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      Retrospective Analysis of Indications and Complications Related to Implantation of Permanent Pacemaker: 25 Years of Experience in 31 Dogs

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          Abstract

          Introduction

          Pacemaker implantation is the only effective symptomatic treatment for life-threatening bradyarrhythmias. Major complications observed after implantation of cardiac pacemakers include lead dislocation, loss of pulse generator function, and inadequate stimulation. The aim of this retrospective single-centre study was to analyse the indications for pacemaker implantation and the incidence and types of complications associated with this procedure in dogs treated for symptomatic bradyarrhythmia.

          Material and Methods

          The retrospective analysis included 31 dogs with symptomatic bradyarrhythmia, implanted with permanent cardiac pacemakers in 1992–2017. The list of analysed variables included patient age, breed, sex, indication for pacemaker implantation, comorbidities, and the incidence of procedure-related complications along with the type thereof.

          Results

          The most common indication for pacemaker implantation was 3 rd degree AVB, followed by SSS, advanced 2 nd degree AVB, and PAS. Pacemaker implantation was associated with a 35% overall complication rate and 6.45% periprocedural mortality. There were no significant differences in terms of procedure-related complications with regard to age, sex, breed, indications for pacemaker implantation, or comorbidities.

          Conclusions

          Cardiac pacing is the only effective treatment of symptomatic bradycardia, but as an invasive procedure, may pose a risk of various complications, including death.

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          Most cited references30

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          Complications related to permanent pacemaker therapy.

          This study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent. Eleven percent of patients needed an invasive procedure due to an early or late complication.
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            The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope.

            The present study was undertaken to identify and quantitate the symptoms associated with neurocardiogenic syncope, syncope due to ventricular tachycardia, and syncope resulting from atrioventricular block. Eighty patients referred for evaluation of syncope in whom a diagnosis of neurocardiogenic syncope, atrioventricular block, or ventricular tachycardia was established were studied. Each patient was interviewed using a standard questionnaire. The clinical histories were then compared to identify which variables best differentiated the cause of syncope. The clinical histories of patients with syncope due to ventricular tachycardia and atrioventricular block were similar. Only age, the duration of prodromal symptoms, diaphoresis prior to syncope, and fatigue following syncope differed. In contrast, the clinical history in patients with neurocardiogenic syncope differed greatly from that obtained in patients with syncope due to atrioventricular block or ventricular tachycardia. Features of the clinical history that were predictive of syncope due to atrioventricular block or ventricular tachycardia were male sex, age > 54 years, < or = 2 episodes of syncope, and a duration of warning of < or = 5 seconds. Features of the clinical history predictive of syncope not due to ventricular tachycardia or atrioventricular block were palpitations, blurred vision, nausea, warmth, diaphoresis, or lightheadedness prior to syncope, and nausea, warmth, diaphoresis, or fatigue following syncope. The results of this study identify and compare the features of the clinical history obtained in patients with syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope and demonstrate that the clinical history is of value in distinguishing patients with these three causes of syncope.
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              Results of pacemaker implantation in 104 dogs.

              To document the outcome, survival and complications involved in pacemaker implantation in dogs in a retrospective study.
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                Author and article information

                Journal
                J Vet Res
                J Vet Res
                jvetres
                jvetres
                Journal of Veterinary Research
                Sciendo
                2450-7393
                2450-8608
                March 2019
                22 March 2019
                : 63
                : 1
                : 133-140
                Affiliations
                [1 ]Department of Internal Medicine with Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences , 50-366 Wrocław, Poland
                [2 ]Student of Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences , 50-375 Wrocław, Poland
                [3 ]Centre for Experimental Diagnostics and Biomedical Innovations, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences , 50-366 Wrocław, Poland
                [4 ]Department and Clinic of Internal and Occupational Diseases and Hypertension, Wrocław Medical University , 50-556 Wrocław, Poland
                [5 ]Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences , 50-366 Wrocław, Poland
                [6 ]Department of Internal Diseases and Veterinary Diagnosis, Faculty of Veterinary Medicine and Animal Sciences Poznań University of Life Sciences , 60-637 Poznań, Poland
                Author notes
                Article
                jvetres-2019-0016
                10.2478/jvetres-2019-0016
                6458549
                30989145
                0c3bdd98-5e93-432e-98d1-44779558d092
                © 2019 A. Noszczyk-Nowak et al. published by Sciendo

                This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

                History
                : 04 August 2018
                : 04 February 2019
                Page count
                Pages: 8
                Categories
                Research Article

                dog,pacemaker,bradyarrhythmia,atrioventricular block,complication

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