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Biomedical subjects

V Parsonnet

Publications and source records attributed to V Parsonnet.

At least 199 records · Page 11Linked to original sources

Followup of implanted pacemakers: an evaluation of surveillance methods.

A waveform analysis clinic augmented by telephone transmission of pacemaker interval in the late stages of pacemaker life will yield a considerable amount of information and will permit elective replacement of pacemakers in about 90 per cent of cases. The clinic has an advantage over other surveillance systems in the accuracy of the diagnosis, the identification of abnormalities that do not require pacemaker replacement, and the multiple benefits of a direct doctor-patient relationship. No system of surveillance can be recommended over all others in all circumstances. It is sufficient here to indicate the merits of each system and to allow the various centers to develop according to their own particular needs and desires. There is no objection to telephone monitoring alone as long as one realizes that only about 80 per cent of the problems can be detected and that there will be an irreducible percentage of false negative and false positive diagnoses. The danger of errors of this type is not great, but it does exist and should be avoided if possible. Other methods of pacemaker followup, such as simple examination and an electrocardiogram in a doctor's office or changing the pacemaker on the basis of the manufacturer's prediction, are relatively unsatisfactory. It should be stressed that pacemaker surveillance of some type is essential to satisfactory patient care because it provides for maximum utilization of the pacemaker, for replacement only if and when necessary, for detection of 90 per cent of pacemaker problems, and for protection of the patient against unexpected pacemaker failure.

Costs and Cost Analysis

Iatrogenic entrapment of femoropopliteal saphenous vein bypass grafts by the gastrocnemius muscle.

Two patients are described in whom saphenous vein grafts placed distal to the knee joint were "entrapped" by the medial gastrocnemius tendon. In one, the superficial position of the graft was detected by postoperative angiography. In the other, a true aneurysm of the vein graft developed over a 3 year period. The similarity between the iatrogenic and congenital forms of the popliteal entrapment syndrome is noted.

Arterial Occlusive Diseases

Clinical experience with nuclear pacemakers.

Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice.

Arrhythmias, Cardiac