Mahsa Mohammadi

A 21‐year‐old man, known case of the repaired congenital heart disease, developed complete atrioventricular block (AVB) one week after simultaneous bioprosthetic pulmonary and tricuspid valve replacement and atrial septal defect repair. Considering the persistence of the AVB, it was decided to implant a permanent pacemaker. After considering all available options and the issues related to the patient, it was decided to implant a leadless pacemaker (LLP). A Micra pacemaker was implanted successfully, and the patient was discharged in good condition and without any complications. Follow‐up evaluation showed appropriate LLP and bioprosthetic valve functioning. Limited prior experiences and the present report showed that LLP appears to be an ideal option in the patients with bioprosthetic tricuspid valve complicated by conduction disorders.

IntroductionPostoperative atrioventricular block (AVB) has been reported in 1% to 6% of patients after cardiac surgery and 25% to 60% of these patients will finally need a permanent pacemaker (PPM).1-4To avoid tricuspid valve (TV) malfunction, implantation of transvenous pacing leads is generally not preferred in presence of the tricuspid bioprosthesis.5Leadless pacemakers (LLP) have recently become popular in treatment of heart blocks and bradyarrhythmia due to their proven safety and efficacy.6,7 LLPs have advantages of avoiding complications encountered with conventional transvenous pacemakers including infection, lead malfunction, and tricuspid valve regurgitation.8,9 Epicardial pacemaker is the standard recommendation in the setting of prior tricuspid valve surgery. However, prior cardiac surgeries are usually associated with significant pericardial adhesion and most surgeons prefer not to implant epicardial leads in this setting due to impaired electrical properties of pericardial leads in the setting of pericardial adhesions. Therefore, LLPs can be a safe choice for patients with TV surgeries and postoperative AVB. There is a few data about the LLP implantation in presence of the bioprosthetic TV (BTV).10-12 In this report, we described a case of Micra-VR implantation across the BTV in a patient with repaired congenital heart disease.

Background: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. So far, few studies have investigated the effect of maintenance dose of Eptifibatide (glycoprotein IIb/IIIa inhibitor) in STEMI patients who underwent primary percutaneous coronary intervention (PPCI). Therefore, in this study, we investigated the effect of maintenance dose of Eptifibatide in patients with STEMI who underwent PPCI. 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of Eptifibatide in the cardiac catheterization laboratory. Then the patients were randomly divided into two groups, one group (n = 147) received a maintenance dose of intravenous Eptifibatide (infusion of 2 μg/kg/min) and the other group (n = 117) did not receive this treatment. Standard medical treatment of STEMI after PPCI was performed based on guidelines and the same in both groups. All patients were evaluated 1, 2, and 3 months after the start of treatment in terms of predicted outcomes.Results: The occurrence of 3-month major adverse cardiovascular events (MACE) between the case and control groups did not have a statistically significant difference (28.6% versus 35.0%;Pvalue: 0.286). Also, investigations showed that the rate of re-infarction (Pvalue: 0.024) and target lesion revascularization (Pvalue: 0.003) was significantly lower in the group that received Eptifibatide infusion.Conclusions: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-infarction and target lesion revascularization. It also does not increase the risk of bleeding and cerebrovascular events.

Aim: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. In this study, we investigated the effect of maintenance dose of Eptifibatide (intravenous drug of GP IIb/IIIa inhibitor) in patients with STEMI who underwent primary percutaneous coronary intervention (PPCI). Methods: 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of eptifibatide. Then the patients were randomly divided into two groups, one group (n=147) received a maintenance dose of intravenous eptifibatide (infusion of 2g/kg/min) and the other group (n=117) did not receive this treatment. All patients were evaluated 1 and 3 months after the start of treatment in terms of predicted outcomes. Results: The occurrence of three-month MACE between the case and control groups did not have a statistically significant difference (28.6% versus 35.0% ; P-value: 0.286). Re-hospitalization occurred in 10 patients (6.8%) from the case group and 30 patients (25.6%) from the control group, which was statistically significant (P-value: 0.000). Also, investigations showed that the rate of re-infarction (P-value: 0.024) and target lesion revascularization (P-value: 0.003) was significantly lower in the group that received Eptifibatide infusion. Conclusion: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-hospitalization and re-infarction. It also does not increase the risk of bleeding and cerebrovascular events.