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

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

Soluble adhesion molecules in patients with acute coronary syndrome after percutaneous coronary intervention with drug-coated balloon, drug-eluting stent or bare metal stent

Adhesion molecules play an important role in inflammation, atherosclerosis and coronary artery disease (CAD). These molecules are expressed on the surface of dysfunctional endothelial cells, causing inflammatory cells from the circulation to adhere and migrate through the endothelium. Their expression is upregulated in acute coronary syndrome (ACS) and after percutaneous coronary intervention (PCI). The contact between stent struts and endothelium upregulates endothelial cell gene expression, endothelial cell activation and inflammation. The paclitaxel or sirolimus eluting stents inhibited expression of adhesion molecules in several studies and reduced the incidence of major adverse cardiac events (MACE) after drug-eluting stent (DES) over bare metal stent (BMS) implantation. Therefore, we propose that elevated serum levels of the soluble adhesion molecules after primary PCI in patients treated with BMS or DES implantation versus drug-coated balloon (DCB) application to the vulnerable coronary plaque might be a predictor of MACE and further adverse outcomes. Consequently, DCB-only strategy in patients with ACS might be a superior approach in comparison to BMS implantation and non-inferior approach when compared to DES implantation

Drug-Coated Balloon Versus Drug-Eluting Stent in Primary Percutaneous Coronary Intervention : A Feasibility Study

Drug-eluting stents (DES) represent a significant evolution in the treatment of patients with acute myocardial infarction with ST elevation. However, stent-related adverse events have led to an introduction of drug-coated balloons (DCB) applied particularly to bifurcation lesions, in-stent restenosis and small vessel disease. The aim of this study was to determine whether DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary percutaneous coronary intervention (pPCI). Seventy-five STEMI patients were randomized into DES and DCB groups of 37 and 38 patients, respectively. The study end-points were major adverse cardiac events and the late lumen loss during the 6 months following the pPCI. Reinfarction occurred in 5.4% of patients in the DES and 5.3% of patients in the DCB group after 1 month (risk ratio = 1.03, 95% CI [0.15-6.91], P = 0.98). After 6 months, major adverse cardiac events were reported in 5.4% of patients in the DES group and none in the DCB group (risk ratio = 5.13, 95% CI [0.25-103.42], P = 0.29). Late lumen loss in the DES group was 0.10 ± 0.19 mm and −0.09 ± 0.09 mm in the DCB group (P < 0.05). A DCB-only strategy is safe and feasible in the pPCI setting, and showed good clinical and angiographic outcomes in 6 months follow-up period

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