attacks on 83 occasions. A dual demand pacemaker was implanted to sense and interrupt attacks of tachycardia automatically. The pacing electrode was positioned in the proximal coronary sinus near to the atrioventricular node; a site from which fixed rate underdrive pacing successfully interrupted attacks throughout a trial period of one week, with a lead left in this position on a temporary basis. Complete control of the arrhythmia was obtained in the six months after pacemaker implantation. Images PMID:7459160

  18. Electromagnetic interference with a bipolar pacemaker by an induction heating (IH) rice cooker.

    PubMed

    Nagatomo, Toshihisa; Abe, Haruhiko; Kohno, Ritsuko; Toyoshima, Takeshi; Fujimoto, Hiroshi; Kondo, Shoichi; Kabashima, Narutoshi; Takeuchi, Masaaki; Tamura, Masahito; Okazaki, Masahiro; Otsuji, Yutaka

    2009-01-01

    Electromagnetic fields may interfere with normal pacemaker function. Despite new device designs and bipolar leads, electromagnetic interference (EMI) remains a concern when pacemaker recipients are exposed to various household appliances. We report the observation of EMI by an induction heating (IH) rice cooker in a patient with sick sinus syndrome who was the recipient of a bipolar dual chamber-pacing system. Stored electrograms revealed episodes of inappropriate ventricular pacing, all coinciding with the opening of an IH rice cooker. Recipients of implantable medical devices must be warned to handle IH rice cookers with caution. PMID:19246854

  19. Myopotential inhibition of a bipolar pacemaker caused by electrode insulation defect.

    PubMed Central

    Amikam, S; Peleg, H; Lemer, J; Riss, E

    1977-01-01

    A patient is described in whom myopotentials orginating from the anterior abdominal wall muscle suppressed the implanted demand pacemaker despite its bipolar mode of action. This phenomenon was shown by simultaneous recording of the electrocardiogram the electromyogram. At operation, a defect in the insulation of a previously repaired epicardial electrode was found lying in close proximity to these muscles. After repair of the insulation defect, normal pacemaker function was restored. It is suggested that the myopotentials leaked into the pacing system through the insulation defect, thereby suppressing the demand unit, which maintained its bipolar mode of pacing throughout. Images PMID:145229

  20. Tracking preference as unusual trigger of pacemaker-mediated tachycardia in a resynchronization device.

    PubMed

    Crea, Pasquale; Picciolo, Giuseppe; Luzza, Francesco

    2016-01-01

    A 59-year-old woman with a history of congestive heart failure, who previously received a biventricular cardioverter-defibrillator was admitted with dyspnea and peripheral edema. She was noted on telemetry to have multiple self-terminated episodes of rapid ventricular pacing, consistent with pacemaker-mediated tachycardia. All episodes started after three consecutive ventricular extrasystoles. "Tracking preference" algorithm, designed to maintain atrial-tracked biventricular pacing in CRT devices, resulted turned on. It affected minimum PVARP and resulted the trigger for pacemaker mediated tachycardia. PMID:26976512

  1. Permanent dots in radiation therapy.

    PubMed

    Uyeda, L M

    1987-01-01

    Currently the word tattoo is used to describe the permanent marks used on patients in radiation therapy. This article offers alternative wording and the reasons why a new term is suggested. Guidelines for the standardization and administration of permanent marks concludes the article. PMID:3588884

  2. Permanent-Magnet Meissner Bearing

    NASA Technical Reports Server (NTRS)

    Robertson, Glen A.

    1994-01-01

    Permanent-magnet meissner bearing features inherently stable, self-centering conical configuration. Bearing made stiffer or less stiff by selection of magnets, springs, and spring adjustments. Cylindrical permanent magnets with axial magnetization stacked coaxially on rotor with alternating polarity. Typically, rare-earth magnets used. Magnets machined and fitted together to form conical outer surface.

  3. Mechanisms underlying the cardiac pacemaker: the role of SK4 calcium-activated potassium channels

    PubMed Central

    Weisbrod, David; Khun, Shiraz Haron; Bueno, Hanna; Peretz, Asher; Attali, Bernard

    2016-01-01

    The proper expression and function of the cardiac pacemaker is a critical feature of heart physiology. The sinoatrial node (SAN) in human right atrium generates an electrical stimulation approximately 70 times per minute, which propagates from a conductive network to the myocardium leading to chamber contractions during the systoles. Although the SAN and other nodal conductive structures were identified more than a century ago, the mechanisms involved in the generation of cardiac automaticity remain highly debated. In this short review, we survey the current data related to the development of the human cardiac conduction system and the various mechanisms that have been proposed to underlie the pacemaker activity. We also present the human embryonic stem cell-derived cardiomyocyte system, which is used as a model for studying the pacemaker. Finally, we describe our latest characterization of the previously unrecognized role of the SK4 Ca2+-activated K+ channel conductance in pacemaker cells. By exquisitely balancing the inward currents during the diastolic depolarization, the SK4 channels appear to play a crucial role in human cardiac automaticity. PMID:26725737

  4. Beating irregularity of single pacemaker cells isolated from the rabbit sinoatrial node.

    PubMed Central

    Wilders, R; Jongsma, H J

    1993-01-01

    Single pacemaker heart cells discharge irregularly. Data on fluctuations in interbeat interval of single pacemaker cells isolated from the rabbit sinoatrial node are presented. The coefficient of variation of the interbeat interval is quite small, approximately 2%, even though the coefficient of variation of diastolic depolarization rate is approximately 15%. It has been hypothesized that random fluctuations in interbeat interval arise from the stochastic behavior of the membrane ionic channels. To test this hypothesis, we constructed a single channel model of a single pacemaker cell isolated from the rabbit sinoatrial node, i.e., a model into which the stochastic open-close kinetics of the individual membrane ionic channels are incorporated. Single channel conductances as well as single channel open and closed lifetimes are based on experimental data from whole cell and single channel experiments that have been published in the past decade. Fluctuations in action potential parameters of the model cell are compared with those observed experimentally. It is concluded that fluctuations in interbeat interval of single sinoatrial node pacemaker cells indeed are due to the stochastic open-close kinetics of the membrane ionic channels. PMID:8312495

  5. Measuring contraction propagation and localizing pacemaker cells using high speed video microscopy

    NASA Astrophysics Data System (ADS)

    Akl, Tony J.; Nepiyushchikh, Zhanna V.; Gashev, Anatoliy A.; Zawieja, David C.; Coté, Gerard L.

    2011-02-01

    Previous studies have shown the ability of many lymphatic vessels to contract phasically to pump lymph. Every lymphangion can act like a heart with pacemaker sites that initiate the phasic contractions. The contractile wave propagates along the vessel to synchronize the contraction. However, determining the location of the pacemaker sites within these vessels has proven to be very difficult. A high speed video microscopy system with an automated algorithm to detect pacemaker location and calculate the propagation velocity, speed, duration, and frequency of the contractions is presented in this paper. Previous methods for determining the contractile wave propagation velocity manually were time consuming and subject to errors and potential bias. The presented algorithm is semiautomated giving objective results based on predefined criteria with the option of user intervention. The system was first tested on simulation images and then on images acquired from isolated microlymphatic mesenteric vessels. We recorded contraction propagation velocities around 10 mm/s with a shortening speed of 20.4 to 27.1 μm/s on average and a contraction frequency of 7.4 to 21.6 contractions/min. The simulation results showed that the algorithm has no systematic error when compared to manual tracking. The system was used to determine the pacemaker location with a precision of 28 μm when using a frame rate of 300 frames per second.

  6. Measuring contraction propagation and localizing pacemaker cells using high speed video microscopy.

    PubMed

    Akl, Tony J; Nepiyushchikh, Zhanna V; Gashev, Anatoliy A; Zawieja, David C; Cot, Gerard L

    2011-02-01

    Previous studies have shown the ability of many lymphatic vessels to contract phasically to pump lymph. Every lymphangion can act like a heart with pacemaker sites that initiate the phasic contractions. The contractile wave propagates along the vessel to synchronize the contraction. However, determining the location of the pacemaker sites within these vessels has proven to be very difficult. A high speed video microscopy system with an automated algorithm to detect pacemaker location and calculate the propagation velocity, speed, duration, and frequency of the contractions is presented in this paper. Previous methods for determining the contractile wave propagation velocity manually were time consuming and subject to errors and potential bias. The presented algorithm is semiautomated giving objective results based on predefined criteria with the option of user intervention. The system was first tested on simulation images and then on images acquired from isolated microlymphatic mesenteric vessels. We recorded contraction propagation velocities around 10 mm/s with a shortening speed of 20.4 to 27.1 μm/s on average and a contraction frequency of 7.4 to 21.6 contractions/min. The simulation results showed that the algorithm has no systematic error when compared to manual tracking. The system was used to determine the pacemaker location with a precision of 28 μm when using a frame rate of 300 frames per second. PMID:21361700

  7. Transcription factor ISL1 is essential for pacemaker development and function

    PubMed Central

    Liang, Xingqun; Zhang, Qingquan; Cattaneo, Paola; Zhuang, Shaowei; Gong, Xiaohui; Spann, Nathanael J.; Jiang, Cizhong; Cao, Xinkai; Zhao, Xiaodong; Zhang, Xiaoli; Bu, Lei; Wang, Gang; Chen, H.S. Vincent; Zhuang, Tao; Yan, Jie; Geng, Peng; Luo, Lina; Banerjee, Indroneal; Chen, Yihan; Glass, Christopher K.; Zambon, Alexander C.; Chen, Ju; Sun, Yunfu; Evans, Sylvia M.

    2015-01-01

    The sinoatrial node (SAN) maintains a rhythmic heartbeat; therefore, a better understanding of factors that drive SAN development and function is crucial to generation of potential therapies, such as biological pacemakers, for sinus arrhythmias. Here, we determined that the LIM homeodomain transcription factor ISL1 plays a key role in survival, proliferation, and function of pacemaker cells throughout development. Analysis of several Isl1 mutant mouse lines, including animals harboring an SAN-specific Isl1 deletion, revealed that ISL1 within SAN is a requirement for early embryonic viability. RNA-sequencing (RNA-seq) analyses of FACS-purified cells from ISL1-deficient SANs revealed that a number of genes critical for SAN function, including those encoding transcription factors and ion channels, were downstream of ISL1. Chromatin immunoprecipitation assays performed with anti-ISL1 antibodies and chromatin extracts from FACS-purified SAN cells demonstrated that ISL1 directly binds genomic regions within several genes required for normal pacemaker function, including subunits of the L-type calcium channel, Ank2, and Tbx3. Other genes implicated in abnormal heart rhythm in humans were also direct ISL1 targets. Together, our results demonstrate that ISL1 regulates approximately one-third of SAN-specific genes, indicate that a combination of ISL1 and other SAN transcription factors could be utilized to generate pacemaker cells, and suggest ISL1 mutations may underlie sick sinus syndrome. PMID:26193633

  8. Popeye domain containing proteins are essential for stress-mediated modulation of cardiac pacemaking in mice

    PubMed Central

    Froese, Alexander; Breher, Stephanie S.; Waldeyer, Christoph; Schindler, Roland F.R.; Nikolaev, Viacheslav O.; Rinné, Susanne; Wischmeyer, Erhard; Schlueter, Jan; Becher, Jan; Simrick, Subreena; Vauti, Franz; Kuhtz, Juliane; Meister, Patrick; Kreissl, Sonja; Torlopp, Angela; Liebig, Sonja K.; Laakmann, Sandra; Müller, Thomas D.; Neumann, Joachim; Stieber, Juliane; Ludwig, Andreas; Maier, Sebastian K.; Decher, Niels; Arnold, Hans-Henning; Kirchhof, Paulus; Fabritz, Larissa; Brand, Thomas

    2012-01-01

    Cardiac pacemaker cells create rhythmic pulses that control heart rate; pacemaker dysfunction is a prevalent disorder in the elderly, but little is known about the underlying molecular causes. Popeye domain containing (Popdc) genes encode membrane proteins with high expression levels in cardiac myocytes and specifically in the cardiac pacemaking and conduction system. Here, we report the phenotypic analysis of mice deficient in Popdc1 or Popdc2. ECG analysis revealed severe sinus node dysfunction when freely roaming mutant animals were subjected to physical or mental stress. In both mutants, bradyarrhythmia developed in an age-dependent manner. Furthermore, we found that the conserved Popeye domain functioned as a high-affinity cAMP-binding site. Popdc proteins interacted with the potassium channel TREK-1, which led to increased cell surface expression and enhanced current density, both of which were negatively modulated by cAMP. These data indicate that Popdc proteins have an important regulatory function in heart rate dynamics that is mediated, at least in part, through cAMP binding. Mice with mutant Popdc1 and Popdc2 alleles are therefore useful models for the dissection of the mechanisms causing pacemaker dysfunction and could aid in the development of strategies for therapeutic intervention. PMID:22354168

  9. 76 FR 64223 - Cardiovascular Devices; Reclassification of External Pacemaker Pulse Generator Devices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... rule (44 FR 13284, March 9, 1979 and 44 FR 13372, March 9, 1979), the Cardiovascular Devices Panel... premarket approval for external pacemaker pulse generator devices (52 FR 17732, May 11, 1987). In 2009, FDA..., 2009 (74 FR 16214, April 9, 2009). In response to that order, FDA received reclassification...

  10. Survival of 4 dogs with persistent atrial standstill treated by pacemaker implantation.

    PubMed

    Thomason, Justin D; Kraus, Marc S; Fallaw, Tiffany L; Calvert, Clay A

    2016-03-01

    Pacemakers were implanted in 4 client-owned female dogs which had persistent atrial standstill. Three dogs were alive after 14 to 39 months and 1 dog was euthanized after 10.5 years. This report demonstrates that some dogs with persistent atrial standstill can survive for extended time periods. PMID:26933268

  11. Safety of Electromagnetic Articulography in Patients with Pacemakers and Implantable Cardioverter-Defibrillators

    ERIC Educational Resources Information Center

    Joglar, Jose A.; Nguyen, Carol; Garst, Diane M.; Katz, William F.

    2009-01-01

    Purpose: "Electromagnetic articulography (EMA)" uses a helmet to create alternating magnetic fields for tracking speech articulator movement. An important safety consideration is whether EMA magnetic fields interfere with the operation of speakers' pacemakers or implantable cardioverter-defibrillators (ICDs). In this investigation, individuals…

  12. Decreased human circadian pacemaker influence after 100 days in space: a case study

    NASA Technical Reports Server (NTRS)

    Monk, T. H.; Kennedy, K. S.; Rose, L. R.; Linenger, J. M.

    2001-01-01

    OBJECTIVE: The objectives of this study were (1) to assess the circadian rhythms and sleep of a healthy, 42-year-old male astronaut experiencing microgravity (weightlessness) for nearly 5 months while living aboard Space Station Mir as it orbited Earth and (2) to determine the effects of prolonged space flight on the endogenous circadian pacemaker, as indicated by oral temperature and subjective alertness rhythms, and their ramifications for sleep, alertness, and performance. METHODS: For three 12- to 14-day blocks of time (spread throughout the mission), oral temperatures were taken and subjective alertness was self-rated five times per day. Sleep diaries and performance tests were also completed daily during each block. RESULTS: Examination of the subject's circadian alertness and oral temperature rhythms suggested that the endogenous circadian pacemaker seemed to function quite well up to 90 days in space. Thereafter (on days 110-122), the influence of the endogenous circadian pacemaker on oral temperature and subjective alertness circadian rhythms was considerably weakened, with consequent disruptions in sleep. CONCLUSIONS: Space missions lasting more than 3 months might result in diminished circadian pacemaker influence in astronauts, leading to eventual sleep problems.

  13. Precise Estimation of Cellular Radio Electromagnetic Field in Elevators and EMI Impact on Implantable Cardiac Pacemakers

    NASA Astrophysics Data System (ADS)

    Harris, Louis-Ray; Hikage, Takashi; Nojima, Toshio

    The purpose of this paper is to investigate the possible impact of cellular phones' signals on implantable cardiac pacemakers in elevators. This is achieved by carrying out precise numerical simulations based on the Finite-Difference-Time-Domain method to examine the electromagnetic fields in elevator models. In order to examine the realistic and complicated situations where humans are present in the elevator, we apply the realistic homogeneous human phantom and cellular radios operating in the frequency bands 800MHz, 1.5GHz and 2GHz. These computed results of field strength inside the elevator are compared with a certain reference level determined from the experimentally obtained maximum interference distance of implantable cardiac pacemakers. This enables us to carry out a quantitative evaluation of the EMI risk to pacemakers by cellular radio transmission. The results show that for the case when up to 5 mobile radio users are present in the elevator model used, there is no likelihood of pacemaker malfunction for the frequency bands 800MHz, 1.5GHz and 2GHz.

  14. Hyperpolarization-activated cation and T-type calcium ion channel expression in porcine and human renal pacemaker tissues.

    PubMed

    Hurtado, Romulo; Smith, Carl S

    2016-05-01

    Renal pacemaker activity triggers peristaltic upper urinary tract contractions that propel waste from the kidney to the bladder, a process prone to congenital defects that are the leading cause of pediatric kidney failure. Recently, studies have discovered that hyperpolarization-activated cation (HCN) and T-type calcium (TTC) channel conductances underlie murine renal pacemaker activity, setting the origin and frequency and coordinating upper urinary tract peristalsis. Here, we determined whether this ion channel expression is conserved in the porcine and human urinary tracts, which share a distinct multicalyceal anatomy with multiple pacemaker sites. Double chromagenic immunohistochemistry revealed that HCN isoform 3 is highly expressed at the porcine minor calyces, the renal pacemaker tissues, whereas the kidney and urinary tract smooth muscle lacked this HCN expression. Immunofluorescent staining demonstrated that HCN(+) cells are integrated within the porcine calyx smooth muscle, and that they co-express TTC channel isoform Cav3.2. In humans, the anatomic structure of the minor calyx pacemaker was assayed via hematoxylin and eosin analyses, and enabled the visualization of the calyx smooth muscle surrounding adjacent papillae. Strikingly, immunofluorescence revealed that HCN3(+) /Cav3.2(+) cells are also localized to the human minor calyx smooth muscle. Collectively, these data have elucidated a conserved molecular signature of HCN and TTC channel expression in porcine and human calyx pacemaker tissues. These findings provide evidence for the mechanisms that can drive renal pacemaker activity in the multi-calyceal urinary tract, and potential causes of obstructive uropathies. PMID:26805464

  15. Perinatal AIDS: Permanency Planning for the African-American Community.

    ERIC Educational Resources Information Center

    Taylor-Brown, Susan; And Others

    1992-01-01

    Conducted a retrospective chart review utilizing Norwood's model on the families of the 83 infants whose cord blood was positive for maternal HIV antibodies or who were congenitally infected with HIV. Discusses implications for permanency planning in the context of their impact on the African-American community. (KS)

  16. QTC TENDENCY IN PACEMAKER DEPENDENT PATIENTS - PROGNOSTIC MEANING OF LONG QTC DURING 5 YEAR FOLLOW UP.

    PubMed

    Tsetskhladze, E; Khintibidze, I

    2016-04-01

    Prolongation of ventricular repolarization, which is represented by QTc prolongation on the standard ECG can be considered as increased risk for fatal arrhythmia. However, in pacemaker dependency (with ventricular pacing from the right apex) Ventricular Pacemaker causes abnormal steps of ventricular activation and therefore widens QRS complex and alters ventricular repolarization. It is still questionable whether QTc prolongation in right ventricular-paced patients is associated with increased risk of fatal arrhythmia or other cardiac complications. The other important question is whether the pacemaker dependent patient with long QTc interval may safely receive medications with known potential to prolong ventricular repolarization. The aim of the study was to determine whether QTc prolongation in VP (ventricular pacemaker) patients is associated with increased risk of fatal arrhythmia or other cardiac complications and whether these patients can safely receive medications with known potential to prolong ventricular repolarization. The study is based on retrospective analysis of the QTc interval prior and after pacemaker insertion; dynamic changes of QTc interval and possible influence of the medications, with known potential to prolong ventricular repolarization. Study population consisted 76 patients with narrow native QRS complexes and QTcF/QTcB <500 ms for both male and female patients. QTc prolongation in VP patients most likely does not represent true repolarization abnormalities and is not associated with risk of fatal arrhythmia. While analysis of group receiving medications with known potency of QTc increase we found no additional tendency of QTc increase. Based on our data receiving the medications with known potency of QTc prolongation in VP patients should be considered as safe approach. Long-term follow up data (5 years) assessed retrospectively shows that in patients with widened QRS after VP are at increased risk of development of HF and HF

  17. How to test mode switching in pacemakers implanted in patients: the MOST study.

    PubMed

    Padeletti, Luigi; Gasparini, Maurizio; Porciani, Maria Cristina; Pieragnoli, Paolo; Colella, Andrea; Michelucci, Antonio; Proclemer, Alessandro; Tognarini, Stefano; Mantica, Massimo; Coltorti, Fernando; Corbucci, Giorgio; Sutton, Richard

    2002-02-01

    Optimal management of atrial arrhythmias with dual chamber pacemakers requires proper performance of automatic mode switching (AMS). The aim of this study was to develop a reliable technique to test the AMS function by using an external electronic device capable of mimicking the occurrence of supraventricular arrhythmias (Supraventricular Arrhythmia Simulator [SAS]). The SAS delivers low voltage pulse trains (200 mV, 20 ms) through two skin electrodes. Each pulse train lasts 15 seconds and starts synchronously with a pacing pulse of the implanted pacemaker to avoid interference from the operator. The pulse train rate is set at 350, 250, and 160 beats/min to simulate AF, atrial flutter, and atrial tachycardia (AT), respectively. Thirty-five patients implanted with Vitatron pacemakers, whose AMS system has been previously validated, were enrolled. Atrial and ventricular sensing were programmed in unipolar mode at 0.5 mV and in bipolar mode at > 2 mV, respectively. All pulses from the SAS were detected by the atrial channel at an amplitude ranging from 1 to 3 mV. The test proved to be safe and reliable at rest and during exercise. AMS occurred immediately at onset or at offset of atrial arrhythmias, and no adverse interference on pacemaker function was seen from the SAS. In conclusion, the described technique and the SAS are safe and reliable for patient and pacemaker function and can be proposed as a useful method to verify proper performance of AMS function irrespective of the type of implanted devices. PMID:11915981

  18. Rapid high-amplitude circumferential slow wave propagation during normal gastric pacemaking and dysrhythmias

    PubMed Central

    O'Grady, Gregory; Du, Peng; Paskaranandavadivel, Nira; Angeli, Timothy R.; Lammers, Wim JEP; Asirvatham, Samuel J.; Windsor, John A.; Farrugia, Gianrico; Pullan, Andrew J.; Cheng, Leo K.

