8 research outputs found
The impact of His bundle pacing on left ventricle global longitudinal strain in heart failure patients with LBBB ā a pilot study
Cardiac implantable electronic devices and lead removal, single center experience
Introduction: Over the past couple of decades, the use of cardiac implantable electronic devices (CIEDs)
has increased significantly. Because of that and because of increased life expectancy of patients, this
has led to an increase in the number of the device and lead complications. Consequently, there is a
growing need to perform lead removal. Today, lead removal is a specialized procedure with well-defined
indications. Indication for lead removal can be infection (infective endocarditis, pocket infection,
pocket erosion, bacteremia), lead-related (fracture, insulation defect, dislocation-if the lead cannot be
repositioned, dysfunction-for reasons other than lead fracture and insulation defect, CIED upgrade/
need for additional lead(s), perforation) and chronic pain due to a periosteal reaction1. Lead removal
can be explantation (removal of leads with a dwell time of less than 1 year and using simple traction),
extraction (removal of leads with a dwell time of more than 1 year or with the use of specialized equipment
(locking stylets, snares, cutting tools, telescoping and laser sheats) regardless of implant time)
and cardiothoracic surgical procedure.
Patients and Methods: We retrospectively analyzed the characteristics, types of devices, and indications
for lead removal in 70 patients at University Hospital Centre Zagreb between January 2014 and
July 2019.
Results: Average patient age was 67.6 years and most patients were male (74.3%). 78.6% of patients were
on anticoagulation or antiplatelet therapy, and 50% had chronic renal failure or diabetes mellitus. Two
most common indications for lead removal were lead dislocation (28 patients) and pocket infection/
erosion (20 patients). Average lead dwelling time was 27.4 months. 38 explantations, 30 extractions,
and 2 surgical removals were performed. Total of 99 leads was removed, 1.28 per procedure.
Conclusion: The procedure was successful in all patients. There was no recurrence of infection after
infected device extraction. Besides 2 cases of pericardial effusion (which were not hemodynamically
significant), no other major complication (cardiac tamponade, cardiac avulsion, SVC tear, death) were
observed.
LITE RATURE
1. Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy L, et al; ESC Scientific Document Group.2018 EHRA expert consensus statement
on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific
studies and registries: endorsed by APHRS/HRS/LAHRS. Europace. 2018 Jul 1;20(7):1217. https://doi.org/10.1093/europace/euy050
Arrhythmias and Electrophysiology
Extended Abstrac
Early experience with subcutaneous implantable cardioverter-defibrillators: results from an emerging implantation centre
Preporuke za perioperacijski postupak kod bolesnika koji imaju ugraÄene kardiovaskularne implantabilne elektroniÄke ureÄaje
Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.U Republici Hrvatskoj na godinu se implantira oko 4000 kardiovaskularnih implantabilnih ureÄaja i taj broj je u stalnom porastu. Anestezija i kirurÅ”ki zahvati kod bolesnika s ugraÄenim implantabilnim ureÄajima nose odreÄene rizike. Ove smjernice su nastale zato Å”to se veÄina zahvata izvodi u ustanovama bez moguÄnosti testiranja i reprogramiranja navedenih ureÄaja ili u vrijeme kada to nije dostupno. Cilj je standardizirati perioperacijsku skrb ovih bolesnika te uÄiniti kirurÅ”ke zahvate dostupnima i sigurnima za veliku veÄinu ovih kirurÅ”kih bolesnika u svim ustanovama u Hrvatskoj
Gender differences in response to CRTD therapy in patients with valvular regurgitation
Introduction: Patients with symptomatic chronic heart failure (sCHF) and implanted cardiac resynchronization device (CRTD) were included in this retrospective study in order to evaluate possible differences in mitral (MR) and tricuspid (TR) valvular regurgitation severity, NYHA class and left ventricle ejection fraction (LVEF) between male and female CRTD patients during follow up of 6 months after CRTD implantation.
Patients and Methods: We included 135 patients (89 men, 46 women) with sCHF due to any cause with implanted CRTD according to guidelines with optimal medical therapy regardless of atrial fibrillation
or in sinus rhythm. Clinical (NYHA class) and echocardiographic data (valve pathology, LVEF) were assessed before and 6 months after CRTD implantation. Using color and continuous wave Doppler, PISA, regurgitation volume and vena contracta measurements, mitral regurgitation (MR) and tricuspid regurgitation (TR) were stratified in 3 grades. Echocardiography was recorded always by the same echo-technician to avoid inter-observer variability.
