Category Archives: Cardiac Rhythm Management (CRM)

Revealing Arrhythmias in the Himalayas

Revealing Arrhythmias in the Himalayas

My colleagues and I had an opportunity to study the effects of high altitude on arrhythmias when Dr David Woods participated in a British Army expedition to the Himalayas. The evaluation of patients with unexplained palpitations or syncope, as we know, can be difficult. Traditionally external Holter monitoring is often used to diagnose these events.…

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Pacemaker Implant Anatomy - Step-by-Step (Part 1)

Pacemaker Implant Anatomy – Step-by-Step (Part 1)

Approach Pacemaker implantation can be performed either from the right side or from the left side (refer to Figure 1). There is no difference in principle. It may depend on the patient’s preference. The right sided approach demands a double curve. The left sided approach allows for a unidirectional curve. It depends on the preference…

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Pacemaker Implantation

Pacemaker Implant Anatomy – Step-by-Step (Part 2)

Atrial Lead – Atrial Appendage Figure 13 shows placement in the atrial appendage. This is the classic position of the atrial lead and often a non-traumatic (passive) J-shaped lead is used for this purpose. All manufacturers make a passive atrial lead with a preformed J (refer to Figures 14 and 15) to aid positioning into…

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Pacemaker Implant Anatomy - Step-by-Step (Part 3)

Pacemaker Implant Anatomy – Step-by-Step (Part 3)

Ventricular Lead One of many ways to enter the ventricle is to make bend of about 90 degree bend in the stylet. Position the sharply curved lead in the direction of the tricuspid ostium. Advancement of the lead in this position will usually cross the tricuspid valve. Some extra support from the stylet, by advancing…

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pacemaker problem solving

Pacemaker Implant Anatomy – Step-by-Step (Part 4)

Problem Solving Entanglement in the Pectinate Muscles The cast of the right atrium (left) gives a good impression of what happens on fluoroscopy. The atrial lead enters the atrium and comes to a halt almost halfway. When pushed further, it curves upwards (right). The position and typical movement (windscreen wiper) tells the implanting physician that…

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