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Pleural disease induced by drugs
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Itraconazole, a triazole used to treat systemic mycosis, has been described in an isolated report to have caused a pleural effusion in a 49-year-old individual following 8 weeks of the drug at 200 mg twice-daily.34 The pleural effusion was followed 1 week later by a pericardial effusion that required pericardiocentesis. Pleural fluid analysis was described as an exudate (total protein 4.3 g/dL); percutaneous pleural biopsy was not diagnostic. Following re-exposure to the drug 6 weeks later, parenchymal infiltrates and cardiomegaly developed without recurrent pericardial effusion. A cardiac evaluation showed no evidence of ischaemic or valvular heart disease, and the authors concluded that the cardiac dysfunction was induced by re-exposure to itraconazole.
Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing)
Published in Expert Review of Medical Devices, 2019
Matteo Ziacchi, Pietro Palmisano, Mauro Biffi, Federico Guerra, Giuseppe Stabile, Giovanni Battista Forleo, Gabriele Zanotto, Antonio D’Onofrio, Maurizio Landolina, Roberto De Ponti, Massimo Zoni Berisso, Renato Pietro Ricci, Giuseppe Boriani
The present survey is the first on this topic. Participation was fair and encompassed more than 1/3 of all Italian centers. The respondents reported favoring a passive atrial lead over an active lead because of the potential complications of the latter. It would be interesting to ascertain which complications are regarded as the most frequent (i.e. dislodgement, pericardial effusion, other) [9]. A large study on atrial lead implantation showed that active (compared with passive) lead fixation increased the risk of pericardial effusion requiring pericardiocentesis, without reducing the dislodgement rate. The same study also concluded that there was a clear association between low atrial septal lead position and lead dislodgement requiring lead revision [10]. As reported in our survey, an active atrial lead is used to pace outside the atrial appendage (e.g. septum or free wall), but in these sites dislocations are more frequent. On the basis of various European registers, it is possible to conclude that, after the left ventricular lead, the atrial lead is associated with the highest risk of complications (though the rates are comparable). It could therefore be concluded that the active-fixation atrial lead is more adaptable and should be used for ‘alternative’ site sensing/pacing. On the other hand, it is also at higher risk of dislodgement when compared to the passive lead. In conclusion, literature does not report a clear advantage of active or passive atrial leads in terms of long-term stability of electrical parameters or complication rates. However, it is fairly well established that an active fixation lead is better in the event of extraction for its structure which makes it more resistant [11]. Our survey revealed that the majority of ICD patients receive a screw-in atrial lead, while in PM patients, operators prefer a passive atrial lead. The reason for this choice is not completely clear, but the probable explanation is that PM patients are considered to be frailer. In conclusion, the respondents’ perception is that the passive atrial lead is safer but not suitable for placement in alternative sites, and more difficult to extract.
Long-term safety and efficacy of combined percutaneous LAA and PFO/ASD closure: a single-center experience (LAAC combined PFO/ASD closure)
Published in Expert Review of Medical Devices, 2019
Jiangtao Yu, Xiaoxia Liu, Junling Zhou, Xin Xue, Manuela Muenzel, P. Christian Schulze, Sven Moebius-Winkler, Thorsten Keil, Zhaohui Meng, Shaoyong Tang
The episodes of pericardial effusion/tamponade during LAAC were successfully treated with pericardiocentesis. The three cases of device thrombi during LAAC procedure all occurred in the access sheath, which were removed by washing with water and adding heparin.