Two undesired conditions resulting from T-Wave oversensing in two patients with hypertrophic cardiomyopathy: Inappropriate ICD shocks and pacemaker dysfunction

Introduction: T-wave oversensing (TWOS) is generally seen in patients with hypertrophic cardiomyopathy (HCM) and is a rare cause of inappropriate implantable cardioverter defibrillator (ICD) shocks. TWOS rarely causes pacemaker dysfunction. Case Presentation: In this paper, we present two patients with hypertrophic cardiomyopathy (HCM). One patient had several in- appropriate ICD shocks, and the other experienced pacemaker dysfunction due to TWOS. ICD interrogation revealed that TWOS occurred only during high heart rates in the first patient. Attempts to fix TWOS, including a higher beta blocker dose, electrophysi- ology study, and ICD re-programming, were unsuccessful. Conclusions: We replaced the previously implanted ICD generator (Medtronic Maximo II DR) with a new one that has a specific diagnostic algorithm to prevent TWOS (Medtronic Protector). After replacement, the patient did not have any inappropriate shocks due to TWOS. The second patient had bradycardic pacemaker rhythm due to TWOS. Although we reposed, the ventricular lead did not stabilize with an adequate threshold, and thus we decided to replace the lead with a new one. The pacemaker dysfunction disappeared after the lead replacement. Patients with HCM must be observed carefully for these undesired conditions

Uzun segment koroner lezyonlarda biyoeriyebilen stentlerin güvenlik ve etkinlik sonlanımları

Introduction: There is limited knowledge about the use of bioresorbable scaffolds (BRSs) in long segment coronary artery lesions. We aimed to evaluate the clinical outcomes of BRS-BRS and drug eluting stents (DESs)-BRS overlapping applications. Patients and Methods: Cross-sectional, single-center study between 2013 and 2016 enrolled 97 patients and 100 lesions scheduled for BRS placement in long segment lesions (> 28 mm). BRS-BRS overlap was performed in 30 patients and 30 lesions, DES-BRS overlap was performed in 67 patients and 70 lesions. Acute procedural success and major adverse cardiac events (MACE) (death, stent thrombosis, and target lesion reintervention) were assessed. Results: Acute procedural success was 97.1% in the overall group. MACE was observed in 6 patients (6.2%) in the entire group, 4 (5.9%) in the DES-BRS group, and 2 (6.6%) in the BRS-BRS group. Conclusion: BRS use might be a safe and effective option for the treatment of long segment lesions. Both BRS-BRS overlap and BRS-DES overlap may be performed with short overlap segment.Giriş: Uzun segment lezyonlarda biyoeriyebilen stentlerin (BRS) kullanımı ile ilgili sınırlı bilgimiz olduğundan hem BRS-BRS hem de İlaç salınımlı metal stent (DES)-BRS overlap uygulanan hastaların klinik sonuçlarını değerlendirmeyi planladık. Hastalar ve Yöntem: Tek merkezli, kesitsel planlanan; Ocak 2013-Haziran 2016 tarihleri arasında uzun segment lezyonlara (> 28 mm) BRS yerleştirilmesi planlanan 97 hasta ve 100 lezyon çalışmaya alındı. Otuz hasta ve 30 lezyonda BRS-BRS overlap uygulanırken , 67 hasta 70 lezyona DES-BRS overlap uygulandı. Akut işlem başarısı ve MACE (ölüm, stent trombozu, hedef damara yeniden girişim) değerlendirildi. Bulgular: Akut işlem başarısı %97.1 idi. Tüm hasta grubunda toplam MACE 6 (%6.2) hastada gelişirken, DES-BRS grubunda 4 (%5.9), BRS-BRS grubunda 2 (%6.6) hastada MACE gerçekleşti. Sonuç: Uzun segment lezyonlarda BRS kullanımı seçenek olarak değerlendirilebilinir. BRS-BRS veya BRSDES overlap yapacak şekilde yerleştiriken kısa segment overlap olacak şekilde gerçekleştirilmelidir