Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study

Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population

Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951

Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients

Background: Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods: Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2: < 80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. Results: Our analysis included 1316 patients (group 1: 202; group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities, more pacemakers than implantable cardioverter-defibrillators, whereas the dwelling time of the oldest lead and the number of leads were similar, irrespective of patient's age. In group 1, the radiological success rate for lead was higher (99.0% vs 95.9%; P <.001) and the fluoroscopy time lower (13.0 vs 15.0 min; P =.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P =.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P =.24) and with no procedure-related deaths in elderly group. Conclusions: Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure

Utility of risk scores to predict adverse events in cardiac lead extraction

Introduction: Increasing device implantations, patient comorbidities, and longer life expectancy contribute to an increased need for lead extraction. Even if transvenous lead extraction (TLE) is a highly successful procedure, some serious procedural complications are reported. In order to identify those patients who are at higher risk, risk stratification scores were proposed. Areas covered: The major obstacles to lead extractions are represented by the body’s response to the foreign implanted material and by the following development of fibrotic reaction between the lead and the vascular system. Several clinical factors and device features are associated with major complications and worse outcomes. Although different multiparametric scores predicting the safety and the efficacy of TLE procedures were reported, none of these scores were prospective evaluated. Expert commentary: A correct risk stratification is needed in order to refer complex patients to centers with proven experience and avoid futile procedures. Furthermore, the identification of high-risk patients allows to perform the extraction procedure in the operating room instead of electrophysiology lab. Albeit some risk scores able to predict adverse event in cardiac lead extraction were described, there are still several limitations to their use and reproducibility

A Transvenous removal of pacing and ICD leads: single italian referral center experience.

Introduction: Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center. Methods: since January 1997 to December 2019, we managed 2769 consecutive patients (2100 men, mean age 65.5 years) with 5086 leads (mean pacing period 73.6 months, range 1-576). PL were 3998 (1828 ventricular, 1704 atrial, 466 coronary sinus leads), DL were 1088 (1067 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 79% (systemic 27%, local 52%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools; an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach. Results: Removal was attempted in 5076 leads because the technique was not applicable in 10 PL. Among these, 4952 leads were completely removed (97.6%), 49 (1.0%) partially removed, 75 (1.4%) not removed. Among 4989 exposed leads, 818 were removed by manual traction (16.4%), 3664 by mechanical dilatation using the venous entry site (73.4%), 48 by femoral approach (FA) (1.0%) and 335 by JA (6.7%). All the free-floating leads were completely removed, 25.3% by FA and 74.7% by JA. Major complications occurred in 20 cases (0.72%): cardiac tamponade (19 cases, 4 deaths), hemotorax (1 death). Conclusions: our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads

The in-ear region as a novel anatomical site for ECG signal detection: validation study on healthy volunteers

Purpose: Early detection of cardiac arrhythmias is a major opportunity for mobile health, as wearable devices nowadays available can detect single-lead electrocardiogram (ECG). The study aims to validate the in-ear region as a new anatomical site for ECG signal detection and looks towards designing innovative ECG wearable devices. Methods: We performed ECG using KardiaMobile device (AliveCor®) on 35 healthy volunteers. First, ECG was detected by standard modality using both hands. Then, ECG was detected using the left in-ear region instead of the right hand. All the recorded ECGs were analyzed by the device and by two cardiologists in blind testing. Results: We successfully collected 70 ECGs performed on 35 volunteers (male 54%, age 39.1 ± 10.7 years; BMI 22.9 ± 2.89 kg/m2) with no differences observed by KardiaMobile in ECG reports detected in the two different modalities. All the ECGs were reported as normal by the device and the two cardiologists. Moreover, linear regression analysis showed good correlation between the amplitude (mV) of P (r = 0.76; r2 = 0.57; p < 0.0001) and QRS waves (r = 0.81; r2 = 0.65; p < 0.0001), the intervals (ms) of PR (r = 0.91; r2 = 0.83; p < 0.0001; LOA − 0.60–0.41; CC = 0.91), QRS (r = 0.78; r2 = 0.61; p < 0.0001; LOA − 0.49–0.43; CC = 0.78), QT (r = 0.85; r2 = 0.71; p < 0.0001; LOA − 1.31–1.20; CC = 0.85), and heart rate (r = 0.94; r2 = 0.89; p < 0.0001; LOA − 7.82–7.76; CC = 0.94) detected in two different modalities. Conclusion: The in-ear region is a reliable novel anatomical site for ECG signal detection in normal healthy subjects. Further studies are needed to validate this new ECG detection modality also in case of cardiac arrhythmias and to support the development of new wearable devices

