AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 pa...AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.CONCLUSION In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.展开更多
Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique"...Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.展开更多
We present a rare case of Twiddler's syndrome diagnosed in an asymptomatic patient on a routine follow up.This case reiterates the need for frequent monitoring of the implanted device.In addition,it was detected 4...We present a rare case of Twiddler's syndrome diagnosed in an asymptomatic patient on a routine follow up.This case reiterates the need for frequent monitoring of the implanted device.In addition,it was detected 4 years after implantation of an automatic implantable cardioverter defibrillator.This late representation is extremely uncommon.展开更多
Objective To report our initial experience of transveneous pectoral implantation of single lead implantable cardioverter defibrillator (ICD) in fifteen patients. Methods Fifteen patients (male 13, female 2, mean ag...Objective To report our initial experience of transveneous pectoral implantation of single lead implantable cardioverter defibrillator (ICD) in fifteen patients. Methods Fifteen patients (male 13, female 2, mean age of 51.7 years), including dilated cardiomyopathy in 4, hypertrophic cardiomyopathy in 2, coronary artery disease in 5 and syncope of unknown etiology in 2, underwent ICD implantation. Indications for ICD implantation were ventricular fibrillation (8 patients) and refractory ventricular tachycardia (7 patients). All patients had syncope out of hospital. The ICD system were Medtronic Jewel active can in 5 patients (Model 7219C in 2, 7220C in 3) and CPI Ventak PRxⅢ in 9 patients. For active can, shocks were delivered through distal coil to ICD shell and for PRxⅢ through the endotak lead of proximal to distal coil. Successful implantation criteria was 2 consecutive defibrillation at less than 24 J. Results All 15 patients had successful implantation using single lead ICD system in catheter laboratory. The mean defibrillation threshold was 12.8 J (5-15 J) and R wave was 9.9 mV (3.7-14.6 mV). All devices were of pectoral implantation. No operative and perioperative complications occurred. In 7.6 months (1-18 months) of follow up, 3 patients had VT terminated by antitachycardia pacing (ATP) and 1 patient VF terminated by shock. Conclusion Transveneous pectoral implantation of single lead ICD is easy to perform and has high defibrillation efficacy and should be a preferred approach.展开更多
At present, malfunction of implantable cardioverter-defibrillator （ICD） lead has already gradually become a serious clinic problems for doctors,to well identify and manage the frequent inappropriate therapy induced ...At present, malfunction of implantable cardioverter-defibrillator （ICD） lead has already gradually become a serious clinic problems for doctors,to well identify and manage the frequent inappropriate therapy induced by sensing abnormality due to pacing/sensing （P/S） lead malfunctions of ICD are another kind of challenge for cardiologists. Methods Lead malfunctions of ICD were identified during follow-up period, in which insulation layer rupture and lead fracture were the most frequent. Except for conventional examinations, events histories and pacing parameters were reviewed from electrogram of ICD to determine the causes of lead malfunctions and guide the management. Results Frequent inappropriate therapy induced by sensing abnormality due to P/S lead malfunctions （normal high-voltage part of ICD lead） was identified in five patients and successfully managed by simply implanting an additional P/S lead but keeping the original defibrillation lead （high-voltage part of the ICD lead）. Follow-up results showed that this method was safe and effective enough for these patients. Conclusions Inappropriate therapy induced by P/S lead malfunction could be well managed by only replacing P/S lead but keeping the normal original defibrillation lead, which could also greatly decrease the risk and medical cost than extracting original lead of ICD or adding a new defibrillation lead.展开更多
Background The need for transvenous lead extraction procedures of coronary sinus （CS） leads is increasing due to rising numbers of implanted cardiac resynchronization therapy devices during the past decade. Methods ...Background The need for transvenous lead extraction procedures of coronary sinus （CS） leads is increasing due to rising numbers of implanted cardiac resynchronization therapy devices during the past decade. Methods From January 2009 to June 2013, 27 CS leads were scheduled for extraction in 27 patients （mean age （63.1±14.6） years）. Indications for lead extraction were infection in 13 and lead dysfunction in 14 cases. Isolated extraction of CS leads was performed in eight, extraction of multiple leads in 19 cases. Among leads with an implant time of 〉12 months （n=19） mean implant duration （MID） was （46.4±15.2） （12-76） months. Groups were formed depending on infectious or non-infectious indications （INF vs. Non-INF）, and the use or non-use of extraction tools （ET1 vs. ET0）. Results Among patients with an implant duration of 〉12 months, complete procedural success was 94.7% and clinical success 100%. Operative mortality was zero. In the INF versus NON-INF groups complete procedural success （100% vs. 91.7%, P=0.43）, mean number of required extraction tools （0.7 （0-2） vs. 0.9 （0-3）, P=0.65） and MID （49.1±15.0 vs. 44.7±15.8, P=0.83） did not differ significantly. Comparing the groups ET1 and ET0 showed no significant differences in complications （n=l vs. n=l, P=-0.81） and MID （47.0±17.5 vs. 45.5±12.6, P=0.71）. Conclusions In specialized centers transvenous lead extraction of coronary sinus leads with a mean implant duration of almost four years can be performed safely and effectively. Neither non-infectious indications nor the use of extraction tools negatively affected the outcome of the procedure.展开更多
随着心血管植入型电子装置(CIED)植入量增多,脉冲发生器囊袋感染、上腔静脉综合征、电极损伤退化或功能障碍等问题日益突出。囊袋清创并电极拔除是根本性解决问题的办法。充分的术前准备、高精准的术中操作以及严密的术后监测,对降低经...随着心血管植入型电子装置(CIED)植入量增多,脉冲发生器囊袋感染、上腔静脉综合征、电极损伤退化或功能障碍等问题日益突出。囊袋清创并电极拔除是根本性解决问题的办法。充分的术前准备、高精准的术中操作以及严密的术后监测,对降低经静脉导线拔除(transvenous lead removal, TLR)术中心脏破裂、大血管撕裂等严重手术并发症至关重要。本文就目前国内外的TLR临床指征、危险因素预测及管理的临床研究进展进行论述,以期降低手术风险,提高电极拔除成功率,为患者带来更多的临床获益。展开更多
文摘AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.CONCLUSION In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.