Results: Mean age of patients was 60 (Ā±10) years. The results showed improvement in LVEF from 25% up to 36% (p=0.006) in all patients regardless of sex and age, as well as worsening of TR (p<0.001) and
no difference in MR (p=0.195). In male patients (N=89), significant worsening in MR and TR was present (p<0.05) while there was no significant worsening in MR (p=0.42) nor TR (p=0.06) in female patients (N=46). In patients older than 60 years (N=82, female 27 (33%), male 55 (67%)), as well as younger than 60 years (N=53; female 19 (36%), male 34 (64%)) significant worsening of TR grade was observed (p<0.05), while the grade of MR remained the same (p=0.255 and p=0.534). An improvement in NYHA class was observed in 75 patients (71%), no change in 25 patients (24%) and worsening in 5 patients (5%). Overall improvement in NYHA class was statistically significant (p<0.001).
Conclusion: Six months after CRTD implantation the severity of MR and TR remained the same in female patients while significant worsening of MR and TR severity was found in male patients. TR worsening might be due to implanted electrodes. The age of patients had no impact on LVEF, TR and MR change. Despite improvement in clinical status and NYHA class, the echocardiography results did not meet our expectations.1-4 Due to limited number of patients the results were not divided according to the etiology of CHF
Primjena ruÄne metode intrakrdijalnih elektrograma odgovarajuÄa je zamjena ehokardiografskoj atrioventrikulskoj i inter-ventrikulskoj optimizaciji resinkronizacijskoga elektrostimulatora srca
Some manufacturers do not provide automated intracardiac electrogram method (IEGM) systems for atrioventricular (AV) and interventricular (VV) delay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the accuracy of manual IEGM method in 48 patients previously implanted with Medtronic Syncra CRT. All patients underwent standard device interrogation followed by CRT optimization by IEGM method and by echocardiography one month after implantation. The patient mean age was 60.7Ā±11.8 years and there were 33 (68.8%) males. After CRT implantation, the left ventricular ejection fraction increased from 28.0Ā±7.9% to 39.1Ā±11.0% (p<0.001). Optimal aortic flow Velocity Time Integral (aVTI) was obtained when VV was set to 20-50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (R=0.823, p<0.001). We found no significant difference in AV, VV and aVTI values between echocardiography and IEGM method. However, IEGM was significantly less time-consuming than echocardiography [20 (10-28) vs. 40 (35-60) minutes, p<0.001]. Manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems in as many CRT devices as possible.Neki proizvoÄaÄi nemaju automatski sustav intrakardijalnog elektrokardiograma (IEGM) za atrioventrikulsku (AV) i in-terventrikulsku (VV) optimizaciju u srÄanoj resinkronizacijskoj terapiji (CRT). Cilj ovoga istraživanja bio je procijeniti toÄnost ruÄnog namjeÅ”tanja IEGM kod bolesnika s ugraÄenom CRT. U istraživanje je bilo ukljuÄeno 48 bolesnika kojima je prethodno ugraÄen Medtronic Syncra CRT. Jedan mjesec nakon ugradnje svim bolesnicima je uÄinjena standardna kontrola elektrostimulatora, nakon Äega je uÄinjena optimizacija CRT, prvo metodom IEGM, a potom ultrazvuÄno. Srednja dob Ābolesnika bila je 60,7Ā±11,8 godina; bila su 33 (68,8%) muÅ”karca. Nakon ugradnje CRT, ejekcijska frakcija lijeve klijetke Ānarasla je s 28,0Ā±7,9% na 39,1Ā±11,0% (p<0,001). NajveÄi integral brzine protoka nad aortnom valvulom (aVTI) dobiven je pri VV intervalu od 20-50 ms lijeve preekscitacije. UtvrÄena je snažna korelacija izmeÄu trajanja VV intervala dobivenog ultrazvuÄno i IEGM (R=0,823, p<0,001). Nismo naÅ”li statistiÄki znaÄajnu razliku izmeÄu vrijednosti AV, VV i aVTI Ādobivenih ultrazvuÄno i metodom IEGM. Ipak, metoda IEGM zahtijeva bitno manje vremena od ultrazvuÄne metode [20 (10-28) prema 40 (35- 60) minuta, p<0,001]. NaÅ”e istraživanje pokazuje da ruÄna metoda IEGM može biti dobra alter-naĀtiva ehokardiografskoj optimizaciji i automatskoj metodi IEGM. TakoÄer ukazuje na potrebu omoguÄavanja automatske IEGM optimizacije kod Å”to viÅ”e CRT ureÄaja
Recommendations for Perioperative Management of Patients with Cardiac Implantable Electronic Devices
Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients