The optimal site at which to pace the right ventricle (RV) is still unclear. This study aimed to answer this question utilising cardiac magnetic resonance imaging, which up until recently was contraindicated in pacemaker patient cohorts. The objective was to determine the effect of apical and outflow tract septal pacing on cardiac function and remodeling as assessed by MRI. In addition, physcial and psychological functional parameters were assessed. A series of sub-studies were performed as part of the research. Study 1 validated the velocity phase encoding used to determine flow measurements. This found measurements were reproducible. Study 2 and 3 focused on the method of CPEX testing in pacing dependent patients and whether a training effect was observed with the CPEX testing. It found that treadmill testing resulted in a greater heart rate response and higher VO2 max results. No significant training effect was observed. Study 4 used phantom models to determine the effect of metal susceptibility artefact on mapping and velocity encoded MR sequences. An inverse relationship between artefact and distance from the pacemaker was observed. At approximinately 10 cm from the device, artefact is negligible. Study 5 determined the best methods of image optimization in the presence of the pacemaker. T1 weighted imaging along with spoiled gradient imaging was less affected by artefact compared to late gadolinium and bSSFP imaging. Study 6 evaluated in-house developed software to measure torsion using data derived from commercial available tagging and feature tracking software. At low heart rates measures were comparable but tagging became less accurate with heart rates over 100 bpm. The main study comprised of the baseline data of 50 patients from the ongoing MAPS trial and some intermediate data after 9 months for a smaller cohort. There was not a significant difference in left ventricular volumes or ejection fraction at baseline but differences were observed in deformational indices including longitudinal strain, strain rate, twist and torsion. At 9 months a difference in ejection fraction was observed between the pacing modes along with differences in deformational parameters. Clinically significant differences were not seen between pacing positions at baseline or 9 months but the outflow tract septal position was superior based on deformational data.

Magnetic resonance imaging (MRI) of patients with cardiac implantable electronic devices (CIED) has been associated with risks such as device/lead movement, device dysfunction, and lead heating. New technological advancements have made it possible for MRI to be safely performed when adhering to an evidence-based protocol; however, this practice has not yet been widely adopted. The purpose of this practice-focused question project was to examine the safety of MRI as a diagnostic modality for the aggregate population of adult patients with MR conditional pacemakers when a nurse-practitioner-led, evidence-based protocol was used. The Iowa model served as the guide for implementation of the program, and the Donabedian framework was used to evaluate the program through process, structure, and outcomes. Evidence was obtained through a documentation template that served as the procedural record in the electronic health record. Demographic information, program fidelity, and manufacturer adherence were analyzed through descriptive statistics. Clinical outcomes related to device function were measured pre- and post- MRI and analyzed with chi square and paired t-test inferential statistics to determine if statistically significant change occurs in the setting of MRI scanning. According to data analysis of 34 studies, there were no statistically significant changes in lead impedance, pacing thresholds, or patient reported symptoms pre- and post- MRI. The pilot program has been recommended for organizational adoption and will increase the scope of advanced practice nurses within the organization and provide the CIED aggregate population with access to an important diagnostic modality.

No description available.

Sammanfattning Bakgrund: I Sverige har cirka 55000 personer pacemaker. Att denna teknik förlänger deras liv är sedan länge känt. För sjuksköterskan är det av intresse att ta del av hur en pacemaker påverkar livskvaliteten för att kunna skapa verktyg för att bemöta denna patientgrupp. Denna litteraturöversikt har genomförts på artiklar som mätt livskvalitet hos patienter med pacemaker med hjälp av två olika mätinstrument. Syfte: Att, med hjälp av SF-36 och Aquarel, beskriva livskvaliteten hos personer med pacemaker. Metod: En litteraturöversikt med 13 kvantitativa artiklar har genomförts, med livskvalitet i fokus. Artiklarna var skrivna mellan 2001-2016 och söktes fram via databaserna CINAHL och Medline.  Resultat: En pacemaker påverkar livskvaliteten positivt, de största signifikanta ökningarna visade sig i SF-36 mätområden fysisk rollfunktion och vitalitet. Men även i Aquarels mätområden arytmier och dyspné/ansträngning. Slutsats: Att få en pacemaker implanterad upplevs påverka patientens livskvalitet positivt. Men det ett komplext område som kräver personcentrerad vård. Där har sjuksköterskan en stor del i vård och omvårdnad. En väl utbildad och påläst vårdpersonal kan göra stor skillnad för patienten.

It is common for clinicians to implant medical devices, such as permanent pacemakers and implantable defibrillators, for cardiac diseases. These medical devices require follow-up care at regular intervals to ensure proper device function and optimal outcomes. Currently, many individuals without insurance or financial resources lack access to recommended follow-up care after implantation of a cardiac device. The purpose of this project was to determine the number of individuals who have had a medical device implanted without insurance coverage over a 3-year period, and then to establish a clinic that provides this service. The standard of care and operating procedure for the pacemaker clinic was established using evidence-based guidelines from the Heart Rhythm Society and the American Heart Association. Complexity science was the theoretical model used to guide this project's design and implementation. This quality improvement initiative was non-experimental, descriptive, and quantitative. Data were extracted from the ICD Registry and United States Census Bureau to determine the number of residents, insurance status, and number of implants over a 3-year period. These data were used to estimate the number of individuals with devices. The data revealed that 40 individuals with low power cardiac devices and 15 individuals with high power devices lacked access to care. The model developed estimates a growth rate of 7 to 10% annually. The pacemaker clinic will provide access to over 70 individuals lacking care for their pacemakers, thereby resulting in improved healthcare outcomes, fewer preventable complications, and optimal device performance.

Background: Sick sinus syndrome (SSS) is common and may require electronic pacemaker implantation, gene therapy (biopacemaking) may be an alternative. For SSS, repair may be better than the generation of a de novo biopacemaker, due to the complex nature of the sinoatrial node (SAN). We hypothesised that an ex vivo model of SSS could be created by the identification of a subsidiary pacemaker in the SAN region, and that expression of a pacemaker channel (HCN4 or HCN212) in this region would accelerate the pacing rate. Methods: A bradycardic SSS model was generated by the removal of the upper two thirds of a rat SAN and a system to record the intrinsic activity during tissue culture was developed. The leading pacemaker site of the SSS preparations were identified by activation mapping then characterised by If blockade, β-adrenergic stimulation, histology and immunohistochemistry. Further SSS preparations were injected in this region with recombinant adenovirus (RAd) expressing no functional ion channel (Ad5-GFP or Ad5-GFP-HCN4Δ); or RAd expressing a functional If channel (Ad5-HCN212 or Ad5-PREK-HCN4). During tissue culture electrical activity was monitored using bipolar electrodes. Results: Tissue culture and monitoring of the rat SAN is feasible and does not induce significant changes in HCN4 or connexin-43 expression. The uninjected SSS preparations displayed a slower rate than the control SAN (p<0.001). In 5/6 cases the subsidiary pacemaker was HCN4 -ve and Connexin-43 +ve (in contrast to the SAN) and was close to the superior aspect of the inferior vena cava. The cell size of the subsidiary pacemaker was comparable to that of the SAN and smaller than working myocardium (p<0.001). Pacing was responsive to β-adrenergic stimulation and was partially dependent on If current. The pacing rate of the AdHCN212-injected SSS preparations was significantly faster than the uninjected SSS preparations (p<0.001). The remaining RAd did not significantly affect the pacing rate of the SSS model. Conclusions: There is subsidiary pacemaker tissue close to the superior aspect of the IVC that shares some characteristics of the SAN. These results suggest that adenovirus-mediated expression of HCN channels in subsidiary pacemaker tissue of the right atrium may be a useful strategy in biopacemaking for SSS.

Coincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMD-related Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.

We have set three main goals. First of all, we tried to find out nurses? knowledge concerning the specific care of patients who have undergone the implantation of pacemaker in the Czech Republic and Slovakia, also their workflow when facing the complications after the implantation of pacemaker and, in the end, to find out what are the most common complications occurring in patients after having their heart pacemaker implanted. Based on these aims, research questions were made: 1. What are the nurses? knowledge concerning the specific care of patients with their pacemaker implanted in the Czech Republic? 2. What are the nurses? knowledge concerning the specific care of patients with their pacemaker implanted in Slovakia? 3. What is the workflow chosen by nurses in the Czech Republic when facing the complications after the implantation of pacemaker? 4. What is the workflow chosen by nurses in Slovakia when facing the complications after the implantation of pacemaker? 5. How often do the complications concerning the patients with their pacemaker implanted occur in the Czech Republic and Slovakia? 6. What are the most common complications occurring in patients after having a heart pacemaker implanted? To be able to achieve the aims and research questions of our work, we used the qualitative research by form of interviews with nurses from the Czech and Slovak hospitals. Information obtained were processed into the final charts and then evaluated. To implement these interviews, 30 nurses from various hospitals in the Slovak and Czech Republic were kindly asked to undergo our survey. The result of the research was that Slovak nurses have knowledge and skills similar to the Czech ones. The responses of the nurses from the both countries were basically the same, just with little differences. They were able to name all kinds of pacemakers and choose the right workflow before and after the implantation of pacemaker. Regarding the second goal, we found out that most nurses contact the doctor of the patient and subsequently stick to his instructions. All in all, the two countries proceed similarly when facing the complications of implantations of pacemaker. The most common procedures were prescribing the antibiotics when infection occurs, preparing the patient for reimplantation or in the case of bleeding, applying the pocket filled with sand to the wound. The third aim we set was to identify the most common complications. Nurses from both countries responded that complications do not usually occur but when they do, they are caused by a dislocation of the electrodes, bleeding or infection.

No description available.

Bakgrund: I Sverige är det cirka 53 000 personer som lever med pacemaker. Att vara beroende av pacemaker kan ha stor inverkan på personens liv. Sjuksköterskan har som roll att ge personcentrerad omvårdnad genom att se till varje individs egna upplevelser av hälsa och ohälsa. Hälsorelaterad livskvalitet (HRQoL) är ett omfattande begrepp som beskriver upplevt välbefinnande fysiskt, psykiskt och socialt. Syfte: Var att beskriva om och på vilket sätt det dagliga livet påverkas av att leva med pacemaker. Metod: En litteraturöversikt med kvantitativa och kvalitativa artiklar har sammanställts utifrån deduktiv ansats. Begreppet HRQoL har använts som teoretisk referensram. Det har gjorts artikelsökningar i databaserna CINAHL, MEDLINE och PsycINFO. Det resulterade i åtta artiklar som analyserades utifrån Elo och Kyngäs innehållsanalys. Resultat: HRQoL förbättrades efter att personer fått pacemaker inopererad. Personer mötte fysiska, psykiska och sociala utmaningar, men pacemakern upplevdes som något positivt då de fått en livsräddande behandling. Slutsats: Att leva med pacemaker är en komplex och individuell upplevelse som kan påverka det dagliga livet. Sjuksköterskan har en viktig roll genom att informera, undervisa, stötta och bemöta dessa personers upplevelser.