文摘Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.
文摘We present a rare case of Twiddler's syndrome diagnosed in an asymptomatic patient on a routine follow up.This case reiterates the need for frequent monitoring of the implanted device.In addition,it was detected 4 years after implantation of an automatic implantable cardioverter defibrillator.This late representation is extremely uncommon.
文摘Objective To report our initial experience of transveneous pectoral implantation of single lead implantable cardioverter defibrillator (ICD) in fifteen patients. Methods Fifteen patients (male 13, female 2, mean age of 51.7 years), including dilated cardiomyopathy in 4, hypertrophic cardiomyopathy in 2, coronary artery disease in 5 and syncope of unknown etiology in 2, underwent ICD implantation. Indications for ICD implantation were ventricular fibrillation (8 patients) and refractory ventricular tachycardia (7 patients). All patients had syncope out of hospital. The ICD system were Medtronic Jewel active can in 5 patients (Model 7219C in 2, 7220C in 3) and CPI Ventak PRxⅢ in 9 patients. For active can, shocks were delivered through distal coil to ICD shell and for PRxⅢ through the endotak lead of proximal to distal coil. Successful implantation criteria was 2 consecutive defibrillation at less than 24 J. Results All 15 patients had successful implantation using single lead ICD system in catheter laboratory. The mean defibrillation threshold was 12.8 J (5-15 J) and R wave was 9.9 mV (3.7-14.6 mV). All devices were of pectoral implantation. No operative and perioperative complications occurred. In 7.6 months (1-18 months) of follow up, 3 patients had VT terminated by antitachycardia pacing (ATP) and 1 patient VF terminated by shock. Conclusion Transveneous pectoral implantation of single lead ICD is easy to perform and has high defibrillation efficacy and should be a preferred approach.
文摘At present, malfunction of implantable cardioverter-defibrillator （ICD） lead has already gradually become a serious clinic problems for doctors,to well identify and manage the frequent inappropriate therapy induced by sensing abnormality due to pacing/sensing （P/S） lead malfunctions of ICD are another kind of challenge for cardiologists. Methods Lead malfunctions of ICD were identified during follow-up period, in which insulation layer rupture and lead fracture were the most frequent. Except for conventional examinations, events histories and pacing parameters were reviewed from electrogram of ICD to determine the causes of lead malfunctions and guide the management. Results Frequent inappropriate therapy induced by sensing abnormality due to P/S lead malfunctions （normal high-voltage part of ICD lead） was identified in five patients and successfully managed by simply implanting an additional P/S lead but keeping the original defibrillation lead （high-voltage part of the ICD lead）. Follow-up results showed that this method was safe and effective enough for these patients. Conclusions Inappropriate therapy induced by P/S lead malfunction could be well managed by only replacing P/S lead but keeping the normal original defibrillation lead, which could also greatly decrease the risk and medical cost than extracting original lead of ICD or adding a new defibrillation lead.
文摘Background The need for transvenous lead extraction procedures of coronary sinus （CS） leads is increasing due to rising numbers of implanted cardiac resynchronization therapy devices during the past decade. Methods From January 2009 to June 2013, 27 CS leads were scheduled for extraction in 27 patients （mean age （63.1±14.6） years）. Indications for lead extraction were infection in 13 and lead dysfunction in 14 cases. Isolated extraction of CS leads was performed in eight, extraction of multiple leads in 19 cases. Among leads with an implant time of 〉12 months （n=19） mean implant duration （MID） was （46.4±15.2） （12-76） months. Groups were formed depending on infectious or non-infectious indications （INF vs. Non-INF）, and the use or non-use of extraction tools （ET1 vs. ET0）. Results Among patients with an implant duration of 〉12 months, complete procedural success was 94.7% and clinical success 100%. Operative mortality was zero. In the INF versus NON-INF groups complete procedural success （100% vs. 91.7%, P=0.43）, mean number of required extraction tools （0.7 （0-2） vs. 0.9 （0-3）, P=0.65） and MID （49.1±15.0 vs. 44.7±15.8, P=0.83） did not differ significantly. Comparing the groups ET1 and ET0 showed no significant differences in complications （n=l vs. n=l, P=-0.81） and MID （47.0±17.5 vs. 45.5±12.6, P=0.71）. Conclusions In specialized centers transvenous lead extraction of coronary sinus leads with a mean implant duration of almost four years can be performed safely and effectively. Neither non-infectious indications nor the use of extraction tools negatively affected the outcome of the procedure.
文摘随着心血管植入型电子装置(CIED)植入量增多,脉冲发生器囊袋感染、上腔静脉综合征、电极损伤退化或功能障碍等问题日益突出。囊袋清创并电极拔除是根本性解决问题的办法。充分的术前准备、高精准的术中操作以及严密的术后监测,对降低经静脉导线拔除(transvenous lead removal, TLR)术中心脏破裂、大血管撕裂等严重手术并发症至关重要。本文就目前国内外的TLR临床指征、危险因素预测及管理的临床研究进展进行论述,以期降低手术风险,提高电极拔除成功率,为患者带来更多的临床获益。
