RESUMEN
BACKGROUND: The final stage of a conventional de-novo cardiac implantable electronic device (CIED) implantation procedure with transvenous lead insertion involves the formation of a pocket by tissue separation superficial to the pectoralis major muscle in the right or left infraclavicular region, where the device is subsequently placed. Over time, a scar "capsule" is formed around the CIED as a result of normal biological remodelling. MATERIALS AND METHODS: The purpose of this study was to analyse the structure and present the variations of CIED capsules observed during device replacement. The nature and extent of this local tissue remodelling, which had occurred from the time of device implantation to its replacement in 2016 (10 ± 3.1 years), was analysed in 100 patients (mean age 77.1 ± 14.5 years), including 45 women and 55 men. RESULTS: The most prevalent types of "capsules" (70% of cases) were those with similar thickness of both walls or a slightly thicker posterior (< 1.0 mm) than anterior wall (< 0.5 mm). The second most common capsule type (23% of cases) was characterised by a significantly thicker posterior wall of scar tissue (> 1.0 mm). The third group of capsules was characterised by various degrees of wall calcification (7% of cases). CONCLUSIONS: The extent and nature of scar tissue structure in the CIED pocket walls seem to correlate with the relative position of cardiac lead loops with respect to the device itself; where the more extensive scarring is likely to result from pocket wall irritation in the capsule formation phase due to lead movements underneath the device. The group of cases with calcified capsules was characterised by "old" device pockets (> 13 years) and the oldest population (patients in their 80s and 90s).
RESUMEN
Left ventricular function can be assessed with pressure-volume diagrams (DPV). Since there exists a relationship between ventricular volume changes and changes in intraventricular impedance (ZIV), we propose a diagram, DPZ, obtained from the intraventricular pressure (PIV) and the ZIV signals. This method was tested in 10 anesthetized mongrel dogs (morphine, sc, 30 mg/kg, and pentobarbital, sc, 5-7 mg/kg). PIV was measured with a Millar microtip catheter advanced under fluoroscopy via the femoral artery. ZIV was measured with a laboratory impedance meter (100 microA rms constant current, 12 kHz) in a tetrapolar configuration using another intraventricular catheter. ECG, aortic pressure and basal ZIV were also recorded to help identification of the different cardiac cycle phases on the diagram. Single-beat and multiple-beat loops were obtained in bradycardia and tachycardia to test for repeatability. These loops were always of a quadrangular-like shape with clockwise rotation. No attempt was made to calibrate the impedance axis in terms of volume. Apparent small volume changes in the isovolumic phases were probably due to ZIV catheter bending and/or movement. It is suggested that DPZ can serve in itself as a complementary evaluation tool of ventricular function by application of different maneuvers (physical, physiological of pharmacological).