Removal of the broken part of implantable cardioverter-defibrillator's electrode causing pulmonary embolism via femoral vein

AbstractA 66-year-old patient with idiopathic dilated cardiomyopathy underwent transvenous extraction of an implantable cardioverter-defibrillator. The distal part of the electrode was broken during manual traction through the left subclavian vein. In the present case, we showed a rare complication of transvenous lead extraction and its management

The effects of magnesium sulfate prophylaxis on arrhythmia and cardiac performance in coronary artery bypass grafting

The aim of this study was to evaluate the effects of magnesium sulfate on cardiac arrhythmia and performance in patients undergone coronary artery bypass grafting. . One hundred patients randomized into placebo (n=50) and magnesium (n=50) groups. the magnesium group received 1.5 g (12.16 mEq) magnesium sulfate intravenously during postoperative first 24 hours, delivered at every 4 hour intervals. the placebo group did not receive magnesium sulfate and served as control. the magnesium group had significantly higher magnesium levels than the placebo group along the course of study (2.037^0.49 versus 1.738±0.41 mEq/L as mean, p = 0.001). Although there was not any significant difference regarding monitorized hemodynamic performances, the magnesium group had reduced levels of mypcardial isdenzyme of creatine kinase (CK-MB) as an indicator of myocardial damage, at postoperative 12th hour and on postoperative day 1 (34.02H2.07 versus 45.98±25.80; p = 0.02 and 32.34±15.26 versus 44.58±41.25 IU/L; p = 0.043, respectively). the supraventricular arrhythmia incidence of magnesium group had lower than that of placebo group (2% versus 26%; p;lt;0.002, as maximum incidence at postoperative 2th hour). No significant difference was demonstrated regarding ventricular arrhythmias, despite higher frequency in control group. Patients in magnesium group need less antiarrhythmic treatment, especially at perioperative and postoperative 12 hour periods (4% versus 16%;p = 0.045 at both observation pefiods). the results of our study suggest that magnesium prophylaxis prevents hypomagnesemia and reduces the incidence of supraventricular and somewhat ventricular tachyarrhythmias by enhancing myocardial protection.Çalışmamızın amacı koroner arter bypass cerrahisi geçiren hastalarda profilaktik magnezyum sülfat uygulamasının kardiyak aritmi ve performans üzerine etkilerini araştırmak idi. 100 hasta eşit olarak plasebo (n=50) ve magnesium (n=50) gruplarına rastgele ayrıldı. Magnesium grubuna 1.5 g (12.16 mEq) magnesium sülfat intravenöz olarak postoperatif ilk 24 saat süresince 4 saatlik peryotlarda verildi. Çalışma süresince magnezyum grubunun magnezyum düzeyleri plasebo grubundan anlamlı olarak yüksekti (ortalama olarak 2.037±0.49 karşı 1.738±0.41 mEq/L, p = 0.001). Monitörize hemodinamik performanslar açısından anlamlı bir fark olmasa da magnesium grubunun miyokardiyal kreatin ki-naz izoenzim düzeyi, miyokardiyal hasarın bir göstergesi olarak, postoperatif 12. saat ve 1. günde anlamlı derecede düşük bulundu (sırasıyla 34.02±l2.07 karşı 45.98^25.80; p = 0.02 ve 32.34±15.26 karşı 44.58±41.25 IU/L; p = 0.043). Magnezyum grubundaki supraventriküler aritmi insidansı plasebo grubundan anlamlı olarak azdı (%2'ye karşı %26; p0.002, postoperatif 2. saatteki maksimum değerler olarak). Kontrol grubunda daha sık görülmesine rağmen ventriküler aritmi açısından anlamlı fark yoktu. Özellikle perioperatif've postoperatif 12. saat gözlemlerinde magnezyum grubunun antiaritmik ihtiyacı anlamlı derecede az oldu (%4'e karşı %16; p=0.045). Çalışmamızın sonuçlan magnezyum profilaksisinin hipomagnezemiyi önlediğini ve özellikle supraventriküler bir ölçüdede ventriküler aritmi insidansını miyokard koruyucu etkileri ile ilişkili olarak azalttlğını göstermektedir