Clinical Effects of Metoprolol Across the Cardiovascular Continuum.

Beta-adrenergetic receptor antagonists cause positive effects across the whole cardiovascular continuum. Compared to non-selective beta-blockers, cardioselective beta-1 blockers have an advantage in patients in whom we wish to avoid beta-2 receptor blockade in the bronchi and peripheral blood vessels, in patients with bronchoobstructive and/or peripheral arterial disease. A negative impact on blood glucose homeostasis and erectile function is to be avoided by selective application. Metoprolol has been internationally known as widely applied and checked cardioselective betablocker for a long time. A series of clinical studies have clearly proved the therapeutic effect of metoprolol in the hypertension, acute and chronic types of coronary heart disease, postinfarction prophylaxis, heart arrhythmia and chronic heart failure syndrome. In all researches, metoprolol has showed good tolerance and safety. If taking proper doses and managing patients properly, the side-effects are rare and reversible. Today, metoprolol succinate is available in Croatia in the form with sustained absorption and gradual plasma clearance with a possibility of a one-day dosage which ensures stable concentration of the drug in the plasma and effects during a period of 24 hours. This is how a safer effect and better cooperation of a patient required for the success of the treatment is achieved

Transvenous Pacemaker Lead Extraction: First Experiences in the University Hospital Centre Rijeka

Posljednih godina dolazi do znatnog porasta broja implantiranih elektrostimulatora srca. Posljedično tomu raste i broj mogućih komplikacija te potreba za njihovom ekstrakcijom. Najčešća indikacija za ekstrakciju elektrostimulatora jest lokalizirana ili sustavna infekcija. S obzirom na to da je riječ o najkompleksnijim i najrizičnijim zahvatima iz područja kardiologije, iz godine u godinu razvijaju se nove tehnike i alati koji znatno olakšavaju ekstrakciju i smanjuju rizik od nastanka mogućih, pokatkad i vrlo teških komplikacija. S obzirom na navedeno, potrebno je organizirati dovoljan broj adekvatnih centara u kojima bi djelovao specijalizirani multidisciplinarni tim educiran za provođenje navedenih zahvata. Od početka 2013. godine na Odjelu za aritmije i elektrostimulaciju Zavoda za kardiovaskularne bolesti Kliničkog bolničkog centra Rijeka započeo je program ekstrakcija elektroda. U razdoblju od dvije i pol godine učinjeno je ukupno 27 zahvata te je uklonjena ukupno 51 elektroda, od čega su dvije bile defibrilatorske. Glavni uzrok ekstrakcije elektroda bila je lokalizirana infekcija / dekubitus lože, dok je sustavna infekcija bila mnogo rjeđa. U postupku ekstrakcije prevladava tehnika trakcije i „locking” stileta. Najznačajnija je komplikacija razvoj simptomatskoga perikardijalnog izljeva. Smrtnih ishoda nije bilo.During recent years there has been a significant increase in pacemaker implantation. Consequently, the number of possible complications and the need for pacemaker lead extraction has grown as well. The most common indication for pacemaker lead extraction is localized or systemic infection. Since lead extraction is among the most complex and dangerous cardiologic procedures, new techniques and tools are being developed on a yearly basis that significantly facilitate extraction and reduce the risk of possible, often very severe, complications. Considering the above, it is necessary to organize enough appropriate centers with specialized multidisciplinary teams trained for the performance of these procedures. Since early 2013, a pacemaker lead extraction program was started at the Department for Arrhythmia and Electrical Stimulation at the University Hospital Centre Rijeka. Over a period of two and a half years, a total of 27 procedures have been performed and 51 pacemaker leads were extracted, of which two were defibrillator leads. The main cause of lead extraction was localized infection/pocket decubitus, while systemic infection was much rarer. Extraction techniques used were predominantly traction and locking stylet extractions. The most significant complication was the development of symptomatic pericardial effusion. There were no fatal outcomes

Long QT syndrome — a cause of sudden death.

