Clinical utility of intracardiac echocardiography in transvenous lead extraction

The epidemics of heart failure and an aging population resulted in an exponential rise in the use of cardiac implantable devices (CIEDs) in developed countries. This is paralleled by the increased rate of complications such as system infection or malfunction. The higher number of complications, and longer patient life expectancies, are followed by an increase in the need for lead extractions.&nbsp

Effectiveness of ICD therapy in real clinical practice. The Olomouc ICD Registry

Background. Clinical parameters linked to a low benefit of ICD implantation and increased mortality risks are needed for an individualized assessment of potential benefits and risks of ICD implantation. Methods. Analysis of a prospective registry of all patients hospitalized from 2009 to 2019 in a single centre for a first implantation of any type of ICD. Results. A total of 2,681 patients were included in the registry. Until the end of follow-up (38.4 ± 29.1 months), 682 (25.4%) patients died. The one-year mortality in all patients, the one-year CV mortality, the three-year mortality in all patients, and the three-year CV mortality were 7.8%, 5.7%, 20.6%, and 14.8%, respectively. There was a statistically significant difference when the subgroups were compared according to the type of cardiomyopathy. No significant difference was found between primary and secondary prevention and between the types of devices. Male gender, age ≥ 75 years, diabetes mellitus, and atrial fibrillation were associated with a significantly increased mortality risk. Conclusion. In an analysis of a long-term follow-up of 2,681 ICD patients, we found no mortality difference between patients with ischemic or non-ischemic cardiomyopathy and in the device type. A higher mortality risk was found in men, patients older than 75 years, diabetics, and those with atrial fibrillation

General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation

Background. Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) is used is not entirely known. Methods. 150 patients with paroxysmal AF were randomized to point-by-point radiofrequency catheter isolation of pulmonary veins (PVI) under general anesthesia (n=77) or conscious sedation (n=73). Adenosine-mediated dormant conduction was eliminated in all patients. Antiarrhythmic medication was discontinued after PVI. During twelve months of follow-up, all patients underwent four times 7-day ECG monitorings. Results. There was no difference between groups in AF recurrence (28.6% vs. 31.5%, P=0.695). Patients in conscious sedation had longer procedure times (160 ± 32.1 vs. 132 ± 31.5 min, P<0.001), longer RF energy application times (40 ± 15 vs. 29 ± 11 min, P<0.001) and longer fluoroscopy times (6.2 min ± 5.3 vs. 4.3 min ± 2.2, P<0.001) with similar complication rates. Conclusion. Conscious sedation is not inferior to general anesthesia in regard to arrhythmia recurrence or complication rates of catheter ablation of paroxysmal atrial fibrillation. However, it is associated with longer procedure times, longer time of radiofrequency energy application and longer fluoroscopy times

Baseline characteristics of patients after matching according to type of heart failure.

<p>*/**Statistical significance of differences between groups tested by the ML chi-square test for categorical variables and by the independent Student’s <i>t</i>-test for continuous variables</p><p>*/**p<0.05/p<0.001</p><p>^aParameters used in a logistic regression model of a propensity score</p><p>^bMedication at discharge was computed on patients who were alive after discharge</p><p>LVEF—left ventricular ejection fraction, BP—blood pressure, MI—myocardial infarction, TIA—transient ischemic attack, PCI—percutaneous coronary intervention, CABG—coronary artery bypass graft, PM—pacemaker, ICD—implantable cardioverter–defibrillator, CRT—cardiac resynchronization therapy, COPD—chronic obstructive pulmonary disease, ARB—angiotensin-2 receptor blockers.</p><p>Baseline characteristics of patients after matching according to type of heart failure.</p

Baseline characteristics of patients before and after matching.

<p>*/**Statistical significance of differences between groups was tested by the ML chi-square test for categorical variables and by the independent Student’s <i>t</i>-test for continuous variables</p><p>*/**p<0.05/p<0.001</p><p>^aParameter used in a logistic regression model of a propensity score</p><p>^bParameter was not known for all patients, and statistics were computed on a reduced basis</p><p>^cMedication at discharge was computed on patients who were alive after discharge</p><p>LVEF—left ventricular ejection fraction, BP—blood pressure, MI—myocardial infarction, TIA—transient ischemic attack, PCI—percutaneous coronary intervention, CABG—coronary artery bypass graft, PM—pacemaker, ICD—implantable cardioverter–defibrillator, CRT—cardiac resynchronization therapy, COPD—chronic obstructive pulmonary disease, ARB—angiotensin-2 receptor blockers.</p><p>Baseline characteristics of patients before and after matching.</p

Long-term mortality for all patients according to a BMI of 25 kg/m² in a non-balanced and balanced dataset and for ADHF and <i>de novo</i> AHF patients.

<p>Long-term mortality for all patients according to a BMI of 25 kg/m² in a non-balanced and balanced dataset and for ADHF and <i>de novo</i> AHF patients.</p

Definition of datasets.

<p>Definition of datasets.</p

Thirty-day mortality according to the BMI category and type of heart failure.

<p>Thirty-day mortality according to the BMI category and type of heart failure.</p