Faculty of Medicine

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Author: search.filters.author.Boshkov, VladimirLanguage: search.filters.language.English

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    Pulse amplitude adjustment provides immediate pacemaker longevity gain
    (Kare Publishing, 2007-07)
    Zlatanovic, Nenad
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    Gjorgov, Nikola
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    Miletic, Branislav
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    Objective: Adjusting pacemaker pulse amplitude influences the longevity of the pacemaker. Our aim was to establish the initial longevity gain. Methods: Forty randomly selected patients with implanted pacemakers were analyzed. Mean age was 65.58±13.7 years. All pacemakers were working on factory settings of pulse amplitude 3.5V and pulse width of 0.4 ms for average of 3 years before the adjustment. Initial mean longevity was projected to 68.61±18.86 months, mean battery voltage 2.78V, and mean battery current 14.21±2.61 µA. Results: Pulse amplitude threshold test was performed and average value of 0.632±0.22V was obtained. Pulse amplitude was programmed to 2.5V and pulse width was left unchanged. New readings of battery data were obtained. Battery voltage did not show immediate changes, and battery current decreased to 11.53±1.98 µA . New average longevity was projected to 81.03±19.82 months, which presents a 12.42 months of initial longevity gain with statistical significance at 95% confidence interval (p=0.003). Positive correlation was found between the new pulse amplitude and new values of battery current (p<0.01). Conclusion: Pulse amplitude decrease of only 1V provides significant initial longevity gain of more than a year. If found correlations would have any impact on further longevity gains over longer period of time is yet to be established.
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    Vascular anomaly – persistent left superior vena cava
    (Hrvatsko kardiološko društvo, 2013-09-23)
    Boshkov, Vladimir
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    ;
    Danilovska, Ilina
    Persistent left superior vena cava (PLSVC) is a very rare congenital vascular anomaly, 0,3% in general population. In 90% of cases PLSVC flows into the right atrium via the coronary sinus, but it can also be associated with other cardiovascular abnormalities including ASD, VSD, bicuspid aortic valve, coarctation of aorta and cor triatriatum, resulting in a right to left sided shunt. Our case, a 72-old male, was admitted to the hospital for a third replacement of the pacemaker. We didn't have any information for any vascular anomaly. The first indication for implantation of a pacemaker — AAI, was dysfunction of sinoatrial node. Few years later, there was progression of the block and the patient was implanted a new system on the other side, a dual-chamber pacemaker (DDDR). During the second re-implantation, the patient was implanted a singlechamber pacemaker (VVIR). Now we noticed malfunction of the system and high impedance of electrode. X-ray before procedure found lead fracture, hence it was decided to implant a new system on the left side and the left subclavia vein was used as a vascular access. Due to contrast application, an aberrant flow was noticed, i.e. the left subclavia vein drained into the right atrium via the coronary sinus, and active fixation was used. Before each intervention we shall review the complete patient documentation in detail and in case we suspect any anomaly we shall carry out an echocardiography. The dilatation of the coronary sinus would indicate PLSVC.