Lead Insertion Research Articles

46 ELECTRO-CATHETER EXTRACTION IN JUGULAR ACCESS:METHODS AND TECHNIQUES

Abstract A significant increase of Pacemaker implantation has resulted in an increase in the number of extractions due to the onset of infections and malfunctions. The transvenous leads extraction by means of a dilator sheath can be difficult for possible fibrotic or calcified adhesions and vegetations along the path of the leads. In 90% of cases the firm adhesions are in the superior vena cava-right atrium, of the tricuspid valve ring of the papillary muscles of the right ventricle and in the lead insertion zone. If standard extraction from the implantation site is difficult along the axis subclavian venous-anonymous vena-superior vena cava, due to the presence of tenacious adhesions along the course of the leads, it is necessary to resort to a right internal jugular approach. During the standard extraction there are particularly delicate points like the anonymous trunk and superior vena cava. At this point the sheath is perpendicular to the vein and there is the possibility of vascular injury. Moreover, the twisting of the sheath doesn't permit a favorable approach at the second part of the lead. In fact, it is very difficult that the force applied during the rotation of the sheaths arrives at the tip of the sheath and is not sufficient to win against the adherences. In this case a right internal jugular approach becomes necessary. This method facilitates the lead extraction because the position of the jugular vein is rectilinear with the superior vein cava and the right part of the heart which permits a better and more precise alignment of the sheath with the vein and hearth cavity. The sheath-lead system has a parallel progress at anonymous vein, the superior vein cava and right atrium. This method reduces vascular injury and makes sheath rotation movement more efficient for resection of adherence, furthermore, for large vegetations it is possible to use big sheaths to simplify the resection. The jugular approach involves the introduction from the femoral vein of a pig tale or a deflectable catheter to take the lead into the right atrium making it intravascular. Furthermore, we proceed with the canalization of the jugular vein in sterile method. Then position an introductory 11 Fr by which a lasso catheter will be introduced. The objective is to capture the lead and bring it out of the jugular vein. Then, the operator will apply the sheath-catheter system and given the good position will proceed with the extraction of the lead, by using rotating movements. The entire procedure is done with a fluoroscopy guide with the use of septums to define the field of view only of area of interest and the exposure of the operators. During the important steps such as the capture of the lead by lasso, the use of ad hoc projections, that help the operator in capturing images, is essential to have a clear reference of the position within the atrium of the catheter itself. During the entire procedure, the modulation of the radiant dose is very important, in fact a Low Dose approach can be chosen at first while doses are increased when needed. