81 research outputs found
Mechanical transvenous extraction of endocardial implantable cardioverter defibrillator leads: feasibility, safety and determinants of success in the pisa experience
No full textIntroduction: Transvenous extraction of implantable electric devices is a well known procedure, almost described and documented for pacing leads, with small series for implantable cardioverter defibrillator (ICD) leads. Aim of our study was to describe a large single center experience in implantable cardioverter defibrillator (ICD) leads extraction by transvenous mechanical technique.
Methods: Since 1997 to June 2010, 352 consecutive patients (309 men, mean age 62.1 years, range 8-92) with 378 ventricular ICD leads (mean implantation time 42.2 months, range 1-204) underwent a mechanical transvenous removal. System features included almost left side implanted systems (92%) with passive fixation (76%) and dual coil (74%) leads. The most common indication for lead extraction was local infection (174 patients, 49%), followed by sepsis (95 patients, 27%) and lead malfunction (83 patients, 24%).
Results: Removal was feasible with a complete success in all the approached leads (100%). 23 leads (6%) were removed by manual traction, 355 by mechanical dilatation, whose 321 (85%) using the venous entry site approach and 34 (9 %) by the transvenous jugular approach crossover. Mean extraction time was 21±31.7 min (range 1-210). No major complications occurred. Dual coil compared with single coil leads showed an higher rate of fibrous adherences at the innominate vein (69% vs 52%, respectively) and superior vena cava (70% vs 51 %, respectively), without differences in the other sites. Comparing the easy ("traction" group) with the complex approach ("transjugular" group), all baseline patient and leads features resulted comparable (p =NS), with the only exception for the lead implantation time that resulted statistically longer in the second group (10.4±10.3 vs 64.3±36.7 min, p<0.01, respectively).
Conclusions: Our large experience shows that transvenous ICD leads removal is a feasible, safe procedure with an high success rate. However, even if the mean dwell time is usually lower than pacing leads, manual traction is rare effective and often transjugular approach may be required
His-bundle pacing to treat an unusual case of chest pain after pacemaker implant
No full textA 63-year-old man with hypertension and 3-vessel coronary artery disease previously treated with coronary artery bypass graft was admitted to our emergency room complaining of chest pain. He had undergone pacemaker implant 5 months before due to paroxysmal advanced atrioventricular block. Electrocardiography and troponin testing were unremarkable. Echocardiography and chest X-ray ruled out lead displacement and perforation. Interrogation showed normal parameters [right atrium: impedance 550 Ohm bipolar, sensing 2.4 mV bipolar; threshold 0.50 V/0.4 ms bipolar; right ventricle (RV): impedance 580 Ohm bipolar, sensing > 25 mV bipolar; threshold 1.5 V/0.4 ms bipolar and 0.4 V/0.4 ms unipolar]. Pain was evoked only during RV pacing. An electrophysiology study demonstrated painful RV pacing from multiple sites. We hypothesized that pain was associated with pacing-induced dyssynchrony. His-bundle pacing (HBP) was considered as a solution. We achieved HBP with a bipolar fixed-screw catheter connected to a cardiac resynchronization therapy pacemaker generator. During HBP above threshold (4.00 V/1.00 ms) the patient did not complain of any pain. He was discharged 3 days later pain-free with His-bundle lead amplitude set at 5.00 V/1.00 ms. After 6 months the patient was asymptomatic, with the device showing normal functioning. This is the first clinical experience of painful RV pacing treated with HBP. Learning objective: Painful right ventricular pacing in the absence of perforation is a rare but potentially underdiagnosed condition. Ventricular dyssynchrony could represent the underlying mechanism. Physiological electromechanical activation achieved via His-bundle pacing could represent an effective therapeutic option