The in-ear region as a novel anatomical site for ECG signal detection: validation study on healthy volunteers

Purpose Early detection of cardiac arrhythmias is a major opportunity for mobile health, as wearable devices nowadays available can detect single-lead electrocardiogram (ECG). The study aims to validate the in-ear region as a new anatomical site for ECG signal detection and looks towards designing innovative ECG wearable devices. Methods We performed ECG using KardiaMobile device (AliveCor (R)) on 35 healthy volunteers. First, ECG was detected by standard modality using both hands. Then, ECG was detected using the left in-ear region instead of the right hand. All the recorded ECGs were analyzed by the device and by two cardiologists in blind testing. Results We successfully collected 70 ECGs performed on 35 volunteers (male 54%, age 39.1 +/- 10.7 years; BMI 22.9 +/- 2.89 kg/m(2)) with no differences observed by KardiaMobile in ECG reports detected in the two different modalities. All the ECGs were reported as normal by the device and the two cardiologists. Moreover, linear regression analysis showed good correlation between the amplitude (mV) of P (r = 0.76; r(2) = 0.57; p < 0.0001) and QRS waves (r = 0.81; r(2) = 0.65; p < 0.0001), the intervals (ms) of PR (r = 0.91; r(2) = 0.83; p < 0.0001; LOA - 0.60-0.41; CC = 0.91), QRS (r = 0.78; r(2) = 0.61; p < 0.0001; LOA - 0.49-0.43; CC = 0.78), QT (r = 0.85; r(2) = 0.71; p < 0.0001; LOA - 1.31-1.20; CC = 0.85), and heart rate (r = 0.94; r(2) = 0.89; p < 0.0001; LOA - 7.82-7.76; CC = 0.94) detected in two different modalities. Conclusion The in-ear region is a reliable novel anatomical site for ECG signal detection in normal healthy subjects. Further studies are needed to validate this new ECG detection modality also in case of cardiac arrhythmias and to support the development of new wearable devices

Safety of transvenous mechanical lead extraction in patients with abandoned leads.

Background: The optimal management of redundant or malfunctioning leads is controversial. Objective: We aimed to evaluate the safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. Methods: We analyzed all TLE procedures performed in our center from January 2009 to December 2017. We evaluated safety and efficacy of mechanical TLE in patients with abandoned (group 1) compared to notabandoned (group 2) leads. Results: We analyzed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with 617 abandoned leads (26%). The total number of leads (3.0 vs 2.0), dwell time of the oldest lead (108.00 months vs 60.00 months) and infectious indication for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs 98.1%; P<0.001). Major complications occurred in only 9 patients (0.7 %), without significant differences among the two groups. The presence of one or more abandoned leads (OR 3.47; 95% IC: 1.07-11.19; P=0.037) and the dwell time of the oldest lead (OR 1.01 for month; 95% IC: 1.01-1.02; P<0.001) were associated with higher risk of clinical unsuccess. Conclusions: Transvenous Mechanical lead extraction is a safe procedure also in high risk settings, like patients with abandoned leads. Success rate resulted a bit lower, especially in presence of abandoned leads with a long implantation time