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There is little information on venous patency after pacing leads are inserted in veins during pacemaker or implantable cardioverter defibrillator (ICD) implantation. Herein we present a report on venous patency during the immediate postoperative period after permanent pacemaker or ICD implantation. Subjects and Methods: Twenty-five patients underwent a permanent pacemaker or ICD implantation by venous puncture method, and venography was performed 1 week later. We assessed the pacemaker-implantation side, approach used, implanted device, number of implanted leads, and clinical symptoms. Results: Narrowing of the vein was found in 14 patients (56%), including 7 patients (28%) with occlusion. Stenosis and occlusion were seen more in patients with left-sided implantation than those with right-sided implantation (71% vs. 25%, P < 0.05). ICD implantation was more frequently associated with venous stenosis or occlusion than pacemaker implantation (65% vs. 37.5%, P < 0.05). The approach used and the number of leads implanted did not correlate with venous stenosis or occlusion. Six of the 7 patients who developed complete occlusion showed clinical symptoms. Conclusion: Thrombus formation after pacemaker implantation can occur in the acute stage within 1 week. The incidence of venous stenosis or thrombus formation was higher with leftsided implantation and ICD.

Introduction: It has become clear that the onset of heart failure is closely linked to right apex pacing, which lengthens the QRS duration and evokes discoordinate contraction of the left ventricle (LV). Currently, it is thought that the site inducing the shortest QRS duration is optimal for pacing. Objectives: The purpose of this study was to ascertain the pacing site inducing the shortest QRS duration and to examine the configuration of the 12-lead electrocardiogram and heart function while pacing at this site. Methods: Nine patients with normal heart function were enrolled. Pacing at right ventricular outflow, mid-interventricular septum (MS), and right ventricular apex was performed. QRS duration was measured and the configuration of the 12-lead electrocardiogram changed by pacing was studied. Output and LV dp/dt were calculated at each pacing site. Results: QRS duration became shorter with MS pacing and the pacing lead situated at the periphery of the coronary sinus and turned in a posterior direction. The configuration of the 12-lead electrocardiogram showed an Rs or rS pattern with II, III, and aVF leads. Output and LV dp/dt showed a tendency to increase with MS pacing. Conclusion: It is thought that mid-interventricular septum pacing shortens the QRS duration.

Pharmacological treatment for atrial fibrillation has a variety of purposes, such as pharmacological defibrillation, maintenance of sinus rhythm, heart rate control to prevent congestive heart failure and prevention of both cerebral infarction and atrial remodeling. Sodium channel blockers are superior to potassium channel blockers for atrial defibrillation, while both sodium and potassium channel blockers are effective in the maintenance of sinus rhythm. In general, digitalis or Ca antagonists are used to control heart rate during atrial fibrillation to prevent congestive heart failure, while amiodarone or bepridil also reduce heart rates during atrial fibrillation. Anticoagulant therapy with warfarin is recommended to prevent cerebral infarction and angiotensin converting enzyme antagonists or angiotensin II receptor blockers are also used to prevent atrial remodeling. One should select appropriate drugs for treatment of atrial fibrillation according to the patient's condition.