Descrizione e studi dell'insigne fabbrica di S. Maria del Fiore metropolitana fiorentina
No full textin varie carte intagliati da Bernardo Sansone Sgrilli architetto e dal medesimo dedicati all'Altezza Reale di Gio: Gastone I. Granduca di ToscanaGest. Titelvignette mit Wappen des Widmungsempfängers (gest. von B.S. Sgrilli nach Vorlage von G.D. Campiglia), Portr. von Giovanni Battista Nelli, ital. Architekt, 1661-1725 (gest. von V. Franceschini nach Vorlage von G.D. Ferretti), 17 Kupfertafeln (gest. von B.S. Sgrilli zumeist nach Vorlagen von G.B. Nelli, davon 16 doppelblgr., numm. Fig. I-XVII, davon Fig. VII und VIII auf 1 Taf., Fig. XIII½ auf ganzseit. Taf.), gest. Vignetten und Initialen, ZierstückeTitelbl. in Rot- und SchwarzdruckErscheinungsjahr im Impressum in römischen Ziffern vor der Verlagsangabe genannt (Vorlageform des Erscheinungsvermerks: In Firenze L'Anno MDCCXXXIII. Per Bernardo Paperini)Widmung von B.S. Sgrilli an Gian Gastone (de' Medici), Grossherzog der Toskana (1671-1737) auf dem Titelbl. und auf Bl. []₂recto-A₂verso (dort datiert: 18. Aug. 1733)Enth. auf Bl. L₂r-v zwei Lobgedichte (unterz.: "Al. Gh.") auf das Werk und den Verf. des erläuternden Textes, Girolamo Ticciati (Bildhauer und Architekt, 1676 - nach 1740), vgl. "Dedicatoria" (Bl. A₁r-v)Lose Beilage: 2 Ausschnitte aus Antiquariatskataloge
A Modified Transvenous Single Mechanical Dilatation Technique to Remove a Chronically Implanted Active-Fixation Coronary Sinus Pacing Lead
No full textWe described a 77-year-old patient, previously implanted with a dual-chamber pacemaker later upgraded to a cardiac resynchronization therapy-defibrillator (CRT-D) device with an active-fixation coronary sinus pacing lead, who underwent a transvenous mechanical extraction procedure for a device-related systemic infection. All leads were removed successfully with a transvenous approach. With regard to the coronary sinus (CS) lead (Attain 4195 StarFix, Medtronic Inc., Minneapolis, MN, USA), manual traction was ineffective and extraction required long and challenging mechanical dilatation up to distal CS using either conventional sheaths or modified CS lead delivery. (PACE 2011; 34: e66-e69
Where is the future of cardiac lead extraction heading?
No full textIntroduction: Transvenous lead extraction (TLE) is the gold standard for lead removal. The increasing rate of cardiac implantable electronic device (CIED) implantations and of CIED related complications highlight the importance of transvenous lead extraction. Areas covered: The TLE scenario is constantly changing. Optimizing lead related technology and improving TLE practice across the world are the cornerstones to improving safety and efficacy. We review the state of the art in TLE, focusing on potential future implications and improvements in terms of skills and technologies. Expert commentary: The increased number of extractions will increase the necessity of safe and effective TLE. New technologies, techniques and appropriate training is warranted across the world
Transvenous removal of pacing and ICD leads: single italian referral center experience.
