A successful permanent pacemaker implantation in a challenging case with giant heart

A successful permanent pacemaker implantation in a challenging case with giant heart 2014 Cardiovascular flashlight doi:10.1093/eurheartj/ehy002 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 19 January 2018 .................................................................................................................................................... A successful permanent pacemaker implantation in a challenging case with giant heart † † Ke Wan , Liuyu Yu , Hongde Hu, and Yuan Fang* Department of Cardiology, West China Hospital, Sichuan University, 37 Guo xue Street, Chengdu 610041, PR China * Corresponding author. Tel: 186 189 80602172, Fax: 186 028 85422353, Email: fangyuanmd@163.com The first two authors contributed equally to this work. A 56-year-old woman suffering from dizziness and pre-syncope was admitted for implantation of pacemaker. She was diagnosed with rheu- matic mitral disease and received mitral valve replacement 25 years ago. Twenty-four hour Holter monitoring found maximum R–R interval of 6.4 s during day time. Chest X-ray showed a giant cardiac silhouette with a cardiothoracic ratio of 0.93 (Panel A). Transthoracic echocar- diography demonstrated right and left atria was extremely enlarged (left atrium, 105 mm 120 mm 147 mm; right atrium, 46 mm 82 mm; left ventricle, 59 mm; right ventricle, 24 mm 42 mm; maximum tricuspid regurgitation velocity, 2.7 m/s) (Panel B). However, the lead failed to be firmly fixed after we removed the guidewire. After repeated attempts, we tried to gradually retrieve the guide wire, and found the lead wasn’t displaced when the retrieval length was 8 cm at maximal. Then we decided to keep the guide wire there to guarantee the lead in place (Panel C; Supplementary material online, Videos S1 and S2). The procedure was uneventful. Electrocardiography showed atrial fibrillation and pacing rate of 60 per minute (Panel D). During 15-month follow-up, no dizziness and syn- cope was reported and patient live well. And echocardiography shows no apparent progression in the enlargement of atria or the degree of tricuspid regurgitation (see Supplementary material online, Videos S3–S5). Rheumatic valvular disease will result into huge heart and pace- maker implantation in such case is very challenging. To our knowledge, this is the first report of a successful pacemaker implantation in a such giant heart. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/21/2014/4818264 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

A successful permanent pacemaker implantation in a challenging case with giant heart

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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1522-9645
D.O.I.
10.1093/eurheartj/ehy002
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Abstract

2014 Cardiovascular flashlight doi:10.1093/eurheartj/ehy002 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 19 January 2018 .................................................................................................................................................... A successful permanent pacemaker implantation in a challenging case with giant heart † † Ke Wan , Liuyu Yu , Hongde Hu, and Yuan Fang* Department of Cardiology, West China Hospital, Sichuan University, 37 Guo xue Street, Chengdu 610041, PR China * Corresponding author. Tel: 186 189 80602172, Fax: 186 028 85422353, Email: fangyuanmd@163.com The first two authors contributed equally to this work. A 56-year-old woman suffering from dizziness and pre-syncope was admitted for implantation of pacemaker. She was diagnosed with rheu- matic mitral disease and received mitral valve replacement 25 years ago. Twenty-four hour Holter monitoring found maximum R–R interval of 6.4 s during day time. Chest X-ray showed a giant cardiac silhouette with a cardiothoracic ratio of 0.93 (Panel A). Transthoracic echocar- diography demonstrated right and left atria was extremely enlarged (left atrium, 105 mm 120 mm 147 mm; right atrium, 46 mm 82 mm; left ventricle, 59 mm; right ventricle, 24 mm 42 mm; maximum tricuspid regurgitation velocity, 2.7 m/s) (Panel B). However, the lead failed to be firmly fixed after we removed the guidewire. After repeated attempts, we tried to gradually retrieve the guide wire, and found the lead wasn’t displaced when the retrieval length was 8 cm at maximal. Then we decided to keep the guide wire there to guarantee the lead in place (Panel C; Supplementary material online, Videos S1 and S2). The procedure was uneventful. Electrocardiography showed atrial fibrillation and pacing rate of 60 per minute (Panel D). During 15-month follow-up, no dizziness and syn- cope was reported and patient live well. And echocardiography shows no apparent progression in the enlargement of atria or the degree of tricuspid regurgitation (see Supplementary material online, Videos S3–S5). Rheumatic valvular disease will result into huge heart and pace- maker implantation in such case is very challenging. To our knowledge, this is the first report of a successful pacemaker implantation in a such giant heart. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/21/2014/4818264 by Ed 'DeepDyve' Gillespie user on 21 June 2018

Journal

European Heart JournalOxford University Press

Published: Jan 19, 2018

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