Sindrom dugog QT intervala (LQTS) je primarni aritmijski poremećaj koji može dovesti do pojave malignih ventrikularnih aritmija tipa torsades de pointe (TdP) i iznenadne srčane smrti. Obilježja u elektrokardiogramu (EKG) uključuju produljenje korigiranog QT intervala i abnormalnosti T-vala. Do danas identificirana genetska osnova za LQTS uključuje trinaest podložnih gena za LQTS: KCNQ1, KCNH2, SCN5A, ANK2, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP9, SNTA1, i KCNJ5. Najčešći genotip su mutacije KCNQ1 te gotovo polovica pacijenata ima tu vrstu mutacije. Navedeni geni kodiraju ionske kanale i regulatorne proteine koji su uključeni u modulaciju struja srčanog akcijskog potencijala. Stečeni oblici LQTS-a mogu također biti uzrokovani genetskim mutacijama, u tim slučajevima nositelji mutacija razvijaju aritmije isključivo u određenim uvjetima (npr. uporaba određenih lijekova). Trenutna terapija uključuje primjenu beta-blokatora, ugradnju implantabilnog kardioverter defibrilatora (ICD) te simpatičku denervaciju srca. LQTS mutacije povezane su s iznenadnom srčanom smrti kod mladih i veoma mladih; a post-mortem genetska testiranja LQTS gena mogu biti korisna kod procjene uzroka iznenadne neobjašnjive smrti (sudden unexplained death). Kaskadni probir koristan je za identificiranje asimptomatskih članova obitelji koji mogu biti pod povećanim rizikom od iznenadne smrti. U ovom preglednom članku prikazali smo gene povezane s LQTS-om zajedno s opisom povezanih patofizioloških mehanizama.Long QT syndrome (LQTS) is a primary arrhythmic disorder that may lead to the precipitation of torsades de pointe (TdP) and sudden death. Electrocardiogram (ECG) features include prolongation of the corrected QT interval and T-wave abnormalities. The genetic basis of LQTS identified to date includes thirteen susceptibility genes for LQTS: KCNQ1, KCNH2, SCN5A, ANK2, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP9, SNTA1, and KCNJ5. Mutations in KCNQ1 are by far the most frequent genotype with nearly half of the patients carrying KCNQ1 mutations. These genes code for ion channels and regulatory proteins that are involved in the modulation of the currents of the cardiac action potential (AP). Acquired forms of LQTS may also have underlying genetic mutations, in these cases mutation carriers develop arrhythmias only under certain conditions (e.g. use of certain medications). Current therapies include use of beta-blockers, implantable cardioverter defibrillators (ICD) and left cardiac sympathetic denervation. LQTS mutations have been associated with sudden death in the young and very young; and postmortem genetic testing in LQTS genes can be useful when assessing the cause of a sudden unexplained death. Cascade screening is also useful to identify asymptomatic family members that may be at risk of sudden death. Here we have reviewed the genes associated with LQTS along with the description of the related pathophysiological mechanisms

Preporuke za postupanje kod bolesnika sa srčanim implantabilnim elektroničkim uređajima koji su podvrgnuti magnetskoj rezonanci - Radna skupina za aritmije i elektrostimulaciju Hrvatskoga kardiološkog društva

For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.Magnetska rezonanca (MR) dugo je bila kontraindicirana dijagnostička metoda kod bolesnika sa srčanim implantabilnim elektroničkim uređajima (CIED). Danas imamo dovoljno dokaza da se MR može sigurno učiniti kod većine bolesnika s CIED. Prvo, postoje uređaji koji mogu biti podvrgnuti MR prema preporukama proizvođača, a drugo, postoje jasni dokazi da većina uređaja koji nisu označeni kao sigurni za MR od proizvođača također mogu biti podvrgnuti MR. Tijekom godina razvijeni su brojni protokoli kardioloških i radioloških društava, međutim, dio liječnika i dalje oklijeva kod postavljanja indikacije za MR u ove skupine bolesnika. Stoga je Radna skupina za aritmije i elektrostimulaciju srca Hrvatskoga kardiološkog društva u suradnji s radiolozima KBC Sestre milosrdnice pripremila preporuke za postupanje s bolesnicima s CIED koji su podvrgnuti MR

Diagnostic accuracy of heart fatty acid binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) in diagnosis of acute myocardial infarction in patients with acute coronary syndrome