No full textIntroduction: 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 2014, we managed 2250 consecutive patients (1718 men, mean age 65.3 years) with 4114 leads (mean pacing period 71.8 months, range 1-576). PL were 3328 (1582 ventricular, 1391 atrial, 355 coronary sinus leads), DL were 786 (765 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 83% (systemic 28%, local 55%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique (Cook Vascular - Leechburg PA, USA) and if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); 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 4105 leads because the technique was not applicable in 9 PL. Among these, 4019 leads were completely removed (97.9%), 44 (1.1%) partially removed, 42 (1.0%) not removed. Among 4020 exposed leads, 625 were removed by manual traction (15.5%), 2998 by mechanical dilatation using the venous entry site (74.6%), 32 by femoral approach (FA) (0.8%) and 279 by JA (7.0%). All the free-floating leads were completely removed, 25.8% by FA and 74.2% by JA. Major complications occurred in 13 cases (0.6%): cardiac tamponade (12 cases, 2 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
Carlo Goldoni, I puntigli domestici
No full textl testo critico della commedia goldoniana è stato allestito sulla princeps Paperini dopo la collazione di tutti i testimoni a stampa e l’individuazione della loro parentela in uno stemma codicum. Dalla collazione è emersa la diversità delle due versioni contenute nei testimoni d’autore cioè la princeps Paperini e la ristampa Pasquali, individuando così varianti d’autore. Al testo critico si affiancano un commento e uno studio storico culturale sulla fortuna editoriale e teatrale della commedia
Role of pre-procedural CT imaging on catheter ablation in patients with atrial fibrillation: procedural outcomes and radiological exposure
No full textBackground: Cardiac computed tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. The aim of the study was to determine the impact of pre-procedural cardiac CT with 3D reconstruction on procedural outcomes and radiological exposure in patients who underwent radiofrequency catheter ablation (RFA) of AF. Methods: In this registry, 493 consecutive patients (age 62 ± 8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent first procedure of RFA were included. A pre-procedural CT scan was obtained in 324 patients (CT group). Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3D electroanatomical navigation system. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT group) and without (no CT group) pre-procedural cardiac CT. Results: Acute PV isolation was obtained in all patients, with a comparable overall complication rate between CT and no CT group (4.3% vs 3%, p = 0.7). No differences were observed about mean duration of the procedure (231 ± 60 vs 233 ± 58 min, p = 0.7) and fluoroscopy time (13 ± 10 vs 13 ± 8 min, p = 0.6) among groups. Cumulative radiation dose resulted significantly higher in the CT group compared with no CT group (8.9 ± 24 vs 4.8 ± 15 mSv, P = 0.02). At 1 year, freedom from AF/atrial tachycardia were comparable among groups (CT group, 227/324 (70%), vs no CT group,119/169 (70%), p = ns). Conclusions: Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure
Transvenous removal of pacing and defibrillating leads: the pisa experience.
No full textIntroduction: Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is today a highly effective technique. Device related complications are currently rising the need of Transvenous Lead Removal (TLR). Aim of this report is to analyse the longstanding experience performed in a single Italian Center.
Methods: since January 1997 to December 2010, we managed 1627 consecutive patients (1238 men, mean age 65.7 years, range 3-95) with 2914 leads (mean pacing period 70.2 months, range 1-420). PL were 2485 (1303 ventricular, 1011 atrial, 171 coronary sinus leads), DL were 429 (409 ventricular, 6 atrial, 14 superior vena cava leads). Indications to TLR were sepsis in in 28%, local infection in 55% and noninfectice indication in 17% of the leads. We performed mechanical dilatation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and, if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); a Internal Trans-Jugular Approach (JA) through the internal jugular vein was performed in case of free-floating leads or failure of standard approach.
Results: Removal was attempted in 2906 leads because the technique was not applicable in 8 PL. Among these, 2852 leads (2423 PL, all the 429 DL) were completely removed (98.1%), 29 (1%) partially removed, 25 (0.9%) not removed. Among 2825 exposed leads, 434 were removed by manual traction (15.4%), 2117 by mechanical dilatation using the venous entry site (74.9%), 15 by femoral approach (FA) (0.5%) and 205 by JA (7.2%). All the free-floating leads were completely removed, 24.7% by FA and 75.3% by JA. Major complications occurred in 10 cases (0.61%): cardiac tamponade (9 cases, 2 deaths), hemotorax (1 death).
Conclusions: our experience shows that in centers provided with wide experience, TLR using mechanical dilation has a high success rate and a low incidence of serious complications. The use of the JA allows a very high effectiveness and safety in case of free-floating or difficult exposed leads
- …
