- The number of permanent pacemakers implanted per year increased by 55.6% between 1993 and 2009, and is continuing to rise. Accordingly, the number of patients treated in the emergency department who have permanent pacemakers is increasing, and it is important for physicians in the emergency department to be familiar with the operation and potential complications of these devices.
- Genetic testing of first-degree relatives is recommended according to 2018 ACC/AHA/HRS guidelines on evaluation of bradycardia and conduction delay.
- Permanent pacing is reasonable intervention for patients with tachy-brady syndrome and symptoms attributable to bradycardia.
- 2018 ACC/AHA/HRS specific guideline considerations for genetic disorders, neuromuscular disorders, and infiltrative disorders (e.g., cardiac sarcoidosis and amyloidosis).
Latest Updates
- The number of permanent pacemakers implanted per year increased by 55.6% between 1993 and 2009, and is continuing to rise. Accordingly, the number of patients treated in the emergency department who have permanent pacemakers is increasing, and it is important for physicians in the emergency department to be familiar with the operation and potential complications of these devices.
- Genetic testing of first-degree relatives is recommended according to 2018 ACC/AHA/HRS guidelines on evaluation of bradycardia and conduction delay.
- Permanent pacing is reasonable intervention for patients with tachy-brady syndrome and symptoms attributable to bradycardia.
- 2018 ACC/AHA/HRS specific guideline considerations for genetic disorders, neuromuscular disorders, and infiltrative disorders (e.g., cardiac sarcoidosis and amyloidosis).
Injection Sclerotherapy and Ablation
- Endovenous laser ablation (EVLA) has many similarities to radiofrequency ablation (RFA), with the primary differences related to the catheter and mechanism used to ablate the vein. EVLA uses a bare-tipped or jacket-tipped fiber to deliver laser energy to a target area.
- The thermal energy generates heat and steam bubbles within the lumen of the target vessel, destroying the endothelial lining of the vessel. This causes an inflammatory and constricting reaction that leads to fibrosis and occlusion of the treated vein.
- Of note, the incidence of severe postprocedure pain and bruising has been significantly decreased with the advent of the new-generation covered fibers and hemoglobin-targeted chromophore, such that these adverse events are now comparable to those seen with RFA.
Antisocial Personality Disorder and Its Clinical Management
- Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
- Research has implicated brain regions that control judgment and impulse control.
- Cognitive-behavioral therapy may be helpful in mild cases.
Antisocial Personality Disorder and Its Clinical Management
- Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
- Research has implicated brain regions that control judgment and impulse control.
- Cognitive-behavioral therapy may be helpful in mild cases.
Injection Sclerotherapy and Ablation
- Endovenous laser ablation (EVLA) has many similarities to radiofrequency ablation (RFA), with the primary differences related to the catheter and mechanism used to ablate the vein. EVLA uses a bare-tipped or jacket-tipped fiber to deliver laser energy to a target area.
- The thermal energy generates heat and steam bubbles within the lumen of the target vessel, destroying the endothelial lining of the vessel. This causes an inflammatory and constricting reaction that leads to fibrosis and occlusion of the treated vein.
- Of note, the incidence of severe postprocedure pain and bruising has been significantly decreased with the advent of the new-generation covered fibers and hemoglobin-targeted chromophore, such that these adverse events are now comparable to those seen with RFA.
- Contemporary understanding of ventricular mechanics with identification of the structure and function of the ventricular myocardial band
- Detailed description of the anatomic proximity of cardiac structures and how knowledge of this proximity helps prevent intraoperative complications and damage to critical cardiac structures
- Comprehensive description of aortic root anatomy and mechanics and application of how this anatomy dictates performance of transcatheter aortic valve replacement
- Contemporary understanding of ventricular mechanics with identification of the structure and function of the ventricular myocardial band
- Detailed description of the anatomic proximity of cardiac structures and how knowledge of this proximity helps prevent intraoperative complications and damage to critical cardiac structures
- Comprehensive description of aortic root anatomy and mechanics and application of how this anatomy dictates performance of transcatheter aortic valve replacement