Introduction: This study aimed to assess whether heart fatty acid-binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) could be used for the accurate diagnosis of acute myocardial infarction (AMI) in acute coronary syndrome (ACS) patients. Materials and methods: The study included 108 ACS patients admitted to a coronary unit within 3 h after chest pain onset. AMI was distinguished from unstable angina (UA) using a classical cardiac troponin I (cTnI) assay. H-FABP and GPBB were measured by ELISA on admission (0 h) and at 3, 6, 12, and 24 h after admission; their accuracy to diagnose AMI was assessed using statistical methods. Results: From 92 patients with ACS; 71 had AMI. H-FABP and GPBB had higher peak value after 3 h from admission than cTnI (P = 0.001). Both markers normalized at 24 h. The area under the receiver operating characteristic curves was significantly greater for both markers in AMI patients than in UA patients at all time points tested, including admission (P < 0.001). At admission, the H-FABP (37%) and GPBB (40%) sensitivities were relatively low. They increased at 3 and 6 h after admission for both markers and decreased again after 24 h. It was 40% for H-FABP and approximately 2-times lower for GPBB (P < 0.01). In AMI patients, both biomarkers had similar specificities, positive- and negative-predictive values, positive and negative likelihood ratios, and risk ratios for AIM. Conclusion: H-FABP and GPBB can contribute to early AMI diagnosis and can distinguish AMI from UA

Long QT syndrome — a cause of sudden death.

Sindrom dugog QT intervala (LQTS) je primarni aritmijski poremećaj koji može dovesti do pojave malignih ventrikularnih aritmija tipa torsades de pointe (TdP) i iznenadne srčane smrti. Obilježja u elektrokardiogramu (EKG) uključuju produljenje korigiranog QT intervala i abnormalnosti T-vala. Do danas identificirana genetska osnova za LQTS uključuje trinaest podložnih gena za LQTS: KCNQ1, KCNH2, SCN5A, ANK2, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP9, SNTA1, i KCNJ5. Najčešći genotip su mutacije KCNQ1 te gotovo polovica pacijenata ima tu vrstu mutacije. Navedeni geni kodiraju ionske kanale i regulatorne proteine koji su uključeni u modulaciju struja srčanog akcijskog potencijala. Stečeni oblici LQTS-a mogu također biti uzrokovani genetskim mutacijama, u tim slučajevima nositelji mutacija razvijaju aritmije isključivo u određenim uvjetima (npr. uporaba određenih lijekova). Trenutna terapija uključuje primjenu beta-blokatora, ugradnju implantabilnog kardioverter defibrilatora (ICD) te simpatičku denervaciju srca. LQTS mutacije povezane su s iznenadnom srčanom smrti kod mladih i veoma mladih; a post-mortem genetska testiranja LQTS gena mogu biti korisna kod procjene uzroka iznenadne neobjašnjive smrti (sudden unexplained death). Kaskadni probir koristan je za identificiranje asimptomatskih članova obitelji koji mogu biti pod povećanim rizikom od iznenadne smrti. U ovom preglednom članku prikazali smo gene povezane s LQTS-om zajedno s opisom povezanih patofizioloških mehanizama.Long QT syndrome (LQTS) is a primary arrhythmic disorder that may lead to the precipitation of torsades de pointe (TdP) and sudden death. Electrocardiogram (ECG) features include prolongation of the corrected QT interval and T-wave abnormalities. The genetic basis of LQTS identified to date includes thirteen susceptibility genes for LQTS: KCNQ1, KCNH2, SCN5A, ANK2, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP9, SNTA1, and KCNJ5. Mutations in KCNQ1 are by far the most frequent genotype with nearly half of the patients carrying KCNQ1 mutations. These genes code for ion channels and regulatory proteins that are involved in the modulation of the currents of the cardiac action potential (AP). Acquired forms of LQTS may also have underlying genetic mutations, in these cases mutation carriers develop arrhythmias only under certain conditions (e.g. use of certain medications). Current therapies include use of beta-blockers, implantable cardioverter defibrillators (ICD) and left cardiac sympathetic denervation. LQTS mutations have been associated with sudden death in the young and very young; and postmortem genetic testing in LQTS genes can be useful when assessing the cause of a sudden unexplained death. Cascade screening is also useful to identify asymptomatic family members that may be at risk of sudden death. Here we have reviewed the genes associated with LQTS along with the description of the related pathophysiological mechanisms

