Objective To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker （PPM） implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker （AAI） PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis （IE） in 5 patients, tricuspid insufficiency （TI） in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty （TVP）， tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively， all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient after TVP had mild TI during follow-up. Conclusion Surgical treatment should be performed as early as possible when infection is too severeto control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.
ObjectiveTo explore the efficacy of an innovative approach of follow-up in patients implanted with permanent pacemaker (DDD). MethodsA total of 400 patients who underwent permanent pacemaker (DDD) implantation between June 2011 and June 2013 were included in the present study. Patients were randomly assigned to the innovative and conventional follow-up groups in a 1：1 manner (200 patients in each group). The baseline characteristics were well balanced with no statistically significant differences in the mean age, proportion of male sex, prevalence of hypertension, position of the electrode or the device used between the two groups. At the end of the follow-up, patient outcomes were compared between the two groups. ResultsThe outcomes of patients were better in the innovative follow-up group, with higher degree of satisfaction, better state of health, lower incidence of complications, and less frequent readmission and follow-up visits (all P<0.05). ConclusionThe innovative approach of follow-up considerably improves patient outcomes, and can be useful in future clinical practice.