    2012-01-01

    Background Gastric slow waves propagate aborally as rings of excitation. Circumferential propagation does not normally occur, except at the pacemaker region. We hypothesized that: i) the unexplained high-velocity, high-amplitude activity associated with the pacemaker region is a consequence of circumferential propagation; ii) rapid, high-amplitude circumferential propagation emerges during gastric dysrhythmias; iii) the driving network conductance might switch between ICC-MP and circular ICC-IM during circumferential propagation; iv) extracellular amplitudes and velocities are correlated. Methods An experimental-theoretical study was performed. HR gastric mapping was performed in pigs during normal activation, pacing and dysrhythmia. Activation profiles, velocities and amplitudes were quantified. ICC pathways were theoretically evaluated in a bidomain model. Extracellular potentials were modelled as a function of membrane potentials. Key Results High-velocity, high-amplitude activation was only recorded in the pacemaker region when circumferential conduction occurred. Circumferential propagation accompanied dysrhythmia in 8/8 experiments, was faster than longitudinal propagation (8.9 vs 6.9 mm/s; p=0.004), and of higher amplitude (739 vs 528 μV; p=0.007). Simulations predicted that ICC-MP could be the driving network during longitudinal propagation, whereas during ectopic pacemaking, ICC-IM could outpace and activate ICC-MP in the circumferential axis. Experimental and modeling data demonstrated a linear relationship between velocities and amplitudes (p<0.001). Conclusions & Inferences The high-velocity and high-amplitude profile of the normal pacemaker region is due to localized circumferential propagation. Rapid circumferential propagation also emerges during a range of gastric dysrhythmias, elevating extracellular amplitudes and organizing transverse wavefronts. One possible explanation for these findings is bidirectional coupling between ICC-MP and circular

  19. Periodic permanent magnet focused klystron

    SciTech Connect

    Ferguson, Patrick; Read, Michael; Ives, R Lawrence

    2015-04-21

    A periodic permanent magnet (PPM) klystron has beam transport structures and RF cavity structures, each of which has permanent magnets placed substantially equidistant from a beam tunnel formed about the central axis, and which are also outside the extent of a cooling chamber. The RF cavity sections also have permanent magnets which are placed substantially equidistant from the beam tunnel, but which include an RF cavity coupling to the beam tunnel for enhancement of RF carried by an electron beam in the beam tunnel.

  20. The development of a system for the evaluation of electromagnetic interference with pacemaker function: hazards in the aircraft environment.

    PubMed

    McDeller, A G; Toff, W D; Hobbs, R A; Robb, D J; Camm, A J

    1989-01-01

    It has been recognized for many years that the electromagnetic (EM) environment within aircraft presents a potential hazard to the subject with a pacemaker. Most of the information currently available is, however, several years old and may not be strictly relevant to modern pacemakers and the electromagnetic environment found in today's civil aircraft. In mid 1986 it was therefore decided to investigate the effect on a number of currently available unipolar pacemakers of typical levels of electromagnetic interference encountered in civil aircraft. PMID:2746623

  1. Evaluation of the Genetic Basis of Familial Aggregation of Pacemaker Implantation by a Large Next Generation Sequencing Panel

    PubMed Central

    Steiner, Hillel A.; Uradu, Andrea; Lynnes, Ty C.; Groh, William J.; Miller, John M.; Lin, Hai; Gao, Hongyu; Wang, Zhiping; Liu, Yunlong; Chen, Peng-Sheng; Vatta, Matteo

    2015-01-01

    Background The etiology of conduction disturbances necessitating permanent pacemaker (PPM) implantation is often unknown, although familial aggregation of PPM (faPPM) suggests a possible genetic basis. We developed a pan-cardiovascular next generation sequencing (NGS) panel to genetically characterize a selected cohort of faPPM. Materials and Methods We designed and validated a custom NGS panel targeting the coding and splicing regions of 246 genes with involvement in cardiac pathogenicity. We enrolled 112 PPM patients and selected nine (8%) with faPPM to be analyzed by NGS. Results Our NGS panel covers 95% of the intended target with an average of 229x read depth at a minimum of 15-fold depth, reaching a SNP true positive rate of 98%. The faPPM patients presented with isolated cardiac conduction disease (ICCD) or sick sinus syndrome (SSS) without overt structural heart disease or identifiable secondary etiology. Three patients (33.3%) had heterozygous deleterious variants previously reported in autosomal dominant cardiac diseases including CCD: LDB3 (p.D117N) and TRPM4 (p.G844D) variants in patient 4; TRPM4 (p.G844D) and ABCC9 (p.V734I) variants in patient 6; and SCN5A (p.T220I) and APOB (p.R3527Q) variants in patient 7. Conclusion FaPPM occurred in 8% of our PPM clinic population. The employment of massive parallel sequencing for a large selected panel of cardiovascular genes identified a high percentage (33.3%) of the faPPM patients with deleterious variants previously reported in autosomal dominant cardiac diseases, suggesting that genetic variants may play a role in faPPM. PMID:26636822

  2. Heart rhythm during permanent cardiac pacing.

    PubMed Central

    Edhag, O; Rosenqvist, M

    1979-01-01

    Heart rhythm was analysed with regard to spontaneous or pacemaker-induced heart activity, in a consecutive series of 282 patients paced for at least 1 year. The mean duration of pacing was 59 (13 to 180) months. The mean age of the patients was 76 (39 to 93) years. Spontaneous heart activity at all routine examinations was found in 33 (12%) of the patients. Pacemaker-induced rhythm only was recorded in 42 per cent of the patients whereas the remaining 46 per cent had varying electrocardiographic patterns. Of the patients with spontaneous rhythm at each visit, 10 had had complete heart block before pacing. Regular sinus activity was recorded at every routine examination in 74 per cent of the patients paced for reasons other than the sick sinus syndrome. This indicated that a substantial number of paced patients might be candidates for atrial triggered pacing. Patients treated with digitalis more often had asystole at the time of replacement of the pacemaker (32%) than those not so treated (19). This suggests an increased risk of sudden death in paced patients on digitalis if the pacemaker fails. PMID:486279

  3. Ventricular fibrillation induced by coagulating mode bipolar electrocautery during pacemaker implantation in Myotonic Dystrophy type 1 patient.

    PubMed

    Russo, Vincenzo; Rago, Anna; DI Meo, Federica; Cioppa, Nadia Della; Papa, Andrea Antonio; Russo, Maria Giovanna; Nigro, Gerardo

    2014-12-01

    The occurrence of ventricular fibrillation, induced by bipolar electrocautery during elective dual chamber pacemaker implantation, is reported in a patient affected by Myotonic Distrophy type 1 with normal left ventricular ejection fraction. PMID:25873784

  4. Initial clinical experience with a new dual sensor SSIR pacemaker controlled by body activity and minute ventilation.

    PubMed

    Alt, E; Combs, W; Fotuhi, P; Bambl, E; Wahlstrand, J; Willhaus, R

    1995-08-01

    Fourteen patients were implanted with a single chamber dual sensor pacemaker (Legend Plus) that measures minute ventilation (VE) via variations in impedance between a bipolar lead and the pacemaker case, and activity via a piezoelectric crystal bonded to the pacemaker case. Chronotropic incompetent patients were exercised on a treadmill and a bicycle in dual sensor mode. Activity only indicated pacing rate was measured using a strap-on pacemaker. Both implanted and strap-on pacemakers were adjusted to yield a steady-state pacing rate of 100 beats/min during hall walk. Pacing rate, VE, and oxygen uptake (VO2) were measured continuously. Linear curve fit analysis slopes for plots of VE versus pacing rate during exercise (1.33-1.49) compared favorably to values reported in normals. Peak pacing rates achieved for treadmill and bicycle testing for dual sensor mode were higher than activity mode alone. Slopes of heart rate to VE or VO2 were not significantly different (P < 0.05) for dual sensor mode in contrast to activity alone. In conclusion, the Legend Plus dual sensor rate adaptive pacing therapy delivered pacing rates more proportional to VE and VO2 under different types of exercise than rates indicated by a strap-on pacemaker in activity mode. PMID:7479170

  5. Exploring sleepiness and entrainment on permanent shift schedules in a physiologically based model.

    PubMed

    Postnova, Svetlana; Layden, Andrew; Robinson, Peter A; Phillips, Andrew J K; Abeysuriya, Romesh G

    2012-02-01

    The effects of permanent shift work on entrainment and sleepiness are examined using a mathematical model that combines a model of sleep-wake switch in the brain with a model of the human circadian pacemaker entrained by light and nonphotic inputs. The model is applied to 8-hour permanent shift schedules to understand the basic mechanisms underlying changes of entrainment and sleepiness. Average sleepiness is shown to increase during the first days on the night and evening schedules, that is, shift start times between 0000 to 0700 h and 1500 to 2200 h, respectively. After the initial increase, sleepiness decreases and stabilizes via circadian re-entrainment to the cues provided by the shifts. The increase in sleepiness until entrainment is achieved is strongly correlated with the phase difference between a circadian oscillator entrained to the ambient light and one entrained to the shift schedule. The higher this phase difference, the larger the initial increase in sleepiness. When entrainment is achieved, sleepiness stabilizes and is the same for different shift onsets within the night or evening schedules. The simulations reveal the presence of a critical shift onset around 2300 h that separates schedules, leading to phase advance (night shifts) and phase delay (evening shifts) of the circadian pacemaker. Shifts starting around this time take longest to entrain and are expected to be the worst for long-term sleepiness and well-being of the workers. Surprisingly, we have found that the circadian pacemaker entrains faster to night schedules than to evening ones. This is explained by the longer photoperiod on night schedules compared to evening. In practice, this phenomenon is difficult to see due to days off on which workers switch to free sleep-wake activity. With weekends, the model predicts that entrainment is never achieved on evening and night schedules unless the workers follow the same sleep routine during weekends as during work days. Overall, the model

  6. Long-term epicardial ventricular pacing from endocardial bipolar pacemaker lead: perforation of right atrial wall.

    PubMed Central

    Lees, D A; Green, G D

    1977-01-01

    One of the hazards of endocardial cardiac pacing is that the pacemaker lead may perforate the myocardial wall or interventricular septum although the incidence of such perforations is believed to be small. This paper describes what is believed to be a unique case in which a pacemaker lead perforated the atrial wall at implantation (or possibly shortly afterwards) and yet gave satisfactory right ventricular epicardial pacing for more than five years. The perforation was discovered during a routine postmortem examination but earlier lateral x-ray examinations would probably have identified the abnormal position of the electrodes. Moreover, the present implantation technique would not have allowed perforation of the atrial wall at implantation to go undetected. Images PMID:882955

  7. Diagnostic imaging and pacemaker implantation in a domestic goat with persistent left cranial vena cava.

    PubMed

    Ranjan, Ravi; Dosdall, Derek; Norlund, Layne; Higuchi, Koji; Silvernagel, Joshua M; Olsen, Aaron L; Davies, Christopher J; MacLeod, Rob; Marrouche, Nassir F

    2014-03-01

    Difficulty was encountered with the insertion of a right atrial pacing lead via the left jugular vein during lead and pacemaker implantation in a clinically normal goat as part of an ongoing rapid atrial pacing - induced atrial fibrillation research project. Fluoroscopic visualization of an abnormal lead advancement path prompted angiographic assessment which revealed a persistent left cranial vena cava (PLCVC) and prominent coronary sinus communicating with the right atrium. Angiography facilitated successful advancement and securing of the pacing lead into the right side of the interatrial septum. Cardiac magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) allowed further characterization of this rare venous anomaly. Even though PLCVC has been reported once in a goat, to the authors' knowledge this is the first report to include MRI/MRA characterization of PLCVC and prominent coronary sinus with successful cardiac pacemaker implantation using the PLCVC. PMID:24480717

  8. Exponential synchronization rate of Kuramoto oscillators in the presence of a pacemaker

    PubMed Central

    Wang, Yongqiang; Doyle, Francis J.

    2013-01-01

    The exponential synchronization rate is addressed for Kuramoto oscillators in the presence of a pacemaker. When natural frequencies are identical, we prove that synchronization can be ensured even when the phases are not constrained in an open half-circle, which improves the existing results in the literature. We derive a lower bound on the exponential synchronization rate, which is proven to be an increasing function of pacemaker strength, but may be an increasing or decreasing function of local coupling strength. A similar conclusion is obtained for phase locking when the natural frequencies are non-identical. An approach to trapping phase differences in an arbitrary interval is also given, which ensures synchronization in the sense that synchronization error can be reduced to an arbitrary level. PMID:24381351

  9. Dynamic resetting of the human circadian pacemaker by intermittent bright light

    NASA Technical Reports Server (NTRS)

    Rimmer, D. W.; Boivin, D. B.; Shanahan, T. L.; Kronauer, R. E.; Duffy, J. F.; Czeisler, C. A.

    2000-01-01

    In humans, experimental studies of circadian resetting typically have been limited to lengthy episodes of exposure to continuous bright light. To evaluate the time course of the human endogenous circadian pacemaker's resetting response to brief episodes of intermittent bright light, we studied 16 subjects assigned to one of two intermittent lighting conditions in which the subjects were presented with intermittent episodes of bright-light exposure at 25- or 90-min intervals. The effective duration of bright-light exposure was 31% or 63% compared with a continuous 5-h bright-light stimulus. Exposure to intermittent bright light elicited almost as great a resetting response compared with 5 h of continuous bright light. We conclude that exposure to intermittent bright light produces robust phase shifts of the endogenous circadian pacemaker. Furthermore, these results demonstrate that humans, like other species, exhibit an enhanced sensitivity to the initial minutes of bright-light exposure.

  10. A fiber optic sensor system for control of rate-adaptive cardiac pacemakers and implantable defibrillators.

    PubMed

    Müller, Stefan; Hexamer, Martin; Werner, Jürgen

    2006-12-01

    Commercially available cardiac pacemakers and implantable cardioverters/defibrillators (ICDs) predominantly use an intracardiac-derived electrocardiogram (ECG) for the detection of arrhythmias. To achieve automatic control of the heart frequency in accordance with cardiovascular strain and improved detection of life-threatening arrhythmias, it is desirable to monitor the heart by an input signal correlated with the hemodynamic state. One possible approach to derive such a signal is to measure the inotropy (mechanical contraction strength of the heart muscle). For this purpose, an optoelectronic measurement system has been designed. The fundamental function of the system has been shown in earlier investigations using an isolated beating pig heart. In this paper the design of two algorithms for use in pacemakers and ICDs based on a fiber optic sensor signal is presented. PMID:17155869

  11. Lodestone: Nature's own permanent magnet

    NASA Technical Reports Server (NTRS)

    Wasilewski, P.

    1976-01-01

    Magnetic hysteresis and microstructural details are presented which explain why the class of magnetic iron ores defined as proto-lodestones, can behave as permanent magnets, i.e. lodestones. Certain of these proto-lodestones which are not permanent magnets can be made into permanent magnets by charging in a field greater than 1000 oersted. This fact, other experimental observations, and field evidence from antiquity and the middle ages, which seems to indicate that lodestones are found as localized patches within massive ore bodies, suggests that lightning might be responsible for the charging of lodestones. The large remanent magnetization, high values of coercive force, and good time stability for the remanent magnetization are all characteristics of proto-lodestone iron ores which behave magnetically as fine scale ( 10 micrometer) intergrowths when subjected to magnetic hysteresis analysis. The magnetic results are easily understood by analysis of the complex proto lodestone microstructural patterns observable at the micrometer scale and less.

  12. Percutaneous retrieval of a radiolucent anchoring sleeve embolized in pulmonary artery during pacemaker implantation.

    PubMed

    Tokuda, Michifumi; Yamane, Teiichi; Sadaoka, Shunichi; Tokutake, Kenichi; Yokoyama, Kenichi; Hioki, Mika; Narui, Ryohsuke; Tanigawa, Shinichi; Inada, Keiichi; Matsuo, Seiichiro; Yoshimura, Michihiro

    2016-08-01

    An 85-year-old female presented to our institution with symptomatic sick sinus syndrome. During pacemaker implantation, an anchoring sleeve in the right ventricular lead was embolized in the left pulmonary artery. Although the anchoring sleeve was radiolucent, digital subtraction angiography revealed an angiographic filling defect in the lower branch of the left pulmonary artery, and a snare catheter enabled the anchoring sleeve to be grasped and extracted. PMID:26391679

  13. The atrial T wave: The elusive electrocardiographic wave exposed by a case of shifting atrial pacemaker.

    PubMed

    Langley, Philip; Caldwell, Jane

    2016-01-01

    The atrial T wave (Ta wave) is the body surface manifestation of atrial repolarisation and, unlike the P wave (atrial depolarisation), is little recognised. We report the case of a patient with shifting pacemaker which clearly demonstrates the effect of the Ta wave on ST segment and T wave. A simple conceptual model is used to explain the observed phenomenon. The case serves as a reminder of this often forgotten ECG wave and its potential effects on other ECG features. PMID:27215648

  14. Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

    PubMed Central

    Reyes, Meredith A.; Seger, John J.

    2015-01-01

    We report the case of an 82-year-old man in whom hemorrhagic pericardial effusion occurred one week after pacemaker implantation, while he was taking apixaban. Few therapies exist for reversing the anti-Xa effect of apixaban. To reverse anticoagulation, our patient underwent plasma exchange, which facilitated pericardiocentesis and prevented possible surgical intervention. To our knowledge, this is the first report of the use of plasmapheresis to reverse the anticoagulant effect of apixaban. PMID:26413023

  15. Symptomatic Trifascicular Block in Steinert's Disease: Is It Too Soon for a Pacemaker?

    PubMed Central

    Roberti, Roberto; LaCapra, Gina; Ramirez, Roberto

    2016-01-01

    We report a case of a 62-year-old male with Steinert's disease who presented with progressive intermittent episodes of lightheadedness five years after he was diagnosed with the disease. On evaluation, he developed a new onset trifascicular block (first degree atrioventricular block, new onset right bundle branch block, and left anterior fascicular block). A dual chamber pacemaker was inserted and lightheadedness improved significantly. PMID:27022487

  16. In vitro characterization of HCN channel kinetics and frequency dependence in myocytes predicts biological pacemaker functionality.

    PubMed

    Zhao, Xin; Bucchi, Annalisa; Oren, Ronit V; Kryukova, Yelena; Dun, Wen; Clancy, Colleen E; Robinson, Richard B

    2009-04-01

    The pacemaker current, mediated by hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, contributes to the initiation and regulation of cardiac rhythm. Previous experiments creating HCN-based biological pacemakers in vivo found that an engineered HCN2/HCN1 chimeric channel (HCN212) resulted in significantly faster rates than HCN2, interrupted by 1-5 s pauses. To elucidate the mechanisms underlying the differences in HCN212 and HCN2 in vivo functionality as biological pacemakers, we studied newborn rat ventricular myocytes over-expressing either HCN2 or HCN212 channels. The HCN2- and HCN212-over-expressing myocytes manifest similar voltage dependence, current density and sensitivity to saturating cAMP concentrations, but HCN212 has faster activation/deactivation kinetics. Compared with HCN2, myocytes expressing HCN212 exhibit a faster spontaneous rate and greater incidence of irregular rhythms (i.e. periods of rapid spontaneous rate followed by pauses). To explore these rhythm differences further, we imposed consecutive pacing and found that activation kinetics of the two channels are slower at faster pacing frequencies. As a result, time-dependent HCN current flowing during diastole decreases for both constructs during a train of stimuli at a rapid frequency, with the effect more pronounced for HCN2. In addition, the slower deactivation kinetics of HCN2 contributes to more pronounced instantaneous current at a slower frequency. As a result of the frequency dependence of both instantaneous and time-dependent current, HCN2 exhibits more robust negative feedback than HCN212, contributing to the maintenance of a stable pacing rhythm. These results illustrate the benefit of screening HCN constructs in spontaneously active myocyte cultures and may provide the basis for future optimization of HCN-based biological pacemakers. PMID:19171659

  17. Traveling waves and dynamical formation of autonomous pacemakers in a bistable medium with periodic boundary conditions

    NASA Astrophysics Data System (ADS)

    Shepelev, Igor A.; Vadivasova, Tatiana E.; Postnov, Dmitry E.

    2015-03-01

    The problem of spatiotemporal pattern formation in the wall of arterial vesselsmay be reduced to 1D or 2D models of nonlinear active medium. We address this problem using the discrete array of non-oscillating (bistable) active units. We show how the specific choice of initial conditions in a 1D model with periodic boundary conditions triggers the self-sustained behaviour. We reveal the core of observed effects being the dynamical formation of localized (few-element size) autonomous pacemakers.

  18. Impact of expanding indications on the safety of pacemakers and defibrillators.

    PubMed

    Maisel, William H

    2003-01-01

    The number of patients living with a pacemaker or implantable cardioverter defibrillator (ICD) increased markedly during the 1990's. Expanding device indications and increasing device sophistication has important implications for patient and device safety. While the FDA is responsible for assessing the safety and efficacy of medical devices, manufacturers, physicians, patients, medical professional societies, and legislators will all play a role in ensuring that medical device patients continue to receive safe, quality medical care. PMID:12766513

  19. Self-powered cardiac pacemaker enabled by flexible single crystalline PMN-PT piezoelectric energy harvester.

    PubMed

    Hwang, Geon-Tae; Park, Hyewon; Lee, Jeong-Ho; Oh, SeKwon; Park, Kwi-Il; Byun, Myunghwan; Park, Hyelim; Ahn, Gun; Jeong, Chang Kyu; No, Kwangsoo; Kwon, HyukSang; Lee, Sang-Goo; Joung, Boyoung; Lee, Keon Jae

    2014-07-23

    A flexible single-crystalline PMN-PT piezoelectric energy harvester is demonstrated to achieve a self-powered artificial cardiac pacemaker. The energy-harvesting device generates a short-circuit current of 0.223 mA and an open-circuit voltage of 8.2 V, which are enough not only to meet the standard for charging commercial batteries but also for stimulating the heart without an external power source. PMID:24740465

  20. Micafungin for Candida albicans pacemaker-associated endocarditis: a case report and review of the literature.

    PubMed

    Tascini, Carlo; Bongiorni, Maria Grazia; Tagliaferri, Enrico; Di Paolo, Antonello; Flammini, Sarah; Soldati, Ezio; Leonildi, Alessandro; Di Cori, Andrea; Menichetti, Francesco

    2013-02-01

    We report on the treatment with micafungin of a pacemaker-associated endocarditis due to Candida albicans. Antifungal therapy was able to reduce vegetation size from 5 to 1 cm making possible the transvenous removal of the device without a high risk of pulmonary embolism. Noteworthy, a high micafungin concentration was documented into the lead vegetation (10 μg/g of vegetation tissue) and this may have contributed to the striking size reduction of vegetation. PMID:23073824

  1. How Permanent Is Permanent Placement for Substance-Exposed Infants?

    ERIC Educational Resources Information Center

    Twomey, Jean E.; Lester, Barry M.

    2007-01-01

    The authors describe a study of families in the Family Drug Treatment Court (FTDC), an effort to promote permanent placement for substance-exposed infants within time requirements mandated by the 1997 Adoption and Safe Families Act (ASFA). The purpose of the study was to evaluate parent functioning after FTDC involvement, infant developmental…

  2. Semipermanent and permanent injectable fillers.

    PubMed

    Jones, Derek H

    2009-10-01

    Today, an impressive array of injectable dermal fillers for facial soft-tissue augmentation is available in the United States. These agents, most of which were introduced in the last half decade, represent a variety of semipermanent and permanent fillers across several categories. Physicians can choose between semipermanent fillers, such as hyaluronic acid derivatives (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLA), and longer-lasting, so-called "permanent fillers," such as polymethyl methacrylate microspheres (PMMA), highly purified forms of liquid silicone, and hydrogel polymers. PMID:19850193

  3. Effects of electromagnetic pulse (EMP) on cardiac pacemakers. Final report, Nov 88-Oct 89

    SciTech Connect

    Ellis, V.J.

    1991-11-01

    The U.S. Army Harry Diamond Laboratories' (HDL's) Woodbridge Research Facility (WRF) has conducted an investigation into the effects of electromagnetic pulse (EMP) on medical electronics. This report specifically documents the findings on the effects of WRF's Army EMP Simulator Operations (AESOP) on cardiac pacemakers (CPMs). Empirical data are furnished and compared to the results of two independent analytical studies. The studies support the conclusion that damage to CPMs that might be located near the WRF boundaries is not likely. Furthermore, any upset in a CPM's operation is considered unlikely and inconsequential to the health of the CPM wearer. Cardiac pacemakers (CPMs) have experienced significant technological advancements over the last decade, evolving from simple and bulky pulse generators to the small and sophisticated computerized units implanted today. With the implementation of sensitive digital electronics in modern pacemaker designs, concerns have been expressed for the possibility of an increased sensitivity of CPMs to electromagnetic interference (EMI). To some extent these concerns have abated to the increased awareness of the EMI problem by the manufacturers, as evident in better peacemaker designs and the decline in reported malfunctions due to EMI.

  4. Sexual interactions influence the molecular oscillations in DN1 pacemaker neurons in Drosophila melanogaster.

    PubMed

    Hanafusa, Shiho; Kawaguchi, Tomoaki; Umezaki, Yujiro; Tomioka, Kenji; Yoshii, Taishi

    2013-01-01

    Circadian rhythms can synchronize to environmental time cues, such as light, temperature, humidity, and food availability. Previous studies have suggested that these rhythms can also be entrained by social interactions. Here, we used Drosophila melanogaster as a model to study the influence of socio-sexual interactions on the circadian clock in behavior and pacemaker neurons. If two flies of opposite sex were paired and kept in a small space, the daily activity patterns of the two flies were clearly different from the sum of the activity of single male and female flies. Compared with single flies, paired flies were more active in the night and morning, were more active during females' active phase, and were less active during males' active phase. These behavioral phenotypes are related to courtship behavior, but not to the circadian clock. Nevertheless, in male-female pairs of flies with clocks at different speeds (wild-type and per (S) flies), clock protein cycling in the DN1 pacemaker neurons in the male brain were slightly influenced by their partners. These results suggest that sexual interactions between male-female couples can serve as a weak zeitgeber for the DN1 pacemaker neurons, but the effect is not sufficient to alter rhythms of behavioral activity. PMID:24367668

  5. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-06-21

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With 'MR-conditional' devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  6. Evaluation of safety and efficacy of pacemaker and defibrillator implantation by axillary incision in pediatric patients.

    PubMed

    Lee, Joselyn C R; Shannon, Kevin; Boyle, Noel G; Klitzner, Thomas S; Bersohn, Malcolm M

    2004-03-01

    We successfully implanted 11 pacemakers, 6 defibrillators, and 1 biventricular pacemaker in 18 pediatric patients (15 female; 4 to 15 years, average age: 9) using the retropectoral transvenous approach with a hidden axillary incision. The average follow-up period was 24 months (range 49 months). Eight patients had congenital structural heart conditions (d-transposition of great arteries S/P Mustard operation, d-transposition of great arteries S/P arterial switch operation, truncus arteriosus, right ventricular diverticula, ventricular septal defect, hypertrophic cardiomyopathy). Four patients had acquired heart conditions (dilated cardiomyopathy, myocarditis). Excellent sensing and pacing thresholds were achieved in all attempted implantations. There was no pneumothorax. There was one lead dislodgement. One lead fracture distant from the subclavian vein occurred 4 months after implantation. Implantation of pacemakers and defibrillators via axillary incisions can be safe and effective in pediatric patients. This approach avoids skin erosion when implanting large devices such as defibrillators or biventricular devices in small patients with limited muscle mass while achieving superior aesthetic results. The axillary or extrathoracic venous entry site avoids subclavian crush syndrome. PMID:15009854

  7. Simulations of light effects on the human circadian pacemaker: implications for assessment of intrinsic period

    NASA Technical Reports Server (NTRS)

    Klerman, E. B.; Dijk, D. J.; Kronauer, R. E.; Czeisler, C. A.

    1996-01-01

    The sensitivity of the human circadian system to light has been the subject of considerable debate. Using computer simulations of a recent quantitative model for the effects of light on the human circadian system, we investigated these effects of light during different experimental protocols. The results of the simulations indicate that the nonuniform distribution over the circadian cycle of exposure to ordinary room light seen in classical free-run studies, in which subjects select their exposure to light and darkness, can result in an observed period of approximately 25 h, even when the intrinsic period of the subject's endogenous circadian pacemaker is much closer to 24 h. Other simulation results suggest that accurate assessment of the true intrinsic period of the human circadian pacemaker requires low ambient light intensities (approximately 10-15 lx) during scheduled wake episodes, desynchrony of the imposed light-dark cycle from the endogenous circadian oscillator, and a study length of at least 20 days. Although these simulations await further experimental substantiation, they highlight the sensitivity to light of the human circadian system and the potential confounding influence of light on the assessment of the intrinsic period of the circadian pacemaker.

  8. Lmo Mutants Reveal a Novel Role for Circadian Pacemaker Neurons in Cocaine-Induced Behaviors

    PubMed Central

    2004-01-01

    Drosophila has been developed recently as a model system to investigate the molecular and neural mechanisms underlying responses to drugs of abuse. Genetic screens for mutants with altered drug-induced behaviors thus provide an unbiased approach to define novel molecules involved in the process. We identified mutations in the Drosophila LIM-only (LMO) gene, encoding a regulator of LIM-homeodomain proteins, in a genetic screen for mutants with altered cocaine sensitivity. Reduced Lmo function increases behavioral responses to cocaine, while Lmo overexpression causes the opposite effect, reduced cocaine responsiveness. Expression of Lmo in the principal Drosophila circadian pacemaker cells, the PDF-expressing ventral lateral neurons (LNvs), is sufficient to confer normal cocaine sensitivity. Consistent with a role for Lmo in LNv function, Lmo mutants also show defects in circadian rhythms of behavior. However, the role for LNvs in modulating cocaine responses is separable from their role as pacemaker neurons: ablation or functional silencing of the LNvs reduces cocaine sensitivity, while loss of the principal circadian neurotransmitter PDF has no effect. Together, these results reveal a novel role for Lmo in modulating acute cocaine sensitivity and circadian locomotor rhythmicity, and add to growing evidence that these behaviors are regulated by shared molecular mechanisms. The finding that the degree of cocaine responsiveness is controlled by the Drosophila pacemaker neurons provides a neuroanatomical basis for this overlap. We propose that Lmo controls the responsiveness of LNvs to cocaine, which in turn regulate the flies' behavioral sensitivity to the drug. PMID:15550987

  9. Magnetic resonance imaging, pacemakers and implantable cardioverter-defibrillators: current situation and clinical perspective

    PubMed Central

    Götte, M.J.W.; Rüssel, I.K.; de Roest, G.J.; Germans, T.; Veldkamp, R.F.; Knaapen, P.; Allaart, C.P.; van Rossum, A.C.

    2010-01-01

    New developments and expanding indications have resulted in a significant increase in the number of patients with pacemakers and internal cardioverterdefibrillators (ICDs). Because of its unique capabilities, magnetic resonance imaging (MRI) has become one of the most important imaging modalities for evaluation of the central nervous system, tumours, musculoskeletal disorders and some cardiovascular diseases. As a consequence of these developments, an increasing number of patients with implanted devices meet the standard indications for MRI examination. Due to the presence of potential life-threatening risks and interactions, however, pacemakers and ICDs are currently not approved by the Food and Drug Administration (FDA) for use in an MRI scanner. Despite these limitations and restrictions, a limited but still growing number of studies reporting on the effects and safety issues of MRI and implanted devices have been published. Because physicians will be increasingly confronted with the issue of MRI in patients with implanted devices, this overview is given. The effects of MRI on an implanted pacemaker and/or ICDs and vice versa are described and, based on the current literature, a strategy for safe performance of MRI in these patients is proposed. (Neth Heart J 2010;18:31-7.) PMID:20111641

  10. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed Central

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-01-01

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  11. Low frequency magnetic emissions and resulting induced voltages in a pacemaker by iPod portable music players

    PubMed Central

    Bassen, Howard

    2008-01-01

    Background Recently, malfunctioning of a cardiac pacemaker electromagnetic, caused by electromagnetic interference (EMI) by fields emitted by personal portable music players was highly publicized around the world. A clinical study of one patient was performed and two types of interference were observed when the clinicians placed a pacemaker programming head and an iPod were placed adjacent to the patient's implanted pacemaker. The authors concluded that "Warning labels may be needed to avoid close contact between pacemakers and iPods". We performed an in-vitro study to evaluate these claims of EMI and present our findings of no-effects" in this paper. Methods We performed in-vitro evaluations of the low frequency magnetic field emissions from various models of the Apple Inc. iPod music player. We measured magnetic field emissions with a 3-coil sensor (diameter of 3.5 cm) placed within 1 cm of the surface of the player. Highly localized fields were observed (only existing in a one square cm area). We also measured the voltages induced inside an 'instrumented-can' pacemaker with two standard unipolar leads. Each iPod was placed in the air, 2.7 cm above the pacemaker case. The pacemaker case and leads were placed in a saline filled torso simulator per pacemaker electromagnetic compatibility standard ANSI/AAMI PC69:2000. Voltages inside the can were measured. Results Emissions were strongest (≈ 0.2 μT pp) near a few localized points on the cases of the two iPods with hard drives. Emissions consisted of 100 kHz sinusoidal signal with lower frequency (20 msec wide) pulsed amplitude modulation. Voltages induced in the iPods were below the noise level of our instruments (0.5 mV pp in the 0 – 1 kHz band or 2 mV pp in the 0 – 5 MHz bandwidth. Conclusion Our measurements of the magnitude and the spatial distribution of low frequency magnetic flux density emissions by 4 different models of iPod portable music players. Levels of less than 0.2 μT exist very close (1 cm

  12. Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

    PubMed Central

    2011-01-01

    Background Biventricular (Biv) pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP) assessment by radial artery tonometry in guiding Biv pacemaker optimization. Methods Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV) ejection fraction (EF) 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI), ejection time (ET), myocardial performance index (MPI), radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. Results Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p < 0.001), LV VTI (15.9 ± 4.8 cm to 18.4 ± 5.1 cm, p < 0.001) and MPI (0.57 ± 0.2 to 0.45 ± 0.13, p < 0.001) and in PEP (246.7 ± 36.1 ms to 234.7 ± 35.5 ms, p = 0.003), PEP/ET (0.88 ± 0.21 to 0.79 ± 0.17, p < 0.001), and PEP/VTI (17.3 ± 7 to 13.78 ± 4.7, p < 0.001). The correlation between comprehensive echo Doppler and radial artery tonometry-PEP guided optimal atrioventricular delay (AVD) and optimal interventricular delay (VVD) was 0.75 (p < 0.001) and 0.69 (p < 0.001) respectively. In 29 patients with follow up assessment, New York Heart Association (NYHA) class reduced from 2.5 ± 0.8 to 2.0 ± 0.9 (p = 0.004) at 1.8 ± 1.4 months. Conclusion An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization. PMID:21794181

  13. Magnetic Fields: Visible and Permanent.

    ERIC Educational Resources Information Center

    Winkeljohn, Dorothy R.; Earl, Robert D.

    1983-01-01

    Children will be able to see the concept of a magnetic field translated into a visible reality using the simple method outlined. Standard shelf paper, magnets, iron filings, and paint in a spray can are used to prepare a permanent and well-detailed picture of the magnetic field. (Author/JN)

  14. Microfilm Permanence and Archival Quality

    ERIC Educational Resources Information Center

    Avedon, Don M.

    1972-01-01

    The facts about microfilm permanence and archival quality are presented in simple terms. The major factors, including the film base material, the film emulsion, processing, and storage conditions are reviewed. The designations on the edge of the film are explained and a list of refernces provided. (14 references) (Author)

  15. Frictionless Bearing Uses Permanent Magnets

    NASA Technical Reports Server (NTRS)

    1965-01-01

    The purpose of this innovation was to develop a frictionless bearing for high speed, light load applications. The device involves the incorporation of permanent magnets in the bearing design. The repulsion of like magnetic poles provides concentric support of the inner member so that no metallic contact occurs between the bearing surfaces.

  16. Biodentine Pulpotomy in Mature Permanent Molar: A Case Report

    PubMed Central

    2016-01-01

    Irreversible pulpitis is the most common reason for endodontic treatment in primary and permanent teeth. Root canal therapy and extraction are the two viable and most documented treatment options for the same. Studies with regards to management of mature permanent teeth with carious exposure and treatment with vital pulp therapies such as adult permanent tooth pulpotomy are scarce. However, permanent tooth pulpotomy with the new calcium-silicate based cements (Mineral Trioxide Aggregate and Biodentine) can help preserve the tooth pulp vitality and promote healing and repair foregoing the more invasive root canal therapy procedure. A 12-year old male patient with irreversible pulpitis in right mandibular first permanent molar was treated with complete coronal pulpotomy with placement of Biodentine in the pulp chamber and a full coronal coverage using stainless steel crown. Clinical and radiographic examinations were performed at three, six, twelve and eighteen months. At the end of 18 months, the patient was completely asymptomatic and the tooth was free of any clinical and radiographic signs of inflammation and infection.

  17. Force and torque effects of a 1.5-Tesla MRI scanner on cardiac pacemakers and ICDs.

    PubMed

    Luechinger, R; Duru, F; Scheidegger, M B; Boesiger, P; Candinas, R

    2001-02-01

    Magnetic resonance imaging (MRI) is a widely accepted tool for the diagnosis of a variety of disease states. However, the presence of an implanted pacemaker is considered to be a strict contraindication to MRI in a vast majority of centers due to safety concerns. In phantom studies, the authors investigated the force and torque effects of the static magnetic field of MRI on pacemakers and ICDs. Thirty-one pacemakers (15 dual chamber and 16 single chamber units) from eight manufacturers and 13 ICDs from four manufacturers were exposed to the static magnetic field of a 1.5-Tesla MRI scanner. Magnetic force and acceleration measurements were obtained quantitatively, and torque measurements were made qualitatively. For pacemakers, the measured magnetic force was in the range of 0.05-3.60 N. Pacemakers released after 1995 had low magnetic force values as compared to the older devices. For these devices, the measured acceleration was even lower than the gravity of the earth (< 9.81 N/kg). Likewise, the torque levels were significantly reduced in newer generation pacemakers (< or = 2 from a scale of 6). ICD devices, except for one recent model, showed higher force (1.03-5.85 N), acceleration 9.5-34.2 N/kg), and torque (5-6 out of 6) levels. In conclusion, modern pacemakers present no safety risk with respect to magnetic force and torque induced by the static magnetic field of a 1.5-Tesla MRI scanner. However, ICD devices, despite considerable reduction in size and weight, may still pose problems due to strong magnetic force and torque. PMID:11270700

  18. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

    SciTech Connect

    James, J; Place, V; Panda, A; Edmonson, H; Felmlee, J; Pooley, R

    2014-06-01

    Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over

  19. Antibiotic therapy for ocular infection.

    PubMed Central

    Snyder, R W; Glasser, D B

    1994-01-01

    Infections of the eye can rapidly damage important functional structures and lead to permanent vision loss or blindness. Broad-spectrum antibiotics should be administered to the appropriate site of infection as soon as a diagnosis is made. Topical drops are preferred for corneal and conjunctival infections. Intravitreal antibiotics, and possibly subconjunctival and parenteral antibiotics, are preferred for endophthalmitis. Parenteral antibiotics are recommended for infection in deep adnexal structures. We review specific aspects of antibiotic therapy for ocular and periocular infection. PMID:7856158

  20. Pacemaker phase shift in the absence of neural activity in guinea-pig stomach: a microelectrode array study

    PubMed Central

    Nakayama, Shinsuke; Shimono, Ken; Liu, Hong-Nian; Jiko, Hideyasu; Katayama, Noburu; Tomita, Tadao; Goto, Kazunori

    2006-01-01

    Gastrointestinal (GI) motility is well organized. GI muscles act as a functional syncytium to achieve physiological functions under the control of neurones and pacemaker cells, which generate basal spontaneous pacemaker electrical activity. To date, it is unclear how spontaneous electrical activities are coupled, especially within a micrometre range. Here, using a microelectrode array, we show a spatio-temporal analysis of GI spontaneous electrical activity. The muscle preparations were isolated from guinea-pig stomach, and fixed in a chamber with an array of 8 × 8 planar multielectrodes (with 300 μm in interpolar distance). The electrical activities (field potentials) were simultaneously recorded through a multichannel amplifier system after high-pass filtering at 0.1 Hz. Dihydropyridine Ca2+ channel antagonists are known to differentiate the electrical pacemaker activity of interstitial cells of Cajal (ICCs) by suppressing smooth muscle activity. In the presence of nifedipine, we observed spontaneous electrical activities that were well synchronized over the array area, but had a clear phase shift depending on the distance. The additional application of tetrodotoxin (TTX) had little effect on the properties of the electrical activity. Furthermore, by constructing field potential images, we visualized the synchronization of pacemaker electrical activities resolving phase shifts that were measurable over several hundred micrometres. The results imply a phase modulation mechanism other than neural activity, and we postulate that this mechanism enables smooth GI motility. In addition, some preparations clearly showed plasticity of the pacemaker phase shift. PMID:16990400

  1. Synergism of coupled subsarcolemmal Ca2+ clocks and sarcolemmal voltage clocks confers robust and flexible pacemaker function in a novel pacemaker cell model

    PubMed Central

    Maltsev, Victor A.; Lakatta, Edward G.

    2009-01-01

    Recent experimental studies have demonstrated that sinoatrial node cells (SANC) generate spontaneous, rhythmic, local subsarcolemmal Ca2+ releases (Ca2+ clock), which occur during late diastolic depolarization (DD) and interact with the classic sarcolemmal voltage oscillator (membrane clock) by activating Na+-Ca2+ exchanger current (INCX). This and other interactions between clocks, however, are not captured by existing essentially membrane-delimited cardiac pacemaker cell numerical models. Using wide-scale parametric analysis of classic formulations of membrane clock and Ca2+ cycling, we have constructed and initially explored a prototype rabbit SANC model featuring both clocks. Our coupled oscillator system exhibits greater robustness and flexibility than membrane clock operating alone. Rhythmic spontaneous Ca2+ releases of sarcoplasmic reticulum (SR)-based Ca2+ clock ignite rhythmic action potentials via late DD INCX over much broader ranges of membrane clock parameters [e.g., L-type Ca2+ current (ICaL) and/or hyperpolarization-activated (“funny”) current (If) conductances]. The system Ca2+ clock includes SR and sarcolemmal Ca2+ fluxes, which optimize cell Ca2+ balance to increase amplitudes of both SR Ca2+ release and late DD INCX as SR Ca2+ pumping rate increases, resulting in a broad pacemaker rate modulation (1.8–4.6 Hz). In contrast, the rate modulation range via membrane clock parameters is substantially smaller when Ca2+ clock is unchanged or lacking. When Ca2+ clock is disabled, the system parametric space for fail-safe SANC operation considerably shrinks: without rhythmic late DD INCX ignition signals membrane clock substantially slows, becomes dysrhythmic, or halts. In conclusion, the Ca2+ clock is a new critical dimension in SANC function. A synergism of the coupled function of Ca2+ and membrane clocks confers fail-safe SANC operation at greatly varying rates. PMID:19136600

  2. Functional Role of CLC-2 Chloride Inward Rectifier Channels in Cardiac Sinoatrial Nodal Pacemaker Cells

    PubMed Central

    Huang, Z. Maggie; Prasad, Chaithra; Britton, Fiona C.; Ye, Linda L.; Hatton, William J.; Duan, Dayue

    2009-01-01

    A novel Cl− inward rectifier channel (Cl,ir) encoded by ClC-2, a member of the ClC voltage-gated Cl− channel gene superfamily, has been recently discovered in cardiac myocytes of several species. However, the physiological role of Cl,ir channels in the heart remains unknown. In this study we tested the hypothesis that Cl,ir channels may play an important role in cardiac pacemaker activity. In isolated guinea-pig sinoatrial node (SAN) cells, Cl,ir current was activated by hyperpolarization and hypotonic cell swelling. RT-PCR and immunohistological analyses confirmed the molecular expression of ClC-2 in guinea-pig SAN cells. Hypotonic stress increased the diastolic depolarization slope and decreased the maximum diastolic potential, action potential amplitude, APD50, APD90, and the cycle-length of the SAN cells. These effects were largely reversed by intracellular dialysis of anti-ClC-2 antibody, which significantly inhibited Cl,ir current but not other pacemaker currents, including the hyperpolarization-activated non-selective cationic “funny” current (If), the L-type Ca2+ currents (ICa,L), the slowly-activating delayed rectifier IKs and the volume-regulated outwardly-rectifying Cl− current (ICl,vol). Telemetry electrocardiograph studies in conscious ClC-2 knockout (Clcn2−/−) mice revealed a decreased chronotropic response to acute exercise stress when compared to their age-matched Clcn2+/+ and Clcn2+/− littermates. Targeted inactivation of ClC-2 does not alter intrinsic heart rate but prevented the positive chronotropic effect of acute exercise stress through a sympathetic regulation of ClC-2 channels. These results provide compelling evidence that ClC-2-encoded endogenous Cl,ir channels may play an important role in the regulation of cardiac pacemaker activity, which may become more prominent under stressed or pathological conditions. PMID:19376127

  3. Evaluation of patients' quality of life aspects after cardiac pacemaker implantation

    PubMed Central

    de Barros, Rubens Tofano; de Carvalho, Sebastião Marcos Ribeiro; Silva, Marcos Augusto de Moraes; Borges, Juliana Bassalobre Carvalho

    2014-01-01

    Objective To evaluate patients' quality of life aspects after pacemaker implantation, relating it to gender, age, and implantation timespan. Methods A total of 107 clinically stable patients of both genders (49.5% women and 50.5% men) over 18 years old (average 69.3±12.6 years) and presenting an implantation timespan of three to 12 months (average 6.36±2.99 months) were evaluated. The evaluation included personal, clinical, and implant data as well as quality of life questionnaires (AQUAREL and SF-36). Statistical analysis was conducted using the t test and Pearson correlation, with a 5% significance level. Results The lowest SF-36 score referred to physical aspects, and the highest score referred to social aspects. In AQUAREL, the lowest score referred to dyspnea, and the highest referred to discomfort. There was a significant association between gender and quality of life in SF-36 (physical functioning and emotional aspects) and in AQUAREL (dyspnea). A negative correlation was observed between age and quality of life (functional capacity in SF-36, and discomfort in AQUAREL) in relation to implantation timespan, a correlation with vitality from SF-36. Conclusion Lower quality of life scores were found in physical aspects and dyspnea; and higher scores in social aspects and discomfort. Men presented higher quality of life scores related to physical functioning, emotional aspects and dyspnea. As age increases, quality of life worsens regarding functional capacity and discomfort; and the longer the pacemaker implantation timespan, the worse quality of life when it comes to vitality. Gender, age, and implantation timespan influence quality of life; thus, these variables must be considered in strategies for improving quality of life of patients with pacemakers. PMID:24896161

  4. Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression

    NASA Technical Reports Server (NTRS)

    Zeitzer, J. M.; Dijk, D. J.; Kronauer, R.; Brown, E.; Czeisler, C.

    2000-01-01

    Ocular exposure to early morning room light can significantly advance the timing of the human circadian pacemaker. The resetting response to such light has a non-linear relationship to illuminance. The dose-response relationship of the human circadian pacemaker to late evening light of dim to moderate intensity has not been well established. Twenty-three healthy young male and female volunteers took part in a 9 day protocol in which a single experimental light exposure6.5 h in duration was given in the early biological night. The effects of the light exposure on the endogenous circadian phase of the melatonin rhythm and the acute effects of the light exposure on plasma melatonin concentration were calculated. We demonstrate that humans are highly responsive to the phase-delaying effects of light during the early biological night and that both the phase resetting response to light and the acute suppressive effects of light on plasma melatonin follow a logistic dose-response curve, as do many circadian responses to light in mammals. Contrary to expectations, we found that half of the maximal phase-delaying response achieved in response to a single episode of evening bright light ( approximately 9000 lux (lx)) can be obtained with just over 1 % of this light (dim room light of approximately 100 lx). The same held true for the acute suppressive effects of light on plasma melatonin concentrations. This indicates that even small changes in ordinary light exposure during the late evening hours can significantly affect both plasma melatonin concentrations and the entrained phase of the human circadian pacemaker.

  5. Association of sleep-wake habits in older people with changes in output of circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Czeisler, C. A.; Dumont, M.; Duffy, J. F.; Steinberg, J. D.; Richardson, G. S.; Brown, E. N.; Sanchez, R.; Rios, C. D.; Ronda, J. M.

    1992-01-01

    Many elderly people complain of disturbed sleep patterns but there is not evidence that the need to sleep decreases with age; it seems rather that the timing and consolidation of sleep change. We tried to find out whether there is a concurrent change in the output of the circadian pacemaker with age. The phase and amplitude of the pacemaker's output were assessed by continuous measurement of the core body temperature during 40 h of sustained wakefulness under constant behavioural and environmental conditions. 27 young men (18-31 years) were compared with 21 older people (65-85 years; 11 men, 10 women); all were healthy and without sleep complaints. The mean amplitude of the endogenous circadian temperature oscillation (ECA) was 40% greater in young men than in the older group. Older men had a lower mean temperature ECA than older women. The minimum of the endogenous phase of the circadian temperature oscillation (ECP) occurred 1 h 52 min earlier in the older than in the young group. Customary bedtimes and waketimes were also earlier in the older group, as was their daily alertness peak. There was a close correlation between habitual waketime and temperature ECP in young men, which may lose precision with age, especially among women. These findings provide evidence for systematic age-related changes in the output of the human circadian pacemaker. We suggest that these changes may underlie the common complaints of sleep disturbance among elderly people. These changes could reflect the observed age-related deterioration of the hypothalamic nuclei that drive mammalian circadian rhythms.

  6. Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions

    SciTech Connect

    Gossman, Michael S.; Nagra, Bipinpreet; Graves-Calhoun, Alison; Wilkinson, Jeffrey

    2011-01-01

    The medical community is advocating for progressive improvement in the design of implantable cardioverter-defibrillators and implantable pacemakers to accommodate elevations in dose limitation criteria. With advancement already made for magnetic resonance imaging compatibility in some, a greater need is present to inform the radiation oncologist and medical physicist regarding treatment planning beam profile changes when such devices are in the field of a therapeutic radiation beam. Treatment plan modeling was conducted to simulate effects induced by Medtronic, Inc.-manufactured devices on therapeutic radiation beams. As a continuation of grant-supported research, we show that radial and transverse open beam profiles of a medical accelerator were altered when compared with profiles resulting when implantable pacemakers and cardioverter-defibrillators are placed directly in the beam. Results are markedly different between the 2 devices in the axial plane and the sagittal planes. Vast differences are also presented for the therapeutic beams at 6-MV and 18-MV x-ray energies. Maximum changes in percentage depth dose are observed for the implantable cardioverter-defibrillator as 9.3% at 6 MV and 10.1% at 18 MV, with worst distance to agreement of isodose lines at 2.3 cm and 1.3 cm, respectively. For the implantable pacemaker, the maximum changes in percentage depth dose were observed as 10.7% at 6 MV and 6.9% at 18 MV, with worst distance to agreement of isodose lines at 2.5 cm and 1.9 cm, respectively. No differences were discernible for the defibrillation leads and the pacing lead.

  7. Burst pacemaker activity of the sinoatrial node in sodium–calcium exchanger knockout mice

    PubMed Central

    Torrente, Angelo G.; Zhang, Rui; Zaini, Audrey; Giani, Jorge F.; Kang, Jeanney; Lamp, Scott T.; Philipson, Kenneth D.; Goldhaber, Joshua I.

    2015-01-01

    In sinoatrial node (SAN) cells, electrogenic sodium–calcium exchange (NCX) is the dominant calcium (Ca) efflux mechanism. However, the role of NCX in the generation of SAN automaticity is controversial. To investigate the contribution of NCX to pacemaking in the SAN, we performed optical voltage mapping and high-speed 2D laser scanning confocal microscopy (LSCM) of Ca dynamics in an ex vivo intact SAN/atrial tissue preparation from atrial-specific NCX knockout (KO) mice. These mice lack P waves on electrocardiograms, and isolated NCX KO SAN cells are quiescent. Voltage mapping revealed disorganized and arrhythmic depolarizations within the NCX KO SAN that failed to propagate into the atria. LSCM revealed intermittent bursts of Ca transients. Bursts were accompanied by rising diastolic Ca, culminating in long pauses dominated by Ca waves. The L-type Ca channel agonist BayK8644 reduced the rate of Ca transients and inhibited burst generation in the NCX KO SAN whereas the Ca buffer 1,2-Bis(2-aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid (acetoxymethyl ester) (BAPTA AM) did the opposite. These results suggest that cellular Ca accumulation hinders spontaneous depolarization in the NCX KO SAN, possibly by inhibiting L-type Ca currents. The funny current (If) blocker ivabradine also suppressed NCX KO SAN automaticity. We conclude that pacemaker activity is present in the NCX KO SAN, generated by a mechanism that depends upon If. However, the absence of NCX-mediated depolarization in combination with impaired Ca efflux results in intermittent bursts of pacemaker activity, reminiscent of human sinus node dysfunction and “tachy-brady” syndrome. PMID:26195795

  8. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  9. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  10. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  11. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  12. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  13. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Permanent offices. 401.3 Section 401.3 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District...

  14. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Permanent offices. 401.3 Section 401.3 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District...

  15. Teaching Object Permanence: An Action Research Study

    ERIC Educational Resources Information Center

    Bruce, Susan M.; Vargas, Claudia

    2013-01-01

    "Object permanence," also known as "object concept" in the field of visual impairment, is one of the most important early developmental milestones. The achievement of object permanence is associated with the onset of representational thought and language. Object permanence is important to orientation, including the recognition of landmarks.…

  16. Corrosion and degradation of a polyurethane/Co-Ni-Cr-Mo pacemaker lead

    SciTech Connect

    Sung, P.; Fraker, A.C.

    1987-12-01

    An investigation to study changes in the metal surfaces and the polyurethane insulation of heart pacemaker leads under controlled in vitro conditions was conducted. A polyurethane (Pellethane 2363-80A)/Co-Ni-Cr-Mo (MP35N) wire lead was exposed in Hanks' physiological saline solution for 14 months and then analyzed using scanning electron microscopy, x-ray energy dispersive analysis, and small angle x-ray scattering. Results showed that some leakage of solution into the lead had occurred and changes were present on both the metal and the polyurethane surfaces.

  17. Unexpected, dramatic improvement in atrioventricular conduction during pacemaker implantation for apparent complete heart block.

    PubMed

    Dizon, Jose'; Wang, Huijian; Biviano, Angelo; Garan, Hasan

    2007-09-01

    We describe the case of a 29-year-old man with complete heart block after aortic and mitral valve surgery for bacterial endocarditis. Prior to pacemaker implantation, the patient had sinus bradycardia with third degree atrioventricular (AV) block. During testing of the atrial lead, the patient manifested intact AV conduction with a constant PR interval, which was robust up to 120 beats/min. This case represents a dramatic example of unexpected, improved AV conduction, perhaps a result of loss of Phase IV block. PMID:17725759

  18. Intracellular calcium and Na+-Ca2+ exchange current in isolated toad pacemaker cells

    PubMed Central

    Ju, Yue-Kun; Allen, David G

    1998-01-01

    Single pacemaker cells were isolated from the sinus venosus of cane toad (Bufo marinus) in order to study the mechanisms involved in the spontaneous firing rate of action potentials. Intracellular calcium concentration ([Ca2+]i) was measured with indo-1 to determine whether [Ca2+]i influenced firing rate. A rapid transient rise of [Ca2+]i was recorded together with each spontaneous action potential. [Ca2+]i at the peak of systole was 655 ± 64 nm and the minimum at the end of diastole was 195 ± 15 nm. Reduction of extracellular Ca2+ concentration from 2 to 0.5 mm caused a reduction in both systolic and diastolic [Ca2+]i and the spontaneous firing rate also gradually declined. Application of the acetoxymethyl (AM) ester of BAPTA (10 μm), in order to increase intracellular calcium buffering, caused a decline in systolic and diastolic [Ca2+]i. The firing rate declined progressively until the cells stopped firing after 10–15 min. At the time that firing ceased, the diastolic [Ca2+]i had declined by 141 ± 38 nm. In the presence of ryanodine (2 μm), which interferes with Ca2+ release from the sarcoplasmic reticulum, the systolic and diastolic [Ca2+]i both declined and the firing rate decreased until the cells stopped firing. At quiescence diastolic [Ca2+]i had declined by 93 ± 20 nm. Exposure of the cells to Na+-free solution caused a rise in [Ca2+]i which exceeded the systolic level after 4.8 ± 0.3 s. This rise is consistent with Ca2+ entry on a Na+-Ca2+ exchanger. Rapid application of caffeine (10–20 mm) to cells clamped at −60 mV caused a rapid increase in [Ca2+]i which then spontaneously declined. An inward current with a similar time course to that of [Ca2+]i was also generated. Application of Ni2+ (5 mm) or 2,4-dichlorobenzamil (25 μm) reduced the amplitude of the inward current produced by caffeine by 96 ± 1 % and 74 ± 10 %, respectively. In a Na+-free solution the caffeine-induced current was reduced by 93 ± 7 %. Under a variety of circumstances

  19. Cardiovascular Devices; Reclassification of External Pacemaker Pulse Generator Devices; Reclassification of Pacing System Analyzers. Final order.

    PubMed

    2016-04-18

    The Food and Drug Administration (FDA) is issuing a final order to reclassify external pacemaker pulse generator (EPPG) devices, which are currently preamendments class III devices (regulated under product code DTE), into class II (special controls) and to reclassify pacing system analyzers (PSAs) into class II (special controls) based on new information and subject to premarket notification. This final order also creates a separate classification regulation for PSAs and places single and dual chamber PSAs, which are currently classified with EPPG devices, and triple chamber PSAs (TCPSAs), which are currently postamendments class III devices, into that new classification regulation. PMID:27101641

  20. Why We Have to Use Cardiac Resynchronization Therapy-Pacemaker More.

    PubMed

    Daubert, Jean-Claude; Martins, Raphaël; Leclercq, Christophe

    2015-12-01

    Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricular fibrillation detected. PMID:26596813

  1. Effect of trimebutine maleate on sinus node pacemaker activity of the rabbit.

    PubMed

    Kotake, H; Kinugawa, T; Hirai, S; Fukugi, M; Hasegawa, J; Mashiba, H

    1987-12-15

    The electrophysiological effects of trimebutine maleate were studied on rabbit sinus node cells with the two-microelectrode voltage clamp method. Trimebutine (above 10 microM) produced a negative chronotropic effect accompanied by decreases in the maximum upstroke velocity at phase 0, slope of phase 4 depolarization and action potential amplitude. The effects on the current systems were depression of the slow inward current and a decrease in the current oscillations induced by elevating [Ca]0. It is concluded that trimebutine exerts a Ca2+ channel blocking effect on the sinus node pacemaker cells. PMID:2450035

  2. Genetically engineered cardiac pacemaker: Stem cells transfected with HCN2 gene and myocytes—A model

    NASA Astrophysics Data System (ADS)

    Kanani, S.; Pumir, A.; Krinsky, V.

    2008-01-01

    One of the successfully tested methods to design genetically engineered cardiac pacemaker cells consists in transfecting a human mesenchymal stem cell (hMSC) with a HCN2 gene and connecting it to a myocyte. We develop and study a mathematical model, describing a myocyte connected to a hMSC transfected with a HCN2 gene. The cardiac action potential is described both with the simple Beeler Reuter model, as well as with the elaborate dynamic Luo Rudy model. The HCN2 channel is described by fitting electrophysiological records, in the spirit of Hodgkin Huxley. The model shows that oscillations can occur in a pair myocyte-stem cell, that was not observed in the experiments yet. The model predicted that: (1) HCN pacemaker channels can induce oscillations only if the number of expressed I channels is low enough. At too high an expression level of I channels, oscillations cannot be induced, no matter how many pacemaker channels are expressed. (2) At low expression levels of I channels, a large domain of values in the parameter space (n, N) exists, where oscillations should be observed. We denote N the number of expressed pacemaker channels in the stem cell, and n the number of gap junction channels coupling the stem cell and the myocyte. (3) The expression levels of I channels observed in ventricular myocytes, both in the Beeler Reuter and in the dynamic Luo Rudy models are too high to allow to observe oscillations. With expression levels below ˜1/4 of the original value, oscillations can be observed. The main consequence of this work is that in order to obtain oscillations in an experiment with a myocyte-stem cell pair, increasing the values of n, N is unlikely to be helpful, unless the expression level of I has been reduced enough. The model also allows us to explore levels of gene expression not yet achieved in experiments, and could be useful to plan new experiments, aimed at improving the robustness of the oscillations.

  3. Incidence and predictors of pacemaker dysfunction with unipolar ventricular lead configuration. Can we identify patients who benefit from bipolar electrodes?

    PubMed

    Wiegand, U K; Bode, F; Bonnemeier, H; Tölg, R; Peters, W; Katus, H A

    2001-09-01

    Unipolar ventricular leads were implanted in a considerable percentage of pacemaker recipients. There is little information on incidence and risk factors for unipolar pacemaker dysfunction using modern lead designs. Included in a cross-sectional analysis were 682 patients who fulfilled the following criteria: chronically implanted bipolar ventricular leads (> 1 year), intraoperative stimulation threshold < 1.0 V/0.5 ms, and potential amplitude > 6 mV. Incidences of chest wall stimulation (CWS) at an output of twice the amplitude threshold and of myopotential oversensing (MPO) at a sensitivity of half the sensing threshold were assessed. Energy (0.60 [0.72] vs 0.63 [0.81] microJ) and sensing thresholds (8.31 [3.18] mV vs 8.47 [3.47] mV) did not differ between uni- and bipolar modes. While all pacemakers worked properly during bipolar configuration, malfunctions were observed in 5.9% of patients during unipolar configuration (CWS = 1.9%, MPO = 4.2%). Patient age > 76 years (hazard ratio HR 8.2; P < 0.001), heart failure > or = NYHA Class II (HR 3.8; P < 0.001), and an antiarrhythmic therapy with Class I or III drugs (HR 3.3; P = 0.002) were independently associated with the occurrence of unipolar pacemaker dysfunction. Use of steroid-eluting leads reduced the probability of pacemaker dysfunction (HR 0.45; P = 0.03). Risk factors for unipolar ventricular pacemaker malfunction were higher age, heart failure, and antiarrhythmic drug therapy. Particularly in these patients, use of bipolar ventricular leads is beneficial. PMID:11584461

  4. Functional effects of β3-adrenoceptor on pacemaker activity in interstitial cells of Cajal from the mouse colon.

    PubMed

    Wu, Mei Jin; Shin, Dong Hoon; Kim, Man Yoo; Park, Chan Guk; Kim, Young Dae; Lee, Jun; Park, Il Koo; Choi, Seok; So, Insuk; Park, Jong Seong; Jun, Jae Yeoul

    2015-05-01

    We investigated the presence of β3-adrenoceptor and its functional effects on pacemaker potentials in colonic interstitial cells of Cajal (ICCs) from mice. The whole-cell patch clamp technique was used to record pacemaker potentials in cultured ICCs and reverse transcription polymerase chain reaction (RT-PCR) was performed to detect the mRNA transcript levels β-adrenoceptors. The β3-adrenoceptor agonist, BRL37344, reduced the frequency of pacemaker potentials in a concentration-dependent manner. The inhibitory effects of BRL37344 were blocked by the pretreatment of propranolol, a nonspecific β-adrenoceptor antagonist, but not by the selective β1-adrenoceptor antagonist atenolol and the selective β2-adrenoceptor antagonist butoxamine. β3-adrenoceptor antagonists SR59230A and L748337 blocked the inhibitory effects of BRL37344. RT-PCR revealed mRNA transcripts of β1- and β3-adrenoceptor, but not β2-adrenoceptor, in c-kit- and Ano-1-positive colonic ICCs. The K(+) channel blockers tetraethylammonium, apamin, and glibenclamide did not block the effects of BRL37344. N(ω)-Nitro-l-arginine methyl ester hydrochloride (L-NAME), an NO synthase inhibitor, and chelerythrine, a protein kinase C inhibitor, also did not block the effects of BRL37344. Noradrenaline mimicked the effects of BRL37344 in colonic ICCs. However, the inhibitory effects of noradrenaline on pacemaker potentials were blocked only by pretreatment with atenolol but not by butoxamine, SR59230A, or L748337. In small intestinal ICCs, BRL37344 had no effect on pacemaker potentials and mRNA transcripts of β1-and β2-adrenoceptor, but not β3-adrenoceptor were detected. These results suggest that β3-adrenoceptors are present in colonic ICCs and may play a role in regulating gastrointestinal motility by the inhibition of pacemaker potentials. PMID:25725113

  5. Alterations of field potentials in isotropic cardiomyocyte cell layers induced by multiple endogenous pacemakers under normal and hypothermal conditions.

    PubMed

    Kienast, R; Stöger, M; Handler, M; Hanser, F; Baumgartner, C

    2014-10-01

    The use of autonomous contracting randomly grown cardiomyocyte monolayers cultivated on microelectrode arrays (MEAs) represents an accepted experimental setting for preclinical experimental research in the field of cardiac electrophysiology. A dominant pacemaker forces a monolayer to adhere to a regular and synchronized contraction. Randomly distributed multiple pacemakers interfere with this dominant center, resulting in more or less frequent changes of propagation direction. This study aims to characterize the impact of changing propagation directions at single electrodes of the MEA on the four intrinsic parameters of registered field potentials (FPs) FPrise, FPMIN, FPpre, and FPdur and conduction velocity (CV) under normal and hypothermal conditions. Primary cultures of chicken cardiomyocytes (n = 18) were plated directly onto MEAs and FPs were recorded in a temperature range between 37 and 29°C. The number and spatiotemporal distribution of biological and artificial pacemakers of each cell layer inside and outside of the MEA registration area were evaluated using an algorithm developed in-house. In almost every second myocardial cell layer, interfering autonomous pacemakers were detected at stable temperatures, showing random spatial distributions with similar beating rates. Additionally, a temperature-dependent change of the dominant pacemaker center was observed in n = 16 experiments. A significant spread-direction-dependent variation of CV, FPrise, FPMIN, and FPpre up to 14% could be measured between different endogenous pacemakers. In conclusion, based on our results, disregarding the spatial origin of excitation may lead to misinterpretations and erroneous conclusions of FP parameters in the verification of research hypotheses in cellular electrocardiology. PMID:25085965

  6. Deterioration of autonomic neuronal receptor signaling and mechanisms intrinsic to heart pacemaker cells contribute to age-associated alterations in heart rate variability in vivo.

    PubMed

    Yaniv, Yael; Ahmet, Ismayil; Tsutsui, Kenta; Behar, Joachim; Moen, Jack M; Okamoto, Yosuke; Guiriba, Toni-Rose; Liu, Jie; Bychkov, Rostislav; Lakatta, Edward G

    2016-08-01

    We aimed to determine how age-associated changes in mechanisms extrinsic and intrinsic to pacemaker cells relate to basal beating interval variability (BIV) reduction in vivo. Beating intervals (BIs) were measured in aged (23-25 months) and adult (3-4 months) C57BL/6 male mice (i) via ECG in vivo during light anesthesia in the basal state, or in the presence of 0.5 mg mL(-1) atropine + 1 mg mL(-1) propranolol (in vivo intrinsic conditions), and (ii) via a surface electrogram, in intact isolated pacemaker tissue. BIV was quantified in both time and frequency domains using linear and nonlinear indices. Although the average basal BI did not significantly change with age under intrinsic conditions in vivo and in the intact isolated pacemaker tissue, the average BI was prolonged in advanced age. In vivo basal BIV indices were found to be reduced with age, but this reduction diminished in the intrinsic state. However, in pacemaker tissue BIV indices increased in advanced age vs. adults. In the isolated pacemaker tissue, the sensitivity of the average BI and BIV in response to autonomic receptor stimulation or activation of mechanisms intrinsic to pacemaker cells by broad-spectrum phosphodiesterase inhibition declined in advanced age. Thus, changes in mechanisms intrinsic to pacemaker cells increase the average BIs and BIV in the mice of advanced age. Autonomic neural input to pacemaker tissue compensates for failure of molecular intrinsic mechanisms to preserve average BI. But this compensation reduces the BIV due to both the imbalance of autonomic neural input to the pacemaker cells and altered pacemaker cell responses to neural input. PMID:27168363

  7. Permanent-File-Validation Utility Computer Program

    NASA Technical Reports Server (NTRS)

    Derry, Stephen D.

    1988-01-01

    Errors in files detected and corrected during operation. Permanent File Validation (PFVAL) utility computer program provides CDC CYBER NOS sites with mechanism to verify integrity of permanent file base. Locates and identifies permanent file errors in Mass Storage Table (MST) and Track Reservation Table (TRT), in permanent file catalog entries (PFC's) in permit sectors, and in disk sector linkage. All detected errors written to listing file and system and job day files. Program operates by reading system tables , catalog track, permit sectors, and disk linkage bytes to vaidate expected and actual file linkages. Used extensively to identify and locate errors in permanent files and enable online correction, reducing computer-system downtime.

  8. Method of making permanent magnets

    DOEpatents

    McCallum, R.W.; Dennis, K.W.; Lograsso, B.K.; Anderson, I.E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles. Wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties. 13 figures.

  9. Method of making permanent magnets

    DOEpatents

    McCallum, R. William; Dennis, Kevin W.; Lograsso, Barbara K.; Anderson, Iver E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties.

  10. Circadian pacemaker in the suprachiasmatic nuclei of teleost fish revealed by rhythmic period2 expression.

    PubMed

    Watanabe, Nanako; Itoh, Kae; Mogi, Makoto; Fujinami, Yuichiro; Shimizu, Daisuke; Hashimoto, Hiroshi; Uji, Susumu; Yokoi, Hayato; Suzuki, Tohru

    2012-09-01

    In mammals, the role of the suprachiasmatic nucleus (SCN) as the primary circadian clock that coordinates the biological rhythms of peripheral oscillators is well known. However, in teleosts, it remains unclear whether the SCN also functions as a circadian pacemaker. We used in situ hybridization (ISH) techniques to demonstrate that the molecular clock gene, per2, is expressed in the SCN of flounder (Paralichthys olivaceus) larvae during the day and down-regulated at night, demonstrating that a circadian pacemaker exists in the SCN of this teleost. The finding that per2 expression in the SCN was also observed in the amberjack (Seriola dumerili), but not in medaka (Oryzias latipes), implies that interspecific variation exists in the extent to which the SCN controls the circadian rhythms of fish species, presumably reflecting their lifestyle. Rhythmic per2 expression was also detected in the pineal gland and pituitary, and aperiodic per2 expression was observed in the habenula, which is known to exhibit circadian rhythms in rodents. Since the ontogeny of per2 expression in the brain of early flounder larvae can be monitored by whole mount ISH, it is possible to investigate the effects of drugs and environmental conditions on the functional development of circadian clocks in the brain of fish larvae. In addition, flounder would be a good model for understanding the rhythmicity of marine fish. Our findings open a new frontier for investigating the role of the SCN in teleost circadian rhythms. PMID:22732079

  11. Ionic currents during sustained pacemaker activity in rabbit sino-atrial myocytes.

    PubMed Central

    Zaza, A; Micheletti, M; Brioschi, A; Rocchetti, M

    1997-01-01

    1. The contribution of various ionic currents to diastolic depolarization (DD) in rabbit sinoatrial myocytes was evaluated by the action potential clamp technique. Individual currents were identified, during sustained pacemaking activity reproduced under voltage clamp conditions, according to their sensitivity to specific channel blockers. 2. The current sensitive to dihydropyridines (DHPs), blockers of L-type Ca2+ current (ICa,L), was small and outward during most of DD. Diastolic DHP-sensitive current was affected by changes in the driving force for K+, but it was insensitive to E-4031, which blocks the current termed IK,r; it was abolished by cell dialysis with a Ca2+ chelator. 3. The current sensitive to 2 mM Cs+ (ICs), a blocker of hyperpolarization-activated current (I(f)), was inward during the whole DD and it was substantially larger than the net inward current flowing during this phase. However, diastolic IK,r, identified in the same cells as the current sensitive to the blocker E-4031, exceeded ICs 2-fold. 4. These findings suggest that: (a) Ca2+ influx during the pacemaker cycle increases a K+ conductance, thus inverting the direction of the net current generated by L-type Ca2+ channel activity during DD; (b) the magnitude of I(f) would be adequate to account fully for DD; however, the coexistence of a larger IK,r suggests that other channels besides I(f) contribute inward current during this phase. PMID:9457645

  12. Reflex vasovagal syncope--is there a benefit in pacemaker therapy?

    PubMed

    Sousa, Pedro Alexandre; Candeias, Rui; Marques, Nuno; Jesus, Ilídio

    2014-05-01

    Reflex vasovagal syncope often affects young populations and is associated with a benign prognosis in terms of mortality. However, a minority of patients have recurrent episodes, with a considerable impact on their quality of life. Pacemaker therapy has been an option in these patients since the 1990s if a conservative strategy fails. Initially, non-randomized and open-label randomized trials showed promising results, but these studies were associated with a significant placebo effect. Recently, an approach based on the use of implantable loop recorders has shown that some patients with reflex vasovagal syncope could benefit from implantation with dual-chamber pacemakers, particularly patients aged >40 years, with recurrent syncopal episodes resulting in frequent injuries, in whom a long asystole (≥3 s asystole with syncope or ≥6 s asystole without syncope) has been documented with an implantable loop recorder. The authors present a literature review on the role of cardiac pacing in reflex vasovagal syncope and propose a diagnostic and therapeutic decision flowchart for patients with syncope of probable reflex etiology. PMID:24895017

  13. Light microscopy of the lymphatics of the human atrial wall and lymphatic drainage of supraventricular pacemakers.

    PubMed

    Elisková, M; Eliska, O

    1989-01-01

    After injection of Indian ink stained 2% gelatine in 42 human hearts the lymph drainage of the regions of supraventricular cardiac pacemakers and the patterns of the lymphatic vascular bed in the atrial wall were studied. From the sites of the pacemakers the lymph is drained into the tracheobronchial nodes in 100%. Only two of those regions are drained through additional pathways, namely the SAN region into the anterior mediastinal node situated at the azygos vein and the coronary sinus area into the anterior mediastinal lateropericardiac nodes. In the cleared specimens as microscopically the epicardial lymph vessels produce polygonal superficial network; oblique anastomoses of that network run into the deeper layers of subepicardial tissue where they join with deep irregular lymphatic network. Deep subepicardial lymph vessels are often accompanied by veins and nerves. The course of most of myocardial lymph vessels follows the position of muscle cells. In the connective septa these vessels join to form larger trunks and open into the subepicardial vessels. PMID:2475557

  14. [Study on Chaotic Detection Method of Pacemaker Contact-Less Power Supply].

    PubMed

    Zhou, Chenghu; Huang, Mingming; Li, Songtao

    2015-12-01

    In order to improve the reliability of cardiac pacemaker contact-less power supply technology, this paper proposes a novel application of wireless feedback voltage stabilizing technology to adjust heart disease patients with inner power supply filter circuit output voltage and current control method, to keep the output voltage stability, and to ensure that the super capacitor and cardiac pacemaker to get a stable power supply. To implement the real-time accurate voltage control with considering the primary and secondary side inductance coupling coefficient changes, the change of the external power supply voltage and load, it is necessary to test thee real-time and accurate output voltage and current value after rectifying filtering. Therefore, based on the chaotic control theory, we adopted method of phase diagram on the basis of the quick observation after rectifying filtering, so that the method of voltage and current could improve the detection time of the circuit. The phase diagram of proposed control method can be divided into 8 segments, and we got 7 zero-extreme points. When these zero-extreme points are detected, according to extreme points of the zero instantaneous values, the corresponding average values of voltage and current were obtained. Simulation and experimental results showed that using the above method can shorten the response time to less than switch devices 1/2 switching cycles, thus validating the effectiveness and feasibility of the proposed detection algorithm. PMID:27079110

  15. Cardiorespiratory Mechanical Simulator for In Vitro Testing of Impedance Minute Ventilation Sensors in Cardiac Pacemakers.

    PubMed

    Marcelli, Emanuela; Cercenelli, Laura

    2016-01-01

    We developed a cardiorespiratory mechanical simulator (CRMS), a system able to reproduce both the cardiac and respiratory movements, intended to be used for in vitro testing of impedance minute ventilation (iMV) sensors in cardiac pacemakers. The simulator consists of two actuators anchored to a human thorax model and a software interface to control the actuators and to acquire/process impedance signals. The actuators can be driven separately or simultaneously to reproduce the cardiac longitudinal shortening at a programmable heart rate and the diaphragm displacement at a programmable respiratory rate (RR). A standard bipolar pacing lead moving with the actuators and a pacemaker case fixed to the thorax model have been used to measure impedance (Z) variations during the simulated cardiorespiratory movements. The software is able to discriminate the low-frequency component because of respiration (Z(R)) from the high-frequency ripple because of cardiac effect (Z(C)). Impedance minute ventilation is continuously calculated from Z(R) and RR. From preliminary tests, the CRMS proved to be a reliable simulator for in vitro evaluation of iMV sensors. Respiration impedance recordings collected during cardiorespiratory movements reproduced by the CRMS were comparable in morphology and amplitude with in vivo assessments of transthoracic impedance variations. PMID:26501915

  16. Pacemaker potentials for the periodic burst discharge in the heart ganglion of a stomatopod, Squilla oratoria.

    PubMed

    Watanabe, A; Obara, S; Akiyama, T

    1967-03-01

    From somata of the pacemaker neurons in the Squilla heart ganglion, pacemaker potentials for the spontaneous periodic burst discharge are recorded with intracellular electrodes. The electrical activity is composed of slow potentials and superimposed spikes, and is divided into four types, which are: (a) "mammalian heart" type, (b) "slow generator" type, (c) "slow grower" type, and (d) "slow deficient" type. Since axons which are far from the somata do not produce slow potentials, the soma and dendrites must be where the slow potentials are generated. Hyperpolarization impedes generation of the slow potential, showing that it is an electrically excitable response. Membrane impedance increases on depolarization. Brief hyperpolarizing current can abolish the plateau but brief tetanic inhibitory fiber stimulation is more effective for the abolition. A single stimulus to the axon evokes the slow potential when the stimulus is applied some time after a previous burst. Repetitive stimuli to the axon are more effective in eliciting the slow potential, but the depolarization is not maintained on continuous stimulation. Synchronization of the slow potential among neurons is achieved by: (a) the electrotonic connections, with periodic change in resistance of the soma membrane, (b) active spread of the slow potential, and (c) synchronization through spikes. PMID:6034506

  17. Pacemaker Potentials for the Periodic Burst Discharge in the Heart Ganglion of a Stomatopod, Squilla oratoria

    PubMed Central

    Watanabe, Akira; Obara, Shosaku; Akiyama, Toyohiro

    1967-01-01

    From somata of the pacemaker neurons in the Squilla heart ganglion, pacemaker potentials for the spontaneous periodic burst discharge are recorded with intracellular electrodes. The electrical activity is composed of slow potentials and superimposed spikes, and is divided into four types, which are: (a) "mammalian heart" type, (b) "slow generator" type, (c) "slow grower" type, and (d) "slow deficient" type. Since axons which are far from the somata do not produce slow potentials, the soma and dendrites must be where the slow potentials are generated. Hyperpolarization impedes generation of the slow potential, showing that it is an electrically excitable response. Membrane impedance increases on depolarization. Brief hyperpolarizing current can abolish the plateau but brief tetanic inhibitory fiber stimulation is more effective for the abolition. A single stimulus to the axon evokes the slow potential when the stimulus is applied some time after a previous burst. Repetitive stimuli to the axon are more effective in eliciting the slow potential, but the depolarization is not maintained on continuous stimulation. Synchronization of the slow potential among neurons is achieved by: (a) the electrotonic connections, with periodic change in resistance of the soma membrane, (b) active spread of the slow potential, and (c) synchronization through spikes. PMID:6034506

  18. Time and memory: towards a pacemaker-free theory of interval timing.

    PubMed Central

    Staddon, J E; Higa, J J

    1999-01-01

    A popular view of interval timing in animals is that it is driven by a discrete pacemaker-accumulator mechanism that yields a linear scale for encoded time. But these mechanisms are fundamentally at odds with the Weber law property of interval timing, and experiments that support linear encoded time can be interpreted in other ways. We argue that the dominant pacemaker-accumulator theory, scalar expectancy theory (SET), fails to explain some basic properties of operant behavior on interval-timing procedures and can only accommodate a number of discrepancies by modifications and elaborations that raise questions about the entire theory. We propose an alternative that is based on principles of memory dynamics derived from the multiple-time-scale (MTS) model of habituation. The MTS timing model can account for data from a wide variety of time-related experiments: proportional and Weber law temporal discrimination, transient as well as persistent effects of reinforcement omission and reinforcement magnitude, bisection, the discrimination of relative as well as absolute duration, and the choose-short effect and its analogue in number-discrimination experiments. Resemblances between timing and counting are an automatic consequence of the model. We also argue that the transient and persistent effects of drugs on time estimates can be interpreted as well within MTS theory as in SET. Recent real-time physiological data conform in surprising detail to the assumptions of the MTS habituation model. Comparisons between the two views suggest a number of novel experiments. PMID:10220931

  19. Repetitive nonreentrant ventriculoatrial synchrony: An underrecognized cause of pacemaker-related arrhythmia.

    PubMed

    Sharma, Parikshit S; Kaszala, Karoly; Tan, Alex Y; Koneru, Jayanthi N; Shepard, Richard; Ellenbogen, Kenneth A; Huizar, Jose F

    2016-08-01

    Similar to endless loop tachycardia (ELT), repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) is a ventriculoatrial (VA) synchrony pacemaker-mediated arrhythmia. RNRVAS was first described in 1990 and can only occur in the presence of retrograde VA conduction and dual-chamber or cardiac resynchronization devices with tracking (P-synchronous ventricular pacing such as DDD, DDDR) or nontracking pacing modes that allow AV-sequential pacing (DDI, DDIR). RNRVAS is promoted by (1) high lower rate limit or any feature that allows rapid pacing, (2) long AV intervals, or (3) long postventricular atrial refractory period (PVARP). In contrast to ELT, RNRVAS is a less well-recognized form of pacemaker-mediated arrhythmia; thus, unlike ELT, there are no specific device algorithms to prevent, recognize, and terminate RNRVAS. However, RNRVAS has been recently shown to occur frequently. We present a series of cases, some of which were found fortuitously. Owing to its clinical implications, we propose that algorithms should be developed to prevent, identify, and terminate RNRVAS. PMID:27050909

  20. Calcium-dependent phosphorylation regulates neuronal stability and plasticity in a highly precise pacemaker nucleus

    PubMed Central

    Macleod, Gregory T.; Zakon, Harold H.

    2011-01-01

    Specific types of neurons show stable, predictable excitability properties, while other neurons show transient adaptive plasticity of their excitability. However, little attention has been paid to how the cellular pathways underlying adaptive plasticity interact with those that maintain neuronal stability. We addressed this question in the pacemaker neurons from a weakly electric fish because these neurons show a highly stable spontaneous firing rate as well as an N-methyl-d-aspartate (NMDA) receptor-dependent form of plasticity. We found that basal firing rates were regulated by a serial interaction of conventional and atypical PKC isoforms and that this interaction establishes individual differences within the species. We observed that NMDA receptor-dependent plasticity is achieved by further activation of these kinases. Importantly, the PKC pathway is maintained in an unsaturated baseline state to allow further Ca2+-dependent activation during plasticity. On the other hand, the Ca2+/calmodulin-dependent phosphatase calcineurin does not regulate baseline firing but is recruited to control the duration of the NMDA receptor-dependent plasticity and return the pacemaker firing rate back to baseline. This work illustrates how neuronal plasticity can be realized by biasing ongoing mechanisms of stability (e.g., PKC) and terminated by recruiting alternative mechanisms (e.g., calcineurin) that constrain excitability. We propose this as a general model for regulating activity-dependent change in neuronal excitability. PMID:21525377

  1. Quantification of fiber orientation in the canine atrial pacemaker complex using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Ambrosi, Christina M.; Fedorov, Vadim V.; Schuessler, Richard B.; Rollins, Andrew M.; Efimov, Igor R.

    2012-07-01

    The atrial pacemaker complex is responsible for the initiation and early propagation of cardiac impulses. Optical coherence tomography (OCT), a nondestructive imaging modality with spatial resolutions of ˜1 to 15 μm, can be used to identify unique fiber orientation patterns in this region of the heart. Functionally characterized canine sinoatrial nodes (SAN) (n=7) were imaged using OCT up to ˜1 mm below the endocardial tissue surface. OCT images were directly compared to their corresponding histological sections. Fiber orientation patterns unique to the crista terminalis (CT), SAN, and surrounding atrial myocardium were identified with dominant average fiber angles of 89±12 deg, 110±16 deg, and 95±35 deg, respectively. Both the CT and surrounding atrial myocardium displayed predominantly unidirectionally based fiber orientation patterns within each specimen, whereas the SAN displayed an increased amount of fiber disarray manifested quantitatively as a significantly greater standard deviation in fiber angle distribution within specimens [33±7 deg versus 23±5 deg, atrium (p=0.02); 18±3 deg, CT (p=0.0003)]. We also identified unique, local patterns of fiber orientation specific to the functionally characterized block zone. We demonstrate the ability of OCT in detecting components of the atrial pacemaker complex which are intimately involved in both normal and abnormal cardiac conduction.

  2. Cell culture models for oscillator and pacemaker function: recipes for dishes with circadian clocks?

    PubMed

    Earnest, David J; Cassone, Vincent M

    2005-01-01

    Primary cell cultures of avian pinealocytes and the mammalian suprachiasmatic nucleus (SCN), immortalized cell lines derived from the SCN (SCN2.2), and fibroblasts derived from mice and rats have been employed as in vitro models to study the cellular and molecular mechanisms underlying circadian biological clocks. This article compares and contrasts these model systems and describes methods for avian pinealocyte cultures, immortalized SCN2.2 cells, and mouse fibroblast culture. Each of these culture models has advantages and disadvantages. Avian pinealocytes are photoreceptive, contain a circadian pacemaker, and produce rhythms of an easily assayed endocrine output-melatonin. However, the molecular mechanisms underlying pinealocyte function are not understood. SCN2.2 cells express metabolic and molecular rhythms and can impose rhythmicity on cocultured cells as well as rat behavior when transplanted into the brain. Yet, the entrainment pathways are not experimentally established in these cells. Fibroblast cultures are simple to produce and express molecular clock gene rhythms, but they express neither physiological rhythmicity nor pacemaker properties. The relative merits of these culture systems, as well as their impact on understanding circadian organization in vivo, are also considered. PMID:15817312

  3. Drosophila TRPA1 functions in temperature control of circadian rhythm in pacemaker neurons.

    PubMed

    Lee, Youngseok; Montell, Craig

    2013-04-17

    Most animals from flies to humans count on circadian clocks to synchronize their physiology and behaviors. Daily light cycles are well known environmental cues for setting circadian rhythms. Warmer and cooler temperatures that mimic day and night are also effective in entraining circadian activity in most animals. Even vertebrate organisms can be induced to show circadian responses through exposure to temperature cycles. In poikilothermic animals such as Drosophila, temperature differences of only 2-3°C are sufficient to synchronize locomotor rhythms. However, the molecular sensors that participate in temperature regulation of circadian activity in fruit flies or other animals are enigmatic. It is also unclear whether such detectors are limited to the periphery or may be in the central brain. Here, we showed that Drosophila TRPA1 (transient receptor potential cation channel A1) was necessary for normal activity patterns during temperature cycles. The trpA1 gene was expressed in a subset of pacemaker neurons in the central brain. In response to temperature entrainment, loss of trpA1 impaired activity, and altered expression of the circadian clock protein period (Per) in a subset of pacemaker neurons. These findings underscore a role for a thermoTRP in temperature regulation that extends beyond avoidance of noxious or suboptimal temperatures. PMID:23595730

  4. Dynamic tricuspid valve stenosis induced with a pacemaker lead: a case report.

    PubMed

    Skoric, Bosko; Baricevic, Zeljko; Brida, Margarita; Samardzic, Jure; Jurin, Hrvoje; Milicic, Davor

    2014-01-01

    Isolated severe tricuspid valve stenosis due to an endocardial pacemaker lead is extremely rare, and is usually caused by either fibrosis of a perforated or lacerated leaflet, or fibrotic adherence between the lead and the valvular apparatus. Reported cases typically include clinical manifestations of both systemic venous stasis and low cardiac output. The case is presented of a 20-year-old female with a surgically repaired congenital heart disease who developed severe tricuspid stenosis at six years after the implantation of a DDD pacemaker. Unexpectedly, the patient had no signs of venous stasis and suffered only from exercise intolerance. Right heart catheterization under fluoroscopic guidance revealed an atrial lead forming a loop at the level of the tricuspid valve. A paradoxical inspiratory decrease in the transvalvular diastolic gradient, caused by the caudal heart motion and straightening of the loop during inspiration, was noted. Such a dynamic nature with a temporary inspiratory relief of the obstruction may explain the partial clinical presentation of tricuspid stenosis in this case. The lead was removed and the tricuspid valve repaired surgically, after which the patient's recovery was uneventful with normalization of exercise tolerance. PMID:24779342

  5. [Permanent vascular access for haemodialysis].

    PubMed

    Manafov, E N; Batrashov, V A; Sergeev, O G; Yudaev, S S

    2015-01-01

    The presence of a permanent vascular access (PVA) is the pledge of successful treatment of patients being on chronic haemodialysis (CD). Creation and maintenance of a functioning PVA is the priority task of vascular and endovascular surgeons, nephrologists and specialists of haemodialysis departments. According to the KDOQI guidelines, the most preferable type of PVA is a native arteriovenous fistula (AVF). As an alternative it is possible to use a synthetic prosthesis for creating an arteriovenous shunt (AVS) or implantation of a central venous catheter (CVC). Various complications of vascular accesses leading to their loss create the necessity of forming just another PVA, thus negatively influencing the life span and quality of life of this cohort of patients. Improving surgical technique and approaches to treatment, as well as carrying out dynamic monitoring of the condition of the created PVA make it possible to considerably decrease the incidence rate of such complications and to improve the quality of medical care rendered. PMID:26451410

  6. Perspectives on Withdrawing Pacemaker and Implantable Cardioverter-Defibrillator Therapies at End of Life: Results of a Survey of Medical and Legal Professionals and Patients

    PubMed Central

    Kapa, Suraj; Mueller, Paul S.; Hayes, David L.; Asirvatham, Samuel J.

    2010-01-01

    OBJECTIVE: To determine the opinions of medical professionals, legal professionals, and patients regarding the withdrawal of implantable cardioverter-defibrillator (ICD) and pacemaker therapy at the end of life. PARTICIPANTS AND METHODS: A survey regarding 5 cases that focused on withdrawal of ICD or pacemaker therapy at the end of life was constructed and sent to 5270 medical professionals, legal professionals, and patients. The survey was administered from March 1, 2008, to March 1, 2009. RESULTS: Of the 5270 recipients of the survey, 658 (12%) responded. In a terminally ill patient requesting that his ICD be turned off, most legal professionals (90% [63/70]), medical professionals (98% [330/336]), and patients (85% [200/236]) agreed the ICD should be turned off. Most legal professionals (89%), medical professionals (87%), and patients (79%) also considered withdrawal of pacemaker therapy in a non–pacemaker-dependent patient appropriate. However, significantly more legal (81%) than medical professionals (58%; P<.001) or patients (68%, P=.02) agreed with turning off a pacemaker in the pacemaker-dependent patient. A similar number of legal professionals thought turning off a device was legal regardless of whether it was an ICD or pacemaker (45% vs 38%; P=.50). However, medical professionals were more likely to perceive turning off an ICD as legal than turning off a pacemaker (85% vs 41%; P<.001). CONCLUSION: Most respondents thought device therapy should be withdrawn if the patient requested its withdrawal at the end of life. However, opinions of medical professionals and patients tended to be dependent on the type of device, with turning off ICDs being perceived as more acceptable than turning off pacemakers, whereas legal professionals tended to perceive all devices as similar. Thus, education and discussion regarding managing devices at the end of life are important when having end-of-life discussions and making end-of-life decisions to better understand

  7. Torque Performance and Permanent Magnet Arrangement for Interior Permanent Magnet Synchronous Motor

    NASA Astrophysics Data System (ADS)

    Matsumoto, Naohisa; Sanada, Masayuki; Morimoto, Shigeo; Takeda, Yoji

    The use of the interior permanent magnet synchronous motor (IPMSM) has increased in the industrial field because of its excellent characteristics, such as high efficiency, wide range of speed operation and flexibility of the rotor structure. Therefore, the IPMSM, especially one using the rare earth permanent magnet, is being actively studied. In the IPMSM using the rare earth permanent magnet, typically the permanent magnet is deeply embedded in the rotor. However, torque performances are significantly influenced by the rotor structures. This paper describes the torque performances for a single-layer IPMSM using the rare earth permanent magnet when the permanent magnet arrangements are changed.

  8. Atrial Fibrosis Quantified Using Late Gadolinium Enhancement MRI is Associated With Sinus Node Dysfunction Requiring Pacemaker Implant

    PubMed Central

    Akoum, Nazem; Mcgann, Christopher; Vergara, Gaston; Badger, Troy; Ranjan, Ravi; Mahnkopf, Christian; Kholmovski, Eugene; Macleod, Rob; Marrouche, Nassir

    2015-01-01

    Introduction Sinus node dysfunction (SND) commonly manifests with atrial arrhythmias alternating with sinus pauses and sinus bradycardia. The underlying process is thought to be because of atrial fibrosis. We assessed the value of atrial fibrosis, quantified using Late Gadolinium Enhanced-MRI (LGE-MRI), in predicting significant SND requiring pacemaker implant. Methods Three hundred forty-four patients with atrial fibrillation (AF) presenting for catheter ablation underwent LGE-MRI. Left atrial (LA) fibrosis was quantified in all patients and right atrial (RA) fibrosis in 134 patients. All patients underwent catheter ablation with pulmonary vein isolation with posterior wall and septal debulking. Patients were followed prospectively for 329 ± 245 days. Ambulatory monitoring was instituted every 3 months. Symptomatic pauses and bradycardia were treated with pacemaker implantation per published guidelines. Results The average patient age was 65 ± 12 years. The average wall fibrosis was 16.7 ± 11.1% in the LA, and 5.3 ± 6.4% in the RA. RA fibrosis was correlated with LA fibrosis (R2 = 0.26; P < 0.01). Patients were divided into 4 stages of LA fibrosis (Utah I: <5%, Utah II: 5–20%, Utah III: 20–35%, Utah IV: >35%). Twenty-two patients (mean atrial fibrosis, 23.9%) required pacemaker implantation during follow-up. Univariate and multivariate analysis identified LA fibrosis stage (OR, 2.2) as a significant predictor for pacemaker implantation with an area under the curve of 0.704. Conclusions In patients with AF presenting for catheter ablation, LGE-MRI quantification of atrial fibrosis demonstrates preferential LA involvement. Significant atrial fibrosis is associated with clinically significant SND requiring pacemaker implantation. PMID:21806700

  9. Atrial electromechanical sequence in normal subjects and patients with DDD pacemakers.

    PubMed Central

    Wang, K.; Xiao, H. B.; Fujimoto, S.; Gibson, D. G.

    1995-01-01

    OBJECTIVE--To assess the effect of right atrial appendage pacing on atrial electromechanical interrelations in patients with DDD pacemakers. DESIGN--Prospective study by M mode echocardiogram, Doppler echocardiogram, and apexcardiogram, along with electrocardiogram and phonocardiogram. SETTING--Tertiary cardiac referral centre. PATIENTS--20 patients with DDD pacemakers and 20 age matched normal controls. RESULTS--Age, RR interval, atrial size, left ventricular size, and fractional shortening were similar in the two groups. Atrial electromechanical delay (the time from the onset of P wave or atrial pacing spike on ECG to the onset of atrial contraction on M mode echogram) was 68 (SD 7) ms at the lateral site of right atrium, 82 (9) ms at the central fibrous body, 93 (11) ms at the lateral site of left atrium in normals. In patients with DDD pacing, however, this delay increased to 85 (22) ms, 117 (23) ms, and 138 (25) ms respectively (all P < 0.01). Interatrial mechanical delay (the time from the onset of right atrial motion to the onset of the left) increased from 25 (6) ms in normal controls to 53 (18) ms in patients (P < 0.01). Intra-atrial mechanical dispersion (the time from the earliest to the latest onset of regional atrial motion around the atrioventricular ring) in the right atrium increased from 6 (2) ms in normals to 19 (2) ms in patients (P < 0.01), but it remained unchanged in the left atrium (6 (2) ms in normal controls v 7 (2) ms in patients, P > 0.05). Peak atrial shortening rate was not different between the two groups. Differences of atrial electromechanical activity between the two groups were also reflected on Doppler echocardiogram and apexcardiogram. CONCLUSIONS--Right atrial appendage pacing disturbs the normal coordinate sequence of right atrial mechanical activity and leads to a striking and variable increase in intra-atrial conduction time as well as in interatrial conduction time. Left atrial contraction remains synchronous although the

  10. Augmented railgun using a permanent magnet

    SciTech Connect

    Katsuki, S.; Akiyama, H.; Eguchi, N.; Sueda, T.; Soejima, M.; Maeda, S.; Sato, K.N.

    1995-08-01

    The use of a permanent magnet instead of an electromagnet has been proposed for the augmentation of the magnetic field of a railgun driven by a current of approximately 20 kA. A permanent magnet has the following advantages in comparison with conventional augmentations using additional turns: (1) simple configuration of the system, (2) temporally and spatially constant magnetic fields, and (3) high efficiency. Here, the operation of a conventional railgun and that of an augmented railgun using a permanent magnet are compared experimentally, and the usefulness of the permanent magnet is described. {copyright} {ital 1995} {ital American} {ital Institute} {ital of} {ital Physics}.

  11. Initial experiences with a telemedicine framework for remote pacemaker follow-up.

    PubMed

    Kollmann, A; Hayn, D; Garcia, J; Kastner, P; Rotman, B; Tscheliessnigg, K H; Schreier, G

    2006-01-01

    According to international guidelines implanted cardiac pacemakers (PM) have to be checked periodically to ensure that they are working correctly. To spare a significant number of patients the burden of traveling to specialized PM clinics a telemedicine framework has been developed prototypically. A mobile, personal digital assistant (PDA) based PM follow-up unit provides the caregiver at the point-of-care with the necessary infrastructure to perform a basic PM follow-up examination remotely. In case of detected malfunction of the PM the patient is ordered to the hospital for further examination. The system has been evaluated in a clinical pilot trial on 44 patients with a total of 23 different PM models from 8 different manufacturers. The initial results indicate the potential of the concept to work as an efficient, manufacturer independent screening method with the ultimate goal to increase the safety, quality and efficiency of PM therapy. PMID:17946290

  12. Circadian rhythms in healthy aging--effects downstream from the pacemaker

    NASA Technical Reports Server (NTRS)

    Monk, T. H.; Kupfer, D. J.

    2000-01-01

    Using both previously published findings and entirely new data, we present evidence in support of the argument that the circadian dysfunction of advancing age in the healthy human is primarily one of failing to transduce the circadian signal from the circadian timing system (CTS) to rhythms "downstream" from the pacemaker rather than one of failing to generate the circadian signal itself. Two downstream rhythms are considered: subjective alertness and objective performance. For subjective alertness, we show that in both normal nychthemeral (24 h routine, sleeping at night) and unmasking (36 h of constant wakeful bed rest) conditions, advancing age, especially in men, leads to flattening of subjective alertness rhythms, even when circadian temperature rhythms are relatively robust. For objective performance, an unmasking experiment involving manual dexterity, visual search, and visual vigilance tasks was used to demonstrate that the relationship between temperature and performance is strong in the young, but not in older subjects (and especially not in older men).

  13. Adult-specific electrical silencing of pacemaker neurons uncouples the molecular oscillator from circadian outputs

    PubMed Central

    Depetris-Chauvin, Ana; Berni, Jimena; Aranovich, Ezequiel J.; Muraro, Nara I.; Beckwith, Esteban J.; Ceriani, María Fernanda

    2011-01-01

    Summary Background Circadian rhythms regulate physiology and behavior through transcriptional feedback loops of clock genes running within specific pacemaker cells. In Drosophila, molecular oscillations in the small ventral Lateral Neurons (sLNvs) command rhythmic behavior under free-running conditions releasing the neuropeptide PIGMENT DISPERSING FACTOR (PDF) in a circadian fashion. Electrical activity in the sLNvs is also required for behavioral rhythmicity. Yet, how temporal information is transduced into behavior remains unclear. Results Here we developed a new tool for temporal control of gene expression to obtain adult-restricted electrical silencing of the PDF circuit, which led to reversible behavioral arrhythmicity. Remarkably, PER oscillations during the silenced phase remained unaltered, indicating that arrhythmicity is a direct consequence of the silenced activity. Accordingly, circadian axonal remodeling and PDF accumulation were severely affected during the silenced phase. Conclusions Although electrical activity of the sLNvs is not a clock component it coordinates circuit outputs leading to rhythmic behavior. PMID:22018542

  14. Stability, precision, and near-24-hour period of the human circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Czeisler, C. A.; Duffy, J. F.; Shanahan, T. L.; Brown, E. N.; Mitchell, J. F.; Rimmer, D. W.; Ronda, J. M.; Silva, E. J.; Allan, J. S.; Emens, J. S.; Dijk, D. J.; Kronauer, R. E.

    1999-01-01

    Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm reported to range from 13 to 65 hours (median 25.2 hours) and the period of the body temperature rhythm reported to average 25 hours in adulthood, and to shorten with age. However, those observations were based on studies of humans exposed to light levels sufficient to confound circadian period estimation. Precise estimation of the periods of the endogenous circadian rhythms of melatonin, core body temperature, and cortisol in healthy young and older individuals living in carefully controlled lighting conditions has now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. These findings have important implications for understanding the pathophysiology of disrupted sleep in older people.

  15. Electrolytic phenomena and massive gas generation around pacemaker electrodes. Clinical presentation of an unusual pacing failure.

    PubMed

    Di Luzio, V; Curzi, G; Capestro, F; Boccanelli, A; Renzi, R

    1975-12-01

    An unexpected clinical presentation of an unusual pacing failure has been observed in two patients who had had recent implantation of a pacemaker model whose electrodes were made of an nonnoble metal alloy. An intermittent current leakage from the output capacitor and possibly from the output transistor accounted for electrolytic corrosion at the anode, premature depletion of the battery, heart muscle damage and for massive gas generation around electrodes, leading to right ventricular perforation, pneumopericardium and subcutaneous thoracic emphysema. The occurrence of this syndrome shows that, if nonnoble metals are used for electrodes, more attention should be addressed to those conditions which add to polarization problems, as is current leakage from the output circuit components. PMID:1193114

  16. Mop3 Is an Essential Component of the Master Circadian Pacemaker in Mammals

    PubMed Central

    Bunger, Maureen K.; Wilsbacher, Lisa D.; Moran, Susan M.; Clendenin, Cynthia; Radcliffe, Laurel A.; Hogenesch, John B.; Simon, M. Celeste; Takahashi, Joseph S.; Bradfield, Christopher A.

    2013-01-01

    Summary Circadian oscillations in mammalian physiology and behavior are regulated by an endogenous biological clock. Here we show that loss of the PAS protein MOP3 (also known as BMAL1) in mice results in immediate and complete loss of circadian rhythmicity in constant darkness. Additionally, locomotor activity in light–dark (LD) cycles is impaired and activity levels are reduced in Mop3−/− mice. Analysis of Period gene expression in the suprachiasmatic nucleus (SCN) indicates that these behavioral phenotypes arise from loss of circadian function at the molecular level. These results provide genetic evidence that MOP3 is the bona fide heterodimeric partner of mCLOCK. Furthermore, these data demonstrate that MOP3 is a non-redundant and essential component of the circadian pacemaker in mammals. PMID:11163178

  17. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators

    PubMed Central

    Burri, Haran; Senouf, David

    2009-01-01

    In the era of communication technology, new options are now available for following-up patients implanted with pacemakers (PMs) and defibrillators (ICDs). Most major companies offer devices with wireless capabilities that communicate automatically with home transmitters, which then relay data to the physician, thereby allowing remote patient follow-up and monitoring. These systems are being widely used in the USA for remote follow-up, and have been more recently introduced in Europe, where their adoption is increasing. In this article, we describe the currently existing systems, review the available evidence in the literature regarding remote follow-up and monitoring of PMs and ICDs, and finally discuss some unresolved issues. PMID:19470595

  18. The relevance of non-excitable cells for cardiac pacemaker function

    PubMed Central

    Fahrenbach, John P; Mejia-Alvarez, Rafael; Banach, Kathrin

    2007-01-01

    Age-dependent changes in the architecture of the sinus node comprise an increasing ratio between fibroblasts and cardiomyocytes. This change is discussed as a potential mechanism for sinus node disease. The goal of this study was to determine the mechanism through which non-excitable cells influence the spontaneous activity of multicellular cardiomyocyte preparations. Cardiomyocyte monolayers (HL-1 cells) or embryonic stem cell-derived cardiomyocytes were used as two- and three-dimensional cardiac pacemaker models. Spontaneous activity and conduction velocity (θ) were monitored by field potential measurements with microelectrode arrays (MEAs). The influence of fibroblasts (WT-fibs) was determined in heterocellular cultures of different cardiomyocyte and fibroblast ratios. The relevance of heterocellular gap junctional coupling was evaluated by the use of fibroblasts deficient for the expression of Cx43 (Cx43−/−-fibs). The beating frequency and θ of heterocellular cultures depended negatively on the fibroblast concentration. Interspersion of fibroblasts in cardiomyocyte monolayers increased the coefficient of the interbeat interval variability. Whereas Cx43−/−-fibs decreased θ significantly less than WT-fibs, their effect on the beating frequency and the beat-to-beat variability seemed largely independent of their ability to establish intercellular coupling. These results suggest that electrically integrated, non-excitable cells modulate the excitability of cardiac pacemaker preparations by two distinct mechanisms, one dependent and the other independent of the heterocellular coupling established. Whereas heterocellular coupling enables the fibroblast to depolarize the cardiomyocytes or to act as a current sink, the mere physical separation of the cardiomyocytes by fibroblasts induces bradycardia through a reduction in frequency entrainment. PMID:17932143

  19. Alterations of estrous activity in the ewe by circadian-based manipulation of the endogenous pacemaker.

    PubMed

    Guerin, M V; Matthews, C D

    1998-02-01

    The timing of reproductive activity in the seasonal breeding Romney Marsh ewe depends on the measurement of photoperiodic time. In this experiment, artificial light and dark signals are provided in a measured sequence at an inappropriate time of year to induce breeding out of phase with environmental photoperiod. The endogenous circadian responses and reproductive effects are documented. One group (Group A, control) of 6 Romney Marsh ewes was held in natural photoperiod throughout the experiment. For 8 weeks centered about the winter solstice (Stage 1), an additional 18 animals (Groups B, C, and D) were exposed to an artificial earlier dawn. Measurements of endogenous melatonin performed under acutely extended darkness confirmed a phase advance of the endogenous circadian pacemaker of the suprachiasmatic nucleus compared to control animals. In Stage 2, to the summer solstice (21 December), Group B animals were returned to natural photoperiod, Group C animals were subjected to an earlier artificial dusk, and Group D animals were subjected to an artificial delayed dawn. Melatonin measurements during Stage 2 confirmed that onset and offset times for Group C were earlier and that onset and offset times for Group D were delayed compared to corresponding times for Group B animals. Ovarian activity was monitored throughout. During Stage 2, Groups C and D commenced reproductive activity in mid-spring, and this continued until the experimental conditions changed. Groups A and B commenced reproductive activity at the normal timing in the subsequent autumn. Although not exclusive, these results are consistent with a coincidence model to explain the timing of seasonal breeding in this species with a dusk-located phase of the endogenous pacemaker sensitive to both light and melatonin. The temporal relationship between circadian alterations and the environmental photoperiod warrants further investigation as an explanation for seasonal breeding. PMID:9486844

  20. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs

    PubMed Central

    2011-01-01

    Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR

  1. Kinetic properties and functional dynamics of sodium channels during repetitive spiking in a slow pacemaker neuron

    PubMed Central

    Milescu, Lorin S.; Yamanishi, Tadashi; Ptak, Krzysztof; Smith, Jeffrey C.

