Search

Background Pacemaker generators are routinely implanted in the anterior chest. However, where to place the generator may need to be considered from the mental, functional, and cosmetic standpoints. Methods In this study, we performed the left axillary pacemaker generator implantation with a direct puncture of the left axillary vein in 40 consecutive patients, and evaluated the late safety and efficacy of this implantation. Complications, changes in the lead sensing, pacing threshold, and impedance were used as safety indexes for a mean follow-up of 3.4 years. In addition, the efficacy was also evaluated by comparing their questionnaire survey results to 119 patients in a control group of anterior chest implantation. Results Lead dislodgements were observed in two patients of the experiment group. There were no migrations of generators from the implantation site or abnormal variations in the pacing threshold, lead sensing, or impedance. In the left anterior chest and left axillary groups, 85% and 10% of the patients were worried about an external impact, 80% and 25% were worried about electromagnetic interference, and 68% and 0% answered that the pacemaker implantation site was noticeable, respectively. Apparently, more patients had a sense of security and cosmetic satisfaction with the left axillary implantation. Conclusion The left axillary generator implantations may reduce the mental burden and cause no safety concerns, and may be performed if functional or cosmetic outcomes are required.

11Abstract publication information: The abstracts of this study were presented at the conferences below:[1] Mahito N, Naoshi I, Yoshinari E, et al. Evaluation of defibrillation safety with the increased number of sensing to reduce shocks for ventricular fibrillation in Japanese ICD patients. 5th APHRS; 2012.[2] Mahito N, Xin Z, Naoshi I, et al. Evaluation of Defibrillation Safety with the increased Number of Sensing to Reduce Shocks for Ventricular Tachyarrhythmia in Japanese ICD Patients – SANKS STUDY. Venue of the 8th Tawara-Aschoff-Meeting; 2012.BackgroundThe need for ways to minimize the number of implantable cardioverter-defibrillator (ICD) shocks is increasing owing to the risk of its adverse effects on life expectancy. Studies have shown that a longer detection time for ventricular tachyarrhythmia reduces the safety of therapies, in terms of syncope and mortality, but not substantially in terms of the success rate. We aimed to evaluate the effects of increased number of intervals to detect (NID) VF on the safety of ICD shock therapy and on the reduction of inappropriate shocks.MethodsThe present study was a prospective, multicenter, randomized, crossover study. Randomized VF induction testing with NID 18/24 or 30/40 was performed to compare the success rate of defibrillation with a 25-J shock and the time to detection. Inappropriate shock episodes were simulated retrospectively to evaluate a possibility of episodes avoidable at NID 24/32 and 30/40.ResultsThirty-one consecutive patients implanted with an ICD or cardiac resynchronization therapy-defibrillator (CRT-D) were enrolled in this study. The success rate of defibrillation was 100% in both NID groups at the first shock. The time from VF induction to detection showed a significant increase in the NID 30/40 group (6.16±1.29s vs. 9.00±1.31s, p

Pacemaker generators are routinely implanted in the anterior chest. However, where to place the generator may need to be considered from the mental, functional, and cosmetic standpoints.In this study, we performed the left axillary pacemaker generator implantation with a direct puncture of the left axillary vein in 40 consecutive patients, and evaluated the late safety and efficacy of this implantation. Complications, changes in the lead sensing, pacing threshold, and impedance were used as safety indexes for a mean follow-up of 3.4 years. In addition, the efficacy was also evaluated by comparing their questionnaire survey results to 119 patients in a control group of anterior chest implantation.Lead dislodgements were observed in two patients of the experiment group. There were no migrations of generators from the implantation site or abnormal variations in the pacing threshold, lead sensing, or impedance. In the left anterior chest and left axillary groups, 85% and 10% of the patients were worried about an external impact, 80% and 25% were worried about electromagnetic interference, and 68% and 0% answered that the pacemaker implantation site was noticeable, respectively. Apparently, more patients had a sense of security and cosmetic satisfaction with the left axillary implantation.The left axillary generator implantations may reduce the mental burden and cause no safety concerns, and may be performed if functional or cosmetic outcomes are required.

It is reported that squalene hydroperoxide, which is the primary peroxide of squalene, is produced by exposing skin to sunlight. Using squalene hydroperoxide as a marker, we studied inhibitory effects of some antioxidants on lipid peroxide production of sunlight exposed skin. Each ethyl-acetate solution of purified squalene and an antioxidant mixture was applied on the forehead skin, and exposed to sunlight. By specific detection of squalene hydroperoxide using the chemiluminescence-high performance liquid chromatography system (CL-HPLC), the peroxide value of exposed samples could be determined. dl-α-Tocopherol was more effective than BHT.

Background: We reported that as for the placement parts of generator, to place the generator at left axillary fossa with axillary vein puncture was thought to be useful from the mental, functional and cosmetic standpoint. But objective assessment was different. Purpose: The purpose of this study is to make comparative study of mental, functional and cosmetic situation by the generator planting part of pacemaker. Method and Patients: The questioner investigation concerning impact shock from out side of body, electromagnetic wave interference, cosmetic condition and satisfaction rating to present pacemaker planting part was performed to 10 patients at left axillary fossa (F) and 119 patients at the anterior chest (A). Result: 1) There were 66% worry in A for the impact shock to pacemaker planting part from the outside, and 90% in F had the sense of security. 2) 42.3% thought pacemaker to be remarkable and 57.1% was not satisfied in A but 90% was satisfied in F with the placement parts of generator. Conclusion: Though A was 119 and F was 10, and comparative study is difficult. F is giving a good effect as a tendency in the function, the mental and cosmetic aspect compared with A. It is scheduled that the more cases are examined in the future.