Croatian National Data and Comparison with European Practice: Data from the Cardiac Resynchronization Therapy Survey II Multicenter Registry

. The Cardiac Resynchronization Therapy (CRT) Survey II was conducted between October 2015 and December 2016 and included data from 11088 CRT implantations from 42 countries. The survey’s aim was to report on current European CRT practice. The aim of this study was to compare the Croatian national CRT practice with the European data. . Five centres from Croatia recruited consecutive patients, in a 15-month period, who underwent CRT implantation, primary or an upgrade. Data were collected prospectively by using online database. . A total of 115 patients were included in Croatia, which is 33.2% of all CRT implants in Croatia during the study period (total ). Median age of the study population was 67 (61–73) years, and 21.2% were women. Primary heart failure (HF) aetiology was nonischemic in 61.1% of patients, and HF with wide QRS was the most common indication for the implantation (73.5%). 80% of patients had complete left bundle branch block, and over two-third had QRS ≥150 ms. Device-related adverse events were recorded in 4.3% of patients. When compared with European countries, Croatian patients were significantly younger (67 vs. 70 years, ), had similar rate of comorbidities with the exception of higher prevalence of hypertension. Croatian patients significantly more often received CRT-pacemaker when compared with European population (58.3 vs. 29.9%, OR 3.27, 95%CI 2.25–4.74, ). . Our data indicate strict selection of patients among HF population and adherence to guidelines with exception of higher proportion of CRT-pacemaker implantation. This is likely to be influenced by healthcare organization and reimbursement issues in Croatia

DIAGNOSTIC AND PROGNOSTIC VALUE OF HEART FATTY ACID BINDING PROTEINAND GLYCOGEN PHOSPHORYLASE BB ISOENZYMEIN PATIENTS WITH ACUTE CORONARY SYNDROME