    2010-01-01

    We examined the kinetic properties of voltage-gated Na+ channels and their contribution to the repetitive spiking activity of medullary raphé neurons, which exhibit slow pacemaking and strong spiking adaptation. The study is based on a combination of whole-cell patch clamp, modeling and real-time computation. Na+ currents were recorded from neurons in brain slices obtained from male and female neonatal rats, using voltage-clamp protocols designed to reduce space-clamp artifacts and to emphasize functionally relevant kinetic features. A detailed kinetic model was formulated to explain the broad range of transient and stationary voltage-dependent properties exhibited by Na+ currents. The model was tested by injecting via dynamic clamp a model-based current as a substitute for the native TTX-sensitive Na+ currents, which were pharmacologically blocked. The model-based current reproduced well the native spike shape and spiking frequency. The dynamics of Na+ channels during repetitive spiking were indirectly examined through this model. By comparing the spiking activities generated with different kinetic models in dynamic clamp experiments, we determined that state-dependent slow inactivation contributes significantly to spiking adaptation. Through real-time manipulation of the model-based current, we established that suprathreshold Na+ current mainly controls spike shape, whereas subthreshold Na+ current modulates spiking frequency and contributes to the pacemaking mechanism. Since the model-based current was injected in the soma, the results also suggest that somatic Na+ channels are sufficient to establish the essential spiking properties of raphé neurons in vitro. PMID:20826674

  2. Modelling Feedback Excitation, Pacemaker Properties and Sensory Switching of Electrically Coupled Brainstem Neurons Controlling Rhythmic Activity

    PubMed Central

    Hull, Michael J.; Soffe, Stephen R.; Willshaw, David J.; Roberts, Alan

    2016-01-01

    What cellular and network properties allow reliable neuronal rhythm generation or firing that can be started and stopped by brief synaptic inputs? We investigate rhythmic activity in an electrically-coupled population of brainstem neurons driving swimming locomotion in young frog tadpoles, and how activity is switched on and off by brief sensory stimulation. We build a computational model of 30 electrically-coupled conditional pacemaker neurons on one side of the tadpole hindbrain and spinal cord. Based on experimental estimates for neuron properties, population sizes, synapse strengths and connections, we show that: long-lasting, mutual, glutamatergic excitation between the neurons allows the network to sustain rhythmic pacemaker firing at swimming frequencies following brief synaptic excitation; activity persists but rhythm breaks down without electrical coupling; NMDA voltage-dependency doubles the range of synaptic feedback strengths generating sustained rhythm. The network can be switched on and off at short latency by brief synaptic excitation and inhibition. We demonstrate that a population of generic Hodgkin-Huxley type neurons coupled by glutamatergic excitatory feedback can generate sustained asynchronous firing switched on and off synaptically. We conclude that networks of neurons with NMDAR mediated feedback excitation can generate self-sustained activity following brief synaptic excitation. The frequency of activity is limited by the kinetics of the neuron membrane channels and can be stopped by brief inhibitory input. Network activity can be rhythmic at lower frequencies if the neurons are electrically coupled. Our key finding is that excitatory synaptic feedback within a population of neurons can produce switchable, stable, sustained firing without synaptic inhibition. PMID:26824331

  3. Modelling Feedback Excitation, Pacemaker Properties and Sensory Switching of Electrically Coupled Brainstem Neurons Controlling Rhythmic Activity.

    PubMed

    Hull, Michael J; Soffe, Stephen R; Willshaw, David J; Roberts, Alan

    2016-01-01

    What cellular and network properties allow reliable neuronal rhythm generation or firing that can be started and stopped by brief synaptic inputs? We investigate rhythmic activity in an electrically-coupled population of brainstem neurons driving swimming locomotion in young frog tadpoles, and how activity is switched on and off by brief sensory stimulation. We build a computational model of 30 electrically-coupled conditional pacemaker neurons on one side of the tadpole hindbrain and spinal cord. Based on experimental estimates for neuron properties, population sizes, synapse strengths and connections, we show that: long-lasting, mutual, glutamatergic excitation between the neurons allows the network to sustain rhythmic pacemaker firing at swimming frequencies following brief synaptic excitation; activity persists but rhythm breaks down without electrical coupling; NMDA voltage-dependency doubles the range of synaptic feedback strengths generating sustained rhythm. The network can be switched on and off at short latency by brief synaptic excitation and inhibition. We demonstrate that a population of generic Hodgkin-Huxley type neurons coupled by glutamatergic excitatory feedback can generate sustained asynchronous firing switched on and off synaptically. We conclude that networks of neurons with NMDAR mediated feedback excitation can generate self-sustained activity following brief synaptic excitation. The frequency of activity is limited by the kinetics of the neuron membrane channels and can be stopped by brief inhibitory input. Network activity can be rhythmic at lower frequencies if the neurons are electrically coupled. Our key finding is that excitatory synaptic feedback within a population of neurons can produce switchable, stable, sustained firing without synaptic inhibition. PMID:26824331

  4. Leadership in a (permanent) crisis.

    PubMed

    Heifetz, Ronald; Grashow, Alexander; Linsky, Marty

    2009-01-01

    The current economic crisis is not just another rough spell. Today's mix of urgency, high stakes, and uncertainty will continue even after the recession ends. The immediate crisis--which we will get through with policy makers' expert technical adjustments--sets the stage for a sustained, or even permanent, crisis, a relentless series of challenges no one has encountered before. Instead of hunkering down and relying on their familiar expertise to deal with the sustained crisis, people in positions of authority--whether they are CEOs or managers heading up a company initiative--must practice what the authors call adaptive leadership. They must, of course, tackle the underlying causes of the crisis, but they must also simultaneously make the changes that will allow their organizations to thrive in turbulent environments. Adaptive leadership is an improvisational and experimental art, requiring some new practices. Like Julie Gilbert, who overcame internal resistance to reorient Best Buy toward female purchasers, adaptive leaders get things done to meet today's challenges and then modify those things to thrive in tomorrow's world. They also embrace disequilibrium, using turbulence as an opportunity to build crucial new capacities, as Paul Levy did to rescue Beth Israel Deaconess Medical Center from a profound financial crisis. Finally, adaptive leaders, such as Egon Zehnder, the founder of an executive search firm, draw out the leadership skills that reside deep in the organization, recognizing the interdependence of all employees and mobilizing everyone to generate solutions. PMID:19630256

  5. Permanent-magnet multipole with adjustable strength

    DOEpatents

    Halbach, K.

    1982-09-20

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling there between. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  6. Permanent magnet multipole with adjustable strength

    DOEpatents

    Halbach, Klaus

    1985-01-01

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling therebetween. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  7. Gating of Permanent Molds for ALuminum Casting

    SciTech Connect

    David Schwam; John F. Wallace; Tom Engle; Qingming Chang

    2004-03-30

    This report summarizes a two-year project, DE-FC07-01ID13983 that concerns the gating of aluminum castings in permanent molds. The main goal of the project is to improve the quality of aluminum castings produced in permanent molds. The approach taken was determine how the vertical type gating systems used for permanent mold castings can be designed to fill the mold cavity with a minimum of damage to the quality of the resulting casting. It is evident that somewhat different systems are preferred for different shapes and sizes of aluminum castings. The main problems caused by improper gating are entrained aluminum oxide films and entrapped gas. The project highlights the characteristic features of gating systems used in permanent mold aluminum foundries and recommends gating procedures designed to avoid common defects. The study also provides direct evidence on the filling pattern and heat flow behavior in permanent mold castings.

  8. Automatic implantable cardioverter defibrillator pocket infection due to Providencia rettgeri: a case report

    PubMed Central

    De Benedetti, Maria Elena

    2009-01-01

    Coagulase-negative staphylococci and Staphylococcus aureus are the commonest pathogens involved in infections of pacemaker-defibrillator systems. Among causative Gram-negative bacteria, infections due to Klebsiella, Serratia, Pseudomonas, Acinetobacter and other species have been reported. We report herein a unique case of an automatic implantable cardioverter defibrillator infection due to Providencia rettgeri in a 65-year-old male who was admitted to our service with bacteremia and infection of the generator and subcutaneous array in a recently implanted device. PMID:19918391

  9. Automatic implantable cardioverter defibrillator pocket infection due to Providencia rettgeri: a case report.

    PubMed

    Marull, Jorge Manuel; De Benedetti, Maria Elena

    2009-01-01

    Coagulase-negative staphylococci and Staphylococcus aureus are the commonest pathogens involved in infections of pacemaker-defibrillator systems. Among causative Gram-negative bacteria, infections due to Klebsiella, Serratia, Pseudomonas, Acinetobacter and other species have been reported. We report herein a unique case of an automatic implantable cardioverter defibrillator infection due to Providencia rettgeri in a 65-year-old male who was admitted to our service with bacteremia and infection of the generator and subcutaneous array in a recently implanted device. PMID:19918391

  10. Single cardiac Purkinje cells: general electrophysiology and voltage-clamp analysis of the pace-maker current.

    PubMed

    Callewaert, G; Carmeliet, E; Vereecke, J

    1984-04-01

    Single Purkinje cells from dog, sheep and cow hearts were isolated by injecting a Ca-free collagenase containing Tyrode solution in the space between the connective tissue sheath and the Purkinje cells. A small proportion of these cells survived the isolation procedure and these cells were used for further investigation. The cells showed electrophysiological properties similar to intact Purkinje fibres as indicated by the following results. Maximum diastolic potentials between -70 and -85 mV and specific membrane resistances of 21-32 k omega cm2 indicated that the single cells were not leaky or hyperpermeable . The action potential showed a rapid upstroke, with a maximum rate of rise, Vmax' between 150 and 750 V/s, and two phases of fast repolarization separated by a plateau phase with a duration of about 200 ms. Each action potential was followed by a spontaneous depolarization with an amplitude between 1 and 10 mV. The upstroke of the action potential could be blocked by tetrodotoxin (TTX) in a dose-dependent manner. The rate of depolarization of the action potential was sensitive to changes in membrane potential; the resulting S-shaped curve showed a half-maximum potential of -65 mV and a steepness of 0.46 mV-1. The duration of the action potential was sensitive to external K concentrations, catecholamines and TTX in a way similar to intact Purkinje fibres. Both application of catecholamines and lowering the external K concentration induced spontaneous activity. The cells were used to study the ionic nature of the pace-maker current under voltage-clamp conditions using the two-micro-electrode technique. This pace-maker current was blocked in a voltage-dependent manner by 1 mM-Cs, and was not affected by 1 mM-Ba. The steady-state activation curve was shifted in the depolarizing direction by application of adrenaline. In contrast to voltage-clamp data obtained on the pace-maker current of intact Purkinje fibres, the pace-maker current in a single cell did not

  11. Correlation between fundamental binding forces and clinical prognosis of Staphylococcus aureus infections of medical implants

    SciTech Connect

    Yongsunthon, Ruchirej; Fowler, Vance; Lower, Brian H.; Vellano, Francis P.; Alexander, Emily; Reller, L. Barth; Corey, G. Ralph; Lower, Steven

    2007-02-01

    Implanted medical devices (e.g., prosthetic heart valves, permanent pacemakers) significantly improve the quality of life for many humans. However, a common clinical observation is that such devices become colonized with potentially life-threatening Staphylococcus aureus biofilms, which are difficult to combat with host defenses or antibiotics. This study attempts to draw a correlation between the clinical outcome of patients with implanted cardiac devices and the fundamental binding forces ultimately responsible for the initiation of an S. aureus biofilm in-situ. Atomic force microscopy was used to measure forces between a fibronectin-coated probe (simulating a prosthetic implant) and 15 different strains of S. aureus isolated from either patients with infected cardiac devices (invasive population) or healthy human subjects (control population). The fibronectin-coated probe was repeatedly brought into and out of contact with a bacterium’s surface, “fishing” for a reaction with the cell’s fibronectin-binding proteins. More than 40,000 force profiles were measured on 5-10 different cells for each of the 15 clinical strains. A unique force-signature was observed for a binding event between the fibronectin-coated probe and the bacteria. When grouped by the frequency of this force-signature, there was a strong distinction (p=0.01) between the invasive and control populations of S. aureus. This discovery suggests that biofilm forming bacteria may be classified according to their “force taxonomy”, which could have a positive effect on health care as it bridges the long-standing disconnect between macroscopic, clinical investigations and nanometer-scale forces ultimately responsible for a bond between S. aureus and the surface of a prosthetic device.

  12. Permanency and the Foster Care System.

    PubMed

    Lockwood, Katie K; Friedman, Susan; Christian, Cindy W

    2015-10-01

    Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. PMID:26403649

  13. The NASPE/BPEG generic pacemaker code for antibradyarrhythmia and adaptive-rate pacing and antitachyarrhythmia devices.

    PubMed

    Bernstein, A D; Camm, A J; Fletcher, R D; Gold, R D; Rickards, A F; Smyth, N P; Spielman, S R; Sutton, R

    1987-07-01

    A new generic pacemaker code, derived from and compatible with the Revised ICHD Code, was proposed jointly by the North American Society of Pacing and Electrophysiology (NASPE) Mode Code Committee and the British Pacing and Electrophysiology Group (BPEG), and has been adopted by the NASPE Board of Trustees. It is abbreviated as the NBG (for "NASPE/BPEG Generic") Code, and was developed to permit extension of the generic-code concept to pacemakers whose escape rate is continuously controlled by monitoring some physiologic variable, rather than determined by fixed escape intervals measured from stimuli or sensed depolarizations, and to antitachyarrhythmia devices including cardioverters and defibrillators. The NASPE/BPEG Code incorporates an "R" in the fourth position to signify rate modulation (adaptive-rate pacing), and one of four letters in the fifth position to indicate the presence of antitachyarrhythmia-pacing capability or of cardioversion or defibrillation functions. PMID:2441363

  14. RNA Sequencing of Mouse Sinoatrial Node Reveals an Upstream Regulatory Role for Islet-1 in Cardiac Pacemaker Cells

    PubMed Central

    Vedantham, Vasanth; Galang, Giselle; Evangelista, Melissa; Deo, Rahul C.; Srivastava, Deepak

    2015-01-01

    Rationale Treatment of sinus node disease with regenerative or cell-based therapies will require a detailed understanding of gene regulatory networks in cardiac pacemaker cells (PCs). Objective To characterize the transcriptome of PCs using RNA sequencing, and to identify transcriptional networks responsible for PC gene expression. Methods and Results We used laser capture micro-dissection (LCM) on a sinus node reporter mouse line to isolate RNA from PCs for RNA sequencing (RNA-Seq). Differential expression and network analysis identified novel SAN-enriched genes, and predicted that the transcription factor Islet-1 (Isl1) is active in developing pacemaker cells. RNA-Seq on SAN tissue lacking Isl1 established that Isl1 is an important transcriptional regulator within the developing SAN. Conclusions (1) The PC transcriptome diverges sharply from other cardiomyocytes; (2) Isl1 is a positive transcriptional regulator of the PC gene expression program. PMID:25623957

  15. Permanent Magnetic Bearing for Spacecraft Applications

    NASA Technical Reports Server (NTRS)

    Morales, Winfredo; Fusaro, Robert; Kascak, Albert

    2008-01-01

    A permanent, totally passive magnetic bearing rig was designed, constructed, and tested. The suspension of the rotor was provided by two sets of radial permanent magnetic bearings operating in the repulsive mode. The axial support was provided by jewel bearings on both ends of the rotor. The rig was successfully operated to speeds of 5500 rpm using an air impeller. Radial and axial stiffnesses of the permanent magnetic bearings were experimentally measured and then compared to finite element results. The natural damping of the rotor was measured and a damping coefficient was calculated.

  16. Macroscopic simulation of isotropic permanent magnets

    NASA Astrophysics Data System (ADS)

    Bruckner, Florian; Abert, Claas; Vogler, Christoph; Heinrichs, Frank; Satz, Armin; Ausserlechner, Udo; Binder, Gernot; Koeck, Helmut; Suess, Dieter

    2016-03-01

    Accurate simulations of isotropic permanent magnets require to take the magnetization process into account and consider the anisotropic, nonlinear, and hysteretic material behaviour near the saturation configuration. An efficient method for the solution of the magnetostatic Maxwell equations including the description of isotropic permanent magnets is presented. The algorithm can easily be implemented on top of existing finite element methods and does not require a full characterization of the hysteresis of the magnetic material. Strayfield measurements of an isotropic permanent magnet and simulation results are in good agreement and highlight the importance of a proper description of the isotropic material.

  17. Permanent multipole magnets with adjustable strength

    SciTech Connect

    Halbach, K.

    1983-03-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrupole will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented.

  18. Refinement of a limit cycle oscillator model of the effects of light on the human circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Jewett, M. E.; Kronauer, R. E.; Brown, E. N. (Principal Investigator)

    1998-01-01

    In 1990, Kronauer proposed a mathematical model of the effects of light on the human circadian pacemaker. Although this model predicted many general features of the response of the human circadian pacemaker to light exposure, additional data now available enable us to refine the original model. We first refined the original model by incorporating the results of a dose response curve to light into the model's predicted relationship between light intensity and the strength of the drive onto the pacemaker. Data from three bright light phase resetting experiments were then used to refine the amplitude recovery characteristics of the model. Finally, the model was tested and further refined using data from an extensive phase resetting experiment in which a 3-cycle bright light stimulus was presented against a background of dim light. In order to describe the results of the four resetting experiments, the following major refinements to the original model were necessary: (i) the relationship between light intensity (I) and drive onto the pacemaker was reduced from I1/3 to I0.23 for light levels between 150 and 10,000 lux; (ii) the van der Pol oscillator from the original model was replaced with a higher-order limit cycle oscillator so that amplitude recovery is slower near the singularity and faster near the limit cycle; (iii) a direct effect of light on circadian period (tau x) was incorporated into the model such that as I increases, tau x decreases, which is in accordance with "Aschoff's rule". This refined model generates the following testable predictions: it should be difficult to enhance normal circadian amplitude via bright light; near the critical point of a type 0 phase response curve (PRC) the slope should be steeper than it is in a type 1 PRC; and circadian period measured during forced desynchrony should be directly affected by ambient light intensity.

  19. Innominate vein-right atrial bypass for relief of superior vena cava syndrome due to pacemaker lead thrombosis.

    PubMed

    Deo, Salil V; Burkhart, Harold M; Araoz, Philip A; Brady, Peter A

    2010-11-01

    We present a patient with superior vena cava (SVC) obstruction due to multiple intraluminal pacemaker leads. Previous attempts at balloon dilatation of the SVC and surgical angioplasty did not provide a long-term solution. A Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, USA) conduit interposed between the innominate vein and right atrial appendage has resulted in symptomatic relief at a follow-up of 6 months. PMID:21039859

  20. Inhibitory effect of caffeine on pacemaker activity in the oviduct is mediated by cAMP-regulated conductances

    PubMed Central

    Dixon, RE; Hwang, SJ; Britton, FC; Sanders, KM; Ward, SM

    2011-01-01

    BACKGROUND AND PURPOSE Spontaneous electrical activity, termed slow waves, drives rhythmic, propulsive contractions in the smooth muscle of the oviduct (myosalpinx). Myosalpinx contractions cause egg transport through the oviduct. Agents that disrupt slow wave pacemaker activity will therefore disrupt myosalpinx contractions and egg transport. Caffeine is commonly used as a ryanodine receptor agonist and has been previously associated with delayed conception. Here we assessed the effects of caffeine on pacemaker activity in the murine myosalpinx. EXPERIMENTAL APPROACH The effects of caffeine on electrical pacemaker activity were studied using intracellular microelectrode and isometric force measurements on intact oviduct muscle preparations. Responses to caffeine were compared with responses caused by 3-isobutyl-1-methylxanthine (IBMX) and forskolin. KEY RESULTS Caffeine caused hyperpolarization of membrane potential and inhibited slow wave generation and myosalpinx contractions. The effects of caffeine could be mimicked by the KATP channel agonist pinacidil and antagonized by the KATP channel antagonist glibenclamide. Caffeine is known to inhibit cyclic nucleotide phosphodiesterases (PDEs), leading to an increase in cytosolic cAMP and stimulation of downstream cAMP-dependent mechanisms. The effects of caffeine were mimicked by the PDE inhibitor, IBMX, and the adenylyl cyclase activator forskolin. These effects were also reversed by glibenclamide. CONCLUSIONS AND IMPLICATIONS These results suggest that caffeine activates KATP channels in oviduct myosalpinx. Since caffeine abolishes slow waves and associated contractions of the myosalpinx, it would have a negative effect on egg transport through the oviduct and may contribute to the documented delayed conception in women consuming caffeinated beverages. PMID:21615388

  1. Respiratory pattern generator model using Ca++-induced Ca++ release in neurons shows both pacemaker and reciprocal network properties.

