Journal of Interventional Cardiac Electrophysiology最新文献

Introduction: The optimal reimplantation strategies following the removal of infected cardiovascular implantable electronic devices (CIEDs) remain inadequately understood. Given the limitations and risks associated with traditional approaches, the investigation of alternative devices, such as leadless pacemakers (LPs), has gained attention due to their potentially lower infection risk.

Methods: We reviewed literature sources including PubMed, Scopus, and Embase, utilizing a combination of search terms. The inclusion criterion was leadless pacemaker (LP) implantation following lead removal (LR) of infected CIEDs, while the exclusion criterion was LR for noninfectious indications. Study endpoints encompassed patient outcomes during follow-up.

Results: Our literature review yielded 827 articles, of which 22 met the inclusion criteria, encompassing a cohort of 657 patients who underwent LR followed by LP implantation. A total of 295 (44.9%) patients underwent concurrent LP implantation during the LR procedure. The rest underwent delayed procedures, and the overall duration between LR of infected CIED and LP implantation was 4.32 ± 3.9 days. A total of 194 (29.5%) patients had systemic CIED infections, whereas 153 (23.3%) had isolated pocket infections. In our patient cohort, procedural complications were scarce. Over a mean follow-up period of 13.3 ± 9.4 months, pacemaker syndrome was observed in 4 patients (0.61%), and 3 patients (0.46%) experienced persistent or recurrent infections.

Conclusion: Our review finds both concurrent and delayed LP implantation after infected CIED extraction to be safe, with low reinfection rates and minimal complications. LPs could also serve as a bridge to CRT re-implantation minimizing the use of temporary pacing systems.

Background: Little data exists regarding the optimal antithrombotic strategy during S-ICD implantation to prevent pocket hematomas. This study explores the association between perioperative antithrombotic management and the occurrence of pocket hematoma following S-ICD implantation.

Methods: All patients who underwent de novo S-ICD implantation between February 2009 and January 2023 at Amsterdam UMC were included. Data was collected retrospectively from electronic patient records. Clinically significant pocket hematomas were defined as an accumulation of blood at the pocket site within 30 days after implantation.

Results: A total of 347 patients were included of which 224 (64.6%) patients used antithrombotic therapy pre-implantation. The median age at implantation was 50 years (IQR 36-61 years), 33.4% of the patients were female, and the majority of implants were intermuscular (90.2%). A total of 18 patients (5.2%) developed a clinically significant pocket hematoma. There were significantly more pocket hematomas in patients with continued vitamin K antagonists (VKA) compared to patients with interrupted VKA (27.3% (6/22) vs. 4.3% (2/47), respectively, p = 0.01), and continuation of VKA was an independent predictor for pocket hematoma formation in the VKA group (p = 0.04). Moreover, continuation of dual antiplatelet therapy (DAPT) with ticagrelor was associated with significantly more pocket hematomas post-implantation compared to continuation of DAPT with clopidogrel (4/12 vs. 1/28, respectively, p = 0.02).

Conclusion: Continuation of VKA during S-ICD implantation was associated with an increased risk of pocket hematoma formation compared to interruption of VKA. This supports the need for specific perioperative antithrombotic therapy guidelines for S-ICD implantations to reduce the risk of pocket hematomas.

Background: In patients with ventricular arrhythmias (VA) admitted via the emergency department (ED), immediate catheter ablation (CA-VA) might be indicated to stabilize patients. However, the unstable condition of these patients may increase periprocedural risk. This study evaluated the periprocedural safety of immediate CA-VA in patients admitted via the ED.

Methods and results: In total, 223 ED patients who underwent immediate CA-VA from 01/2017 to 12/2022 (mean age 66 ± 13 years, 19% female, 55% heart failure, 59% coronary artery disease) were analyzed in terms of in-hospital outcomes (periprocedural death, pericardial tamponade, thromboembolic events, major bleedings). To address differences to elective patients, ED patients were compared with 784 elective CA-VA patients (mean age 59 ± 15 years, 34% female, 20% heart failure, 33% coronary artery disease, all p < 0.001): ED patients experienced higher rates of periprocedural complications (6.3% vs. 2.0%, p = 0.002) driven by thromboembolic events (2.2% vs. 0.4%, p = 0.02). Life-threatening complications were not different between groups (cardiac tamponade: 2.2% vs. 1.4%, p = 0.56; stroke: 0.9% vs. 0.4%, p = 0.67). Seven ED patients (3.1%) died unrelated to the procedure during hospitalization vs. none in the elective CA-VA group. Emergency admission (OR 3.07, 95% CI 1.48-6.38), age (OR 2.12, 95% CI 1.22-3.70), and heart failure (OR 1.99, 95% CI 0.96-4.15) were independently associated with periprocedural complications and overall death during hospitalization.

Conclusion: Patients with VA admitted via the ED were older, sicker, and more often presented with ventricular tachycardia than elective CA-VA patients. Immediate CA-VA was associated with higher rates of periprocedural complications, driven by thromboembolic events; however, no procedure-related death occurred.