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      Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report

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          Abstract

          Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

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          Venous thrombosis and stenosis after implantation of pacemakers and defibrillators.

          Charles M. Francis, Marla B. Hall, Spencer Rosero … (2005)
          Venous complications of pacemaker/ implantable cardioverter defibrillator (ICD) system implantation rarely cause immediate clinical problems. The challenge starts when patients come for system revision or upgrade. Numerous reports of venous complications such as stenosis, occlusions, and superior vena cava syndrome have been published. We reviewed current knowledge of these complications, management, and their impact on upgrade/revision procedures. One study has suggested that intravenous lead infection promotes local vein stenosis. Another found that the presence of a temporary wire before implantation is associated with an increased risk of stenosis. Although data for ICD leads is based only on three studies-it suggests that the rate of venous complications is very similar to that of pacing systems, and probably data from pacing leads can be extrapolated to ICD leads. Despite 40 years of experience with transcutaneous implanted intravenous pacing systems and dozens of studies, we were unable to identify clear risk factors (confirmed by independent studies) that lead to venous stenosis. Neither the hardware (lead size, number and material) nor the access site choice (cephalic cut down, subclavian or axillary puncture) appears to affect rate of venous complications. A few factors were proposed as predictors of severe venous stenosis/occlusion: presence of multiple pacemaker leads (compared to a single lead), use of hormone therapy, personal history of venous thrombosis, the presence of temporary wire before implantation, previous presence of a pacemaker (ICD as an upgrade) and the use of dual-coil leads. Anticoagulant therapy (for other reasons than pacemaker lead) seemed to have protective antithrombotic effect.
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            Perioperative pulmonary embolism: diagnosis and anesthetic management.

            Matthew C Desciak, Donald Martin (2011)
            All perioperative patients, but especially trauma victims and those undergoing prostate or orthopedic surgery, are at increased risk of venous thromboembolism. Patients at highest risk include those with malignancy, immobility, and obesity; those who smoke; and those taking oral contraceptives, hormone replacement therapy, or antipsychotic medications. Dyspnea, anxiety, and tachypnea are the most common presenting symptoms in awake patients, and hypotension, tachycardia, hypoxemia, and decreased end-tidal CO(2) are the most common findings in patients receiving general anesthesia. The presence of shock and right ventricular failure are associated with adverse outcomes. Helical computed tomographic scanning is the preferred definitive diagnostic study, but transesophageal echocardiography may be valuable in making a presumptive diagnosis in the operating room. Early diagnosis allows supportive therapy and possible anticoagulation (in some cases, to be started before the conclusion of surgery).
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              Left ventricular thrombus development during ventricular fibrillation and resolution during resuscitation in a swine model of sudden cardiac arrest

              Gavin Budhram, Timothy Mader, Lucienne Lutfy … (2014)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (iso-abbrev): Korean J Anesthesiol
                Journal ID (publisher-id): KJAE
                Title: Korean Journal of Anesthesiology
                Publisher: The Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): February 2015
                Publication date (Electronic): 28 January 2015
                Volume: 68
                Issue: 1
                Pages: 74-77
                Affiliations
                Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Chang Jae Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, 180, Wangsanro, Dongdaemun-gu, Seoul 130-709, Korea. Tel: 82-2-958-2099, Fax: 82-2-967-0235, ksw070591@ 123456catholic.ac.kr
                Article
                DOI: 10.4097/kjae.2015.68.1.74
                PMC ID: 4318869
                SO-VID: fccfa8dc-2a96-448f-ae45-3c3a5811fb70
                Copyright © Copyright © the Korean Society of Anesthesiologists, 2015
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 July 2014
                Date revision received : 03 September 2014
                Date accepted : 03 September 2014
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: echocardiography,pacemaker,thrombosis
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: echocardiography, pacemaker, thrombosis

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