    PubMed

    Dunin-Barkowski, W L; Escobar, A L; Lovering, A T; Orem, J M

    2003-10-01

    There are two contradictory explanations for central respiratory rhythmogenesis. One suggests that respiratory rhythm emerges from interaction between inspiratory and expiratory neural semicenters that inhibit each other and thereby provide reciprocal rhythmic activity (Brown 1914). The other uses bursting pacemaker activity of individual neurons to produce the rhythm (Feldman and Cleland 1982). Hybrid models have been developed to reconcile these two seemingly conflicting mechanisms (Smith et al. 2000; Rybak et al. 2001). Here we report computer simulations that demonstrate a unified mechanism of the two types of oscillator. In the model, we use the interaction of Ca(++)-dependent K+ channels (Mifflin et al. 1985) with Ca(++)-induced Ca++ release from intracellular stores (McPherson and Campbell 1993), which was recently revealed in neurons (Hernandez-Cruz et al. 1997; Mitra and Slaughter 2002a,b; Scornik et al. 2001). Our computations demonstrate that uncoupled neurons with these intracellular mechanisms show conditional pacemaker properties (Butera et al. 1999) when exposed to steady excitatory inputs. Adding weak inhibitory synapses (based on increased K+ conductivity) between two model neural pools surprisingly synchronizes the activity of both neural pools. As inhibitory synaptic connections between the two pools increase from zero to higher values, the model produces first dissociated pacemaker activity of individual neurons, then periodic synchronous bursts of all neurons (inspiratory and expiratory), and finally reciprocal rhythmic activity of the neural pools. PMID:14605892

  2. Reducing RF-related heating of cardiac pacemaker leads in MRI: implementation and experimental verification of practical design changes.

    PubMed

    Nordbeck, Peter; Fidler, Florian; Friedrich, Michael T; Weiss, Ingo; Warmuth, Marcus; Gensler, Daniel; Herold, Volker; Geistert, Wolfgang; Jakob, Peter M; Ertl, Georg; Ritter, Oliver; Ladd, Mark E; Bauer, Wolfgang R; Quick, Harald H

    2012-12-01

    There are serious concerns regarding safety when performing magnetic resonance imaging in patients with implanted conductive medical devices, such as cardiac pacemakers, and associated leads, as severe incidents have occurred in the past. In this study, several approaches for altering an implant's lead design were systematically developed and evaluated to enhance the safety of implanted medical devices in a magnetic resonance imaging environment. The individual impact of each design change on radiofrequency heating was then systematically investigated in functional lead prototypes at 1.5 T. Radiofrequency-induced heating could be successfully reduced by three basic changes in conventional pacemaker lead design: (1) increasing the lead tip area, (2) increasing the lead conductor resistance, and (3) increasing outer lead insulation conductivity. The findings show that radiofrequency energy pickup in magnetic resonance imaging can be reduced and, therefore, patient safety can be improved with dedicated construction changes according to a "safe by design" strategy. Incorporation of the described alterations into implantable medical devices such as pacemaker leads can be used to help achieve favorable risk-benefit-ratios when performing magnetic resonance imaging in the respective patient group. PMID:22383393

  3. Activity-dependent changes in extracellular Ca2+ and K+ reveal pacemakers in the spinal locomotor-related network.

    PubMed

    Brocard, Frédéric; Shevtsova, Natalia A; Bouhadfane, Mouloud; Tazerart, Sabrina; Heinemann, Uwe; Rybak, Ilya A; Vinay, Laurent

    2013-03-20

    Changes in the extracellular ionic concentrations occur as a natural consequence of firing activity in large populations of neurons. The extent to which these changes alter the properties of individual neurons and the operation of neuronal networks remains unknown. Here, we show that the locomotor-like activity in the isolated neonatal rodent spinal cord reduces the extracellular calcium ([Ca(2+)]o) to 0.9 mM and increases the extracellular potassium ([K(+)]o) to 6 mM. Such changes in [Ca(2+)]o and [K(+)]o trigger pacemaker activities in interneurons considered to be part of the locomotor network. Experimental data and a modeling study show that the emergence of pacemaker properties critically involves a [Ca(2+)]o-dependent activation of the persistent sodium current (INaP). These results support a concept for locomotor rhythm generation in which INaP-dependent pacemaker properties in spinal interneurons are switched on and tuned by activity-dependent changes in [Ca(2+)]o and [K(+)]o. PMID:23522041

  4. Nonuniform radiation damage in permanent magnet quadrupoles

    SciTech Connect

    Danly, C. R.; Merrill, F. E.; Barlow, D.; Mariam, F. G.

    2014-08-15

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL’s pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components.

  5. Nonuniform radiation damage in permanent magnet quadrupoles.

    PubMed

    Danly, C R; Merrill, F E; Barlow, D; Mariam, F G

    2014-08-01

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL's pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components. PMID:25173260

  6. Characterizing hydrologic permanence in headwater streams

    EPA Science Inventory

    The presentation will be an overview of research to inform jurisdictional determinations for the Clean Water Act, in particular research that hydrographic comparisons of the extent and hydrologic permanence of headwater streams, indicator development, and an evaluation of a rapid...

  7. Permanent Darkness at the Lunar North Pole

    NASA Astrophysics Data System (ADS)

    Bussey, B.; Robinson, M. S.; Spudis, P. D.; Lucey, P. G.

    2001-12-01

    The Clementine mission provided the first dynamic temporal look at the illumination conditions of both lunar poles. Data of the lunar north pole were collected during summer in the northern hemisphere and are therefore ideal for placing a constraint on the maximum amount of permanent shadowed regions that exist. An early estimate of permanent shadow using Clementine data by Nozette and coworkers, based on a conservative measurement of permanently shadowed small craters close to the pole, was 530 km2. A later estimate, produced using Earth based radar topography data (by Margot et al), extended the area analyzed to lower latitudes (85oN), and indicated an increased permanently shadowed area of 2650 km2. By producing movies using Clementine UVVIS data it is possible to study dynamically how the illumination conditions vary during the length of a lunar day (708 hours). These movies show that small areas of permanent shadow possibly exist at lower latitudes than included in the Margot study, including regions of the farside that are inaccessible to Earth based study. An initial analysis shows that portions of north facing crater walls, as far out as 80oN, appear to be permanently shadowed. A preliminary examination of such features has raised the value of the permanently shadowed terrain area to greater than 10,000km2. A recent control network for the north pole will permit a more precise determination of the amount of permanently shadowed terrain. Comparison of this value, together with the data returned by Lunar Prospectors neutron spectrometer will place constraints on the amount of ice present at the lunar north pole as presented by Feldman and coworkers.

  8. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, Roman O.

    1997-01-01

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis.

  9. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, R.O.

    1997-01-21

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis. 10 figs.

  10. Permanent education in health: a review

    PubMed Central

    Miccas, Fernanda Luppino; Batista, Sylvia Helena Souza da Silva

    2014-01-01

    OBJECTIVE To undertake a meta-synthesis of the literature on the main concepts and practices related to permanent education in health. METHODS A bibliographical search was conducted for original articles in the PubMed, Web of Science, LILACS, IBECS and SciELO databases, using the following search terms: “public health professional education”, “permanent education”, “continuing education”, “permanent education health”. Of the 590 articles identified, after applying inclusion and exclusion criteria, 48 were selected for further analysis, grouped according to the criteria of key elements, and then underwent meta-synthesis. RESULTS The 48 original publications were classified according to four thematic units of key elements: 1) concepts, 2) strategies and difficulties, 3) public policies and 4) educational institutions. Three main conceptions of permanent education in health were found: problem-focused and team work, directly related to continuing education and education that takes place throughout life. The main strategies for executing permanent education in health are discussion, maintaining an open space for permanent education, and permanent education clusters. The most limiting factor is mainly related to directly or indirect management. Another highlight is the requirement for implementation and maintenance of public policies, and the availability of financial and human resources. The educational institutions need to combine education and service aiming to form critical-reflexive graduates. CONCLUSIONS The coordination between health and education is based as much on the actions of health services as on management and educational institutions. Thus, it becomes a challenge to implement the teaching-learning processes that are supported by critical-reflexive actions. It is necessary to carry out proposals for permanent education in health involving the participation of health professionals, teachers and educational institutions. PMID:24789649

  11. EDITORIAL: Permanent revolution - or evolution?

    NASA Astrophysics Data System (ADS)

    Dobson, Ken

    1998-03-01

    Honorary Editor It was that temporary Bolshevik Leon Trotsky who developed the principle of `permanent revolution', a principle that perhaps characterizes the recent history of education in (south) Britain more than does, say, principles traditionally associated with the Conservative or Labour parties. As this editorial is being written, changes are being made to primary school education, and the long-awaited details of the post-Dearing reorganizing of post-16 education are yet to hit the overful bookshelves and filing cabinets of school heads and examination board officials. But something unique has happened recently which might have surprised even Trotsky. The Secretary of State for Education has set up targets for primary school pupils' attainment and threatened (or promised) to resign if they are not met within the lifetime of our newly elected parliament. Of course, if Mr Blunkett is still in a position to resign at that stage he will have been the longest serving Secretary of State since time immemorial. But we should not carp: this is truly a revolutionary idea. Not the promise to resign - although this idea is not so fashionable now as it once was. The revolutionary idea is that a major change to an educational process is actually being made that carries with it a predicted and testable outcome. By contrast, when school physics was refreshed a generation ago by the introduction of Nuffield courses at both pre- and post-16 stages, no `targets' were set. I and many other physics teachers certainly preferred teaching these to teaching their predecessor syllabuses, and might even dare to assert that the pupils liked them too. But we still don't really know whether or not they learned more - or even better - physics. Very little happened as far as the outside world was concerned: the usual fraction of students gave up physics at the usual ages, and those who were examined didn't really get a better reward for their more up-to-date and more enjoyably learned

  12. Continuous Holter telemetry of atrial electrograms and marker annotations using a common Holter recording system: impact on Holter electrocardiogram interpretation in patients with dual chamber pacemakers.

    PubMed

    Wiegand, Uwe K H; Bonnemeier, Hendrik; Bode, Frank; Eberhardt, Frank; Chun, Julian K R; Katus, Hugo A; Peters, Werner

    2002-12-01

    The impact of continuous telemetry of atrial electrogram and marker annotations on Holter ECG interpretation was assessed in 98 patients with bipolar dual chamber pacemakers (VDD pacemakers n = 29, DDD(R) systems n = 69). Atrial electrogram and marker annotations were continuously sampled by a telemetry coil that was externally positioned on the pacemaker pocket, amplified, and transduced to a three-channel Holter ECG recorder in addition to an ECG recording. Holter tapes were analyzed by two experienced investigators for quality of P wave recognition and episodes suspicious of pacemaker dysfunction. Initially, only the ECG channel was analyzed. Thereafter, results were compared to those achieved on the basis of the complete recording including atrial electrogram and marker annotations. Recognition of atrial rhythm was markedly improved by Holter telemetry. During 99.3% of recording time telemetry showed a satisfying quality, whereas ECG alone allowed a reliable P wave recognition only during 84.4% of recording time (P < 0.001). One hundred twenty-nine episodes suspicious of pacemaker malfunction occurred in 17 of 98 patients. By analysis of ECG, only 78.3% of episodes were concordantly classified by the investigators. However, 98.4% of all episodes were properly identified when atrial electrogram and marker annotations were added to the analysis (P < 0.001). In particular, discrimination between atrial undersensing, sinus bradycardia, and atrial sensed events within the refractory periods was facilitated. Holter telemetry of atrial electrogram and marker annotations facilitates the analysis of Holter ECGs in pacemaker recipients and improves the detection of pacemaker dysfunctions. PMID:12520673

  13. Synchronization of sinoatrial node pacemaker cell clocks and its autonomic modulation impart complexity to heart beating intervals Short title: Beating-rate variability of sinoatrial node cells

    PubMed Central

    Yaniv, Yael; Ahmet, Ismayil; Liu, Jie; Lyashkov, Alexey E.; Guiriba, Toni-Rose; Okamoto, Yosuke; Ziman, Bruce D.; Lakatta, Edward G.

    2014-01-01

    Background A reduction of complexity of heart-beat interval variability (BIV) that is associated with an increased morbidity and mortality in cardiovascular disease states is thought to derive from the balance of sympathetic and parasympathetic neural impulses to the heart. But rhythmic clock-like behavior intrinsic to pacemaker cells within the sinoatrial node (SAN) drives their beating, even in the absence of autonomic neural input. Objective To test how this rhythmic clock-like behavior intrinsic to pacemaker cells interacts with autonomic impulses to the heart-beat interval variability in vivo. Methods We analyzed BIV in the time and frequency domains and by fractal and entropy analyses: i) in vivo, when the brain input to the SAN is intact; ii) during autonomic denervation in vivo; iii) in isolated SAN tissue (i.e., in which the autonomic-neural input is completely absent); iv) in single pacemaker cells isolated from the SAN; and v) following autonomic receptor stimulation of these cells. Results Spontaneous-beating intervals of pacemaker cells residing within the isolated SAN tissue exhibit fractal-like behavior and have lower approximate entropy than in the intact heart. Isolation of pacemaker cells from SAN tissue, however, leads to a loss in the beating-interval order and fractal-like behavior. β adrenergic receptor stimulation of isolated pacemaker cells increases intrinsic clock synchronization, decreases their action potential period and increases system complexity. Conclusions Both the average-beating interval in vivo and beating interval complexity are conferred by the combined effects of clock periodicity intrinsic to pacemaker cells and their response to autonomic-neural input. PMID:24713624

  14. Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions

    PubMed Central

    Gouvêa de Barros, Bruno; Weber dos Santos, Rodrigo; Lobosco, Marcelo; Alonso, Sergio

    2015-01-01

    The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies. PMID:26583127

  15. Heart Block in Acute Myocardial Infarction: Prognostic Factors and Role of Transvenous Catheter Pacemaker

    PubMed Central

    Narvas, R. M.; Kilgour, J. M.; Basu, S. K.

    1970-01-01

    A prospective study was carried out to determine the prognostic factors in patients with second-degree and complete heart block following acute myocardial infarction and to re-examine the indications for artificial transvenous pacing. Of the 117 consecutive patients with proved acute myocardial infarction, 15 developed advanced heart block (second degree and complete). The presence of the following factors, either alone or in combinations, were attended with poor prognosis: preceding Stokes-Adams syndrome, cardiogenic shock, congestive heart failure, complications secondary to cardiac arrest, anterior infarction and wide QRS complex. In the nine cases requiring artificial transvenous pacemaker because of Stokes-Adams attacks, congestive heart failure or frequent multifocal ventricular ectopic beats, there were five deaths. The remaining six patients, who were without complications and were not paced, all survived; these patients had normal QRS duration with heart rates above 60 per minute. This study indicates that prophylactic transvenous catheter insertion in acute heart block does not appear justified unless specific indication(s) arise. Postmortem studies revealed significant narrowing of all the major coronary vessels in all five fatalities. The overall mortality in this series of cases of acute heart block was 33%. PMID:5410415

  16. ABC transporter functions as a pacemaker for sequestration of plant glucosides in leaf beetles

    PubMed Central

    Strauss, Anja S; Peters, Sven; Boland, Wilhelm; Burse, Antje

    2013-01-01

    Plant-herbivore interactions dominate the planet’s terrestrial ecology. When it comes to host–plant specialization, insects are among the most versatile evolutionary innovators, able to disarm multiple chemical plant defenses. Sequestration is a widespread strategy to detoxify noxious metabolites, frequently for the insect’s own benefit against predation. In this study, we describe the broad-spectrum ATP-binding cassette transporter CpMRP of the poplar leaf beetle, Chrysomela populi as the first candidate involved in the sequestration of phytochemicals in insects. CpMRP acts in the defensive glands of the larvae as a pacemaker for the irreversible shuttling of pre-selected metabolites from the hemolymph into defensive secretions. Silencing CpMRP in vivo creates a defenseless phenotype, indicating its role in the secretion process is crucial. In the defensive glands of related leaf beetle species, we identified sequences similar to CpMRP and assume therefore that exocrine gland-based defensive strategies, evolved by these insects to repel their enemies, rely on ABC transporters as a key element. DOI: http://dx.doi.org/10.7554/eLife.01096.001 PMID:24302568

  17. Profile of St. Jude Medical's Allure Quadra quadripolar pacemaker system for cardiac resynchronization therapy.

    PubMed

    Corbisiero, Raffaele; Muller, David

    2015-01-01

    Congestive heart failure is a major public health epidemic and economic burden in the USA and worldwide. Cardiac resynchronization therapy is an effective therapy for treating congestive heart failure in conjunction with pharmacologic therapy. The average congestive heart failure admission costs approximately US$ 8 billion annually. Current cardiac resynchronization therapy pacemaker systems from various manufacturers deliver therapy-utilizing bipolar leads including the left ventricle, with electrode spacing ranging from 8 to 22 mm. The Quartet LV™ lead model 1458Q (St. Jude Medical Sylmar, CA) is a quadripolar lead with a 4.0 Fr. tip electrode and three 4.7 Fr. ring electrodes located 20, 30 and 47 mm from the tip. The Quartet lead and Allure Quadra TM allows 14 pacing configurations, providing benefits, including reductions in phrenic nerve stimulation, reduced pacing thresholds, improved battery longevity and potential reductions, in non-responders to cardiac resynchronization therapy. In addition, there is cost benefit data from utilizing quadripolar technology compared with traditional bipolar cardiac resynchronization therapy. PMID:25418543

  18. ABC transporter functions as a pacemaker for sequestration of plant glucosides in leaf beetles.

    PubMed

    Strauss, Anja S; Peters, Sven; Boland, Wilhelm; Burse, Antje

    2013-01-01

    Plant-herbivore interactions dominate the planet's terrestrial ecology. When it comes to host-plant specialization, insects are among the most versatile evolutionary innovators, able to disarm multiple chemical plant defenses. Sequestration is a widespread strategy to detoxify noxious metabolites, frequently for the insect's own benefit against predation. In this study, we describe the broad-spectrum ATP-binding cassette transporter CpMRP of the poplar leaf beetle, Chrysomela populi as the first candidate involved in the sequestration of phytochemicals in insects. CpMRP acts in the defensive glands of the larvae as a pacemaker for the irreversible shuttling of pre-selected metabolites from the hemolymph into defensive secretions. Silencing CpMRP in vivo creates a defenseless phenotype, indicating its role in the secretion process is crucial. In the defensive glands of related leaf beetle species, we identified sequences similar to CpMRP and assume therefore that exocrine gland-based defensive strategies, evolved by these insects to repel their enemies, rely on ABC transporters as a key element. DOI: http://dx.doi.org/10.7554/eLife.01096.001. PMID:24302568

  19. A 680 nA ECG acquisition IC for leadless pacemaker applications.

    PubMed

    Yan, Long; Harpe, Pieter; Pamula, Venkata Rajesh; Osawa, Masato; Harada, Yasunari; Tamiya, Kosei; Van Hoof, Chris; Yazicioglu, Refet Firat

    2014-12-01

    A sub- μW ECG acquisition IC is presented for a single-chamber leadless pacemaker applications. It integrates a low-power, wide dynamic-range ECG readout front end together with an analog QRS-complex extractor. To save ASIC power, a current-multiplexed channel buffer is introduced to drive a 7 b-to-10 b self-synchronized SAR ADC which utilizes 4 fF/unit capacitors. The ASIC consumes only 680nA and achieves CMRR > 90 dB, PSRR > 80 dB, an input-referred noise of 4.9 μVrms in a 130 Hz bandwidth, and has rail-to-rail DC offset rejection. Low-power heartbeat detections are evaluated with the help of the ASIC acquiring nearly 20,000 beats across 10 different records from the MIT-BIH arrhythmia database. In the presence of muscle noise, both the average Sensitivity (Se) and Positive Predictivity (PP) show more than 90% when the input SNR > 6 dB. PMID:25546862

  20. Pre-clinical evaluation of a minimally invasive laryngeal pacemaker system in mini-pig.

    PubMed

    Foerster, Gerhard; Arnold, Dirk; Bischoff, Sabine; Boltze, Karsten; Scholle, Hans-Christoph; Schubert, Harald; Mueller, Andreas H

    2016-01-01

    Microlaryngoscopic enlargement techniques have been the standard treatment for bilateral vocal fold paralysis (BVFP) for decades. Laryngeal pacing is a promising alternative treatment based on the electrostimulation of the posterior cricoarytenoid (PCA) muscle. This paper reports on the results of a pre-clinical study aiming to evaluate this method. Eight Göttingen mini-pigs were implanted with a laryngeal pacemaker (LP) implant prototype and with two LP electrodes, one in each PCA muscle. The 6-week follow-up included endoscopic stimulation controls in general anaesthesia and radiographic controls of electrode integrity and position stability. Stimulation parameters for optimal glottal opening were evaluated via videolaryngoscopy. Histopathology was performed upon conclusion of the study. 7/8 (87.5 %) animals were successfully implanted with the LP implant prototype and two LP electrodes. In general, stimulation was effectively delivered and correlated with the expected PCA muscle activation. 2/14 (14.3 %) electrodes dislocated and 1/14 (7.1 %) electrode tip broke. The LP system used in this experiment to induce vocal fold abduction by means of selective functional electrical stimulation of the PCA showed promising results. It may be a valid alternative to the current golden standard for BVFP treatment. Clinical studies are needed to confirm the medical relevance of the LP. PMID:26264908