Cilj rada.Utvrditi dijagnostičku i prognostičku vrijednost dvaju novih humoralnih biljega nekroze kardiomiocita,srčanog proteina koji veže masne kiseline (H-FABP, prema engleskom„heart fatty acid binding protein“)i BB izoenzima glikogen-fosforilaze(GPBB, prema engleskom„glycogen phosphorylase BB isoenzyme“)u bolesnika s akutnim koronarnim sindromom (AKS), te usporediti sa standardnim biljegom, kardijalnim troponinom I (cTnI).Bolesnici i metode.U prospektivno istraživanje uključeno je200 bolesnika s AKS-om, primljenih u Jedinicuintenzivnog liječenja (Zavodza Kardiovaskularne bolesti,Klinikaza internu medicinu,KBC Rijeka)unutar 12 sati od nastupa boli u prsima. Akutni infarkt miokarda (AIM)je dijagnosticiran u skladu s trenutnim univerzalnim smjernicama. Osim praćenja niza standardnih kliničkih i laboratorijskih varijabli (dob, spol, čimbenici rizika, ranije srčane bolesti, vremenski interval od nastupa boli do prijama, rutinske laboratorijske pretrage), bolesnicima je odreĎivan cTnI, H-FABP i GPBB, u uzorku krvi vaĎenom pri prijamu te nakon 3, 6, 12 i 24 sata. U svih bolesnika odreĎena je krivulja serumske dinamike H-FABP-ai GPBB-ate usporeĎena s dinamikom cTnI-a. Bolesnici su radi daljnje analize podijeljeni u dvije podskupine: a) bolesnike primljene unutar 3 sata od nastupa boli, b) bolesnike primljene nakon 3 sata od nastupa boli. Statistička obrada obuhvatila je odreĎivanje ROCkrivulje(ROC, prema engleskom „Receiver OperatingCharacteristic“)i površine Vpod ROC krivuljom(AUC, prema engleskom „Area Under the Curve“) za tri humoralna biljega (c-statistika), zatim odreĎivanje senzitivnosti, specifičnosti, pozitivne i negativne prediktivne vrijednosti H-FABP-ai GPBB-ate usporedbu s cTnI-om.Rezultati.Od 200 bolesnika s AKS-om92 su primljena unutar tri sata od nastupa boli (46%), a 146 je imalo AIM(73%). Prosječna serumska dinamika H-FABP-ai GPBB-abila je značajno brža od cTnI-a, s ranim vršnim vrijednostima nakon 3 sata od prijama, padom izmeĎu 6 i 12 sati te normalizacijom nakon 24 sata, dok je vršna vrijednost cTnI-abila prisutna nakon 12 sati, s blagim padom te povišenom vrijednošću i nakon 24 sata. Iako je rana senzitivnost H-FABP-a i GPBB-a viša u usporedbi sa senzitivnošću cTnI-a, značajno je viša samo za GPBB (40% prema 24%, p=0.045). Najvećasenzitivnostpostiže se istodobnom kombinacijomdvaju biljega,cTnI-ai GPBB-a(54%, p<0.001). Nakon 3 sata od prijama, senzitivnost sva tri biljega podjednako je visoka. Nadalje, cTnI pokazuje bolju senzitivnost u svim vremenskim intervalima u bolesnika primljenih nakon 3 sata od nastupa AIM-a.Sva tri biljega imaju visoku specifičnost i pozitivnu prediktivnu vrijednost.H-FABP i GPBB nemaju prognostičku vrijednost neovisnog prediktora smrti ubolesnika s AKS-om.Zaključak.Dodatna uporabadvaju novihbiljega, H-FABP-ai GPBB-amože značajno poboljšatilaboratorijsku dijagnostiku u ranoj fazi AKS-a te razlikovanje bolesnika s nestabilnom anginom i onih s infarktom miokardaObjectives.To establish diagnostic and prognostic value of two novel humoral markers of myocardial cell necrosis in patients with acute coronary syndrome (ACS), heart fatty acid binding protein (H-FABP) and glycogen phosphorylase BB isoenzyme (GPBB), compared to standard marker, cardiac troponin I (cTnI).Patients and methods.200 patients with ACS, admitted to our coronary care unit within 12 hours from the onset of chest pain, were prospectively included.Acute myocardial infartion (AMI)was diagnosed according to current universal definition and guidelines. Besides series of standard clinical and laboratory variables (age, gender, risk factors, previous heart disease, pain to admission time, routine laboratory tests), cTnI, H-FABP and GPBB were measured from blood samples taken on admission, 3, 6, 12 and24 hours later. H-FABP and GPBB serum dynamics were generated and compared with cTnI curve. For further analysis patients were divided in two subgroups: a) patients admitted within 3 hours from pain onset, b) those admitted later. Statistical analysis included determination of the ROC curve and the area under the curve (AUC) for three markers (c-statistics), determination of the sensitivity, specificity, positive and negative predictive value of H-FABP and GPBB, and comparison with cTnI.Results. Ninety-twoof 200 patients with ACS were admitted within 3 hours from pain onset (46%), and 146 patients had AMI (73%). The mean serum H-FABP and GPBB VIIdynamics were significantly faster, comparing with cTnI, with early peak values after 3 hours from the admission,falling between 6 and 12 hours, and normalization at 24 hours, while mean peak cTnI value was present after 12 hours, remaining positive after 24 hours. The early sensitivity of H-FABP and GPBB was higher compared with cTnI, significantly only for GPBB (40% vs. 24%, p=0.045). The highest sensitivity was found for the combination of cTnI and GPBB (54%, p<0.001). After 3 hours from admission, the sensitivity of all biomarkers was similarly high. Further on, cTnI was better, as well as at all time intervals in patients admitted more than 3 hours after AMI onset. All three biomarkers had similar high specificity and positive predictive value in all patients.H-FABP and GPBB were notindependent predictorsof mortality in patients with ACS.Conclusion.The additional use of H-FABP and GPBB can significantlyimprove laboratory diagnostics in the early phase of ACS and distinguish between patients with unstable angina and those with AMI

Soluble intracellular adhesion molecule-1 and omentin-1 as potential biomarkers of subclinical atherosclerosis in hemodialysis patients

