9^th Annual Meeting on Arrhythmia and Cardiac Surgery July 14-15, 2016 Brisbane, Australia

Jeko Madjarov, is board-certified in general, vascular/endovascular, and cardiothoracic surgery. His clinical interests include adult cardiac and thoracic surgery; aortic surgery, including complex/endovascular aortic repair; and minimally invasive coronary and thoracic surgery. He is a key member of the complex lead extraction program in the department of cardiac electrophysiology. Dr. Madjarov has several patents in the field of diagnosis and treatment of cardiac arrhythmias, endovascular treatment of aortic disease, and complex chest wall reconstruction.Dr. Madjarov received his medical degree summa cum laude from Sofia Medical University, Bulgaria, and completed a cardiac surgery residency at St. Ekaterina University Hospital, Sofia, Bulgaria. In the U.S., he completed general surgery residencies at Yale-New Haven Hospital, New Haven, CT; and Baystate Medical Center/Tufts University School of Medicine, Springfield, MA. He then completed fellowships in vascular/endovascular surgery and cardiovascular/thoracic surgery at Carolinas Medical Center, Charlotte, NC - under Prof. Francis Robicsek. An active inventor, Dr Madjarov is leading several research studies and is also closely involved in the development of new medical technology. He has authored more than 20 publications in peer-review.

Transvenous pacing leads insertion provides good long-term results for implantable cardioverter-defibrillator (ICD). However many factors like venous occlusion, intracardiac shunting, previous surgery or risk of extraction may prohibit or complicate transvenous ICD lead placement. The indications for nontraditional placement of ICD leads have greatly expanded over the past decade especially with the growing population of Adult Congenital patients. The aim of this study was to evaluate the impact of extrapericardial placement of ICD leads for treating ventricular arrhythmia via AntiTachicardic Pacing (ATP) and/or Defibrillation.In vivo studies were performed in 9 female Yorkshire pigs (weight 46.2+/-6.1 kg). Surgical approach via left mini-thoracotomy. The first custom-made bipolar pacing lead was sutured extrapericardially at the level of the lateral wall of the left ventricle (LV) and the second lead was secured in a similar fashion at the level of the basal aspect of the right ventricle without opening the pericardium. The ICD generator was placed into the chest wall. A standard “Shock on T” pacing scheme induced ventricular fibrillation (VF).All ICD systems had acceptable defibrillation thresholds with energy tested at 21J, 29J, 37J x 5. There was no increase in impedance between the coil and generator. There were no inappropriate discharges. Each successful shock converted VF to normal sinus rhythm. The mean R-wave amplitude was 9 mV +/- 4 mV. The mean pacing impedance was 331 Ohms. The mean threshold was 4.8V @ 1.5ms. Extrapericardial placement of ICD leads has demonstrated good performance with stable defibrillator parameter. It appears to be a simple efficacious technique to ICD therapy and in some clinical situations can overcome limitations of transvenous or epicardial approaches as well as provide the ability to deliver ATP which is in stark contrast to currently available technology.

Yuni Twiyarti Pertiwi completed medical school at the age of 25 years from Padjadjaran University, Bandung, Indonesia and now in her Cardiology residency at at third years from Padjadjaran University.

Congenital complete atrioventricular block (CCAVB) is a rare and potentially lethal disease with an estimated incidence of 1 in 15.000 to 20.000 live born infants. Most of the patients with CCAVB have structurally normal hearts, referred to as an ‘isolated’ CCAVB. We present the case of a premature infant with CCAVB who underwent implantation of a permanent pacemaker. The male infant was born at 33 weeks of gestation and weighed 2150 g. Repeat fetal ultrasound assessment before demonstrated fetal cardiomegaly increased at 30 weeks gestation. The decision was made to deliver the baby by cesarean section at 33 0/7 weeks gestation. After birth, the infant showed respiratory distress despite antenatal corticosteroid therapy. There were no clinical signs of hydrops fetalis. The heart rate ranged between 40 and 50 bpm. An electrocardiogram showed that the rate of P wave was 120 bpm and the rate of QRS wave was 50 bpm. The chest x-ray demonstrated dilated heart and echocardiogram showed dilated chambers, small non significant PDA with left to right shunt, no ASD or VSD, and satisfactory contracted ventricles. Respiratory problem was resolved after supportive treatment with temporary pacing. He underwent succesfull implantation of a permanent transepicardial pacemaker (VVIR mode, stimulation rate 120 bpm, output 1,5 mV and sensitivity 2,6 mA). A unipolar epicardial lead was used and the pulse generator was implanted in a pocket made under at the anterior rectus sheath. Surgery was performed without any complications. There was no respiratory problem associated with pacemaker implantations in the abdominal wall. He was discharged at the age of 31 days with a weight of 2350 g. At the 1-year follow up he remains in well condition without any complications. We have reported a case of a CCAVB with succesfull implantation of permanent pacemaker.