Purpose. Atherosclerotic cardiovascular complications represent significant cause of mortality in hemodialysis (HD) patients. The aims of this study were to: (a) investigate association of sICAM-1, sVCAM-1, omentin-1 and other non-traditional risk factors with subclinical atherosclerosis ; (b) examine the diagnostic value of these specific markers in the early detection of subclinical atherosclerosis ; and (c) examine their role as predictors of mortality in group of patients with subclinical atherosclerosis on regular HD. Materials and methods. Starting from November 2011, a cohort of 210 HD patients participated in this 3-year follow-up study. The subjects were divided into three groups according to the presence of atherosclerosis. Atherosclerotic disease was assessed by measuring carotid intima-media thickness (IMT). Samplings were withdrawn at baseline and thereafter every 12 months until the end of follow-up. Results. IMT showed weak correlation with sICAM-1 (r = 0.39, P = 0.001), sVCAM-1 (r = 0.27, P = 0.015) and omentin-1 (r = −0.25, P = 0.020), and also omentin-1 showed good correlation with parameters of systolic and diastolic function (r = 0.52, P = 0.001 and r = 0.51, P = 0.001). Multivariate analysis showed that sICAM-1 and sVCAM-1 concentrations were a strong independent correlate of IMT (P = 0.031 and P = 0.010, respectively). The Cox proportional analysis showed that sICAM-1 and omentin-1 concentrations were strong predictors of cardiovascular death (HR 1.85, CI 1.18–2.32, P = 0.021 and HR 4.14, CI 1.38–12.1, P = 0.004, respectively) and that serial measurements of these markers predict IMT progression (HR 1.98, 95% CI 1.21–2.38, P < 0.002 and HR 2.91, 95% CI 1.57–4.72, P < 0.001, respectively). Conclusions. Our study demonstrated that sICAM-1 and omentin-1 levels are strong predictors of cardiovascular death in HD patients with subclinical atherosclerosis

Transvenous Pacemaker Lead Extraction: First Experiences in the University Hospital Centre Rijeka

Posljednih godina dolazi do znatnog porasta broja implantiranih elektrostimulatora srca. Posljedično tomu raste i broj mogućih komplikacija te potreba za njihovom ekstrakcijom. Najčešća indikacija za ekstrakciju elektrostimulatora jest lokalizirana ili sustavna infekcija. S obzirom na to da je riječ o najkompleksnijim i najrizičnijim zahvatima iz područja kardiologije, iz godine u godinu razvijaju se nove tehnike i alati koji znatno olakšavaju ekstrakciju i smanjuju rizik od nastanka mogućih, pokatkad i vrlo teških komplikacija. S obzirom na navedeno, potrebno je organizirati dovoljan broj adekvatnih centara u kojima bi djelovao specijalizirani multidisciplinarni tim educiran za provođenje navedenih zahvata. Od početka 2013. godine na Odjelu za aritmije i elektrostimulaciju Zavoda za kardiovaskularne bolesti Kliničkog bolničkog centra Rijeka započeo je program ekstrakcija elektroda. U razdoblju od dvije i pol godine učinjeno je ukupno 27 zahvata te je uklonjena ukupno 51 elektroda, od čega su dvije bile defibrilatorske. Glavni uzrok ekstrakcije elektroda bila je lokalizirana infekcija / dekubitus lože, dok je sustavna infekcija bila mnogo rjeđa. U postupku ekstrakcije prevladava tehnika trakcije i „locking” stileta. Najznačajnija je komplikacija razvoj simptomatskoga perikardijalnog izljeva. Smrtnih ishoda nije bilo.During recent years there has been a significant increase in pacemaker implantation. Consequently, the number of possible complications and the need for pacemaker lead extraction has grown as well. The most common indication for pacemaker lead extraction is localized or systemic infection. Since lead extraction is among the most complex and dangerous cardiologic procedures, new techniques and tools are being developed on a yearly basis that significantly facilitate extraction and reduce the risk of possible, often very severe, complications. Considering the above, it is necessary to organize enough appropriate centers with specialized multidisciplinary teams trained for the performance of these procedures. Since early 2013, a pacemaker lead extraction program was started at the Department for Arrhythmia and Electrical Stimulation at the University Hospital Centre Rijeka. Over a period of two and a half years, a total of 27 procedures have been performed and 51 pacemaker leads were extracted, of which two were defibrillator leads. The main cause of lead extraction was localized infection/pocket decubitus, while systemic infection was much rarer. Extraction techniques used were predominantly traction and locking stylet extractions. The most significant complication was the development of symptomatic pericardial effusion. There were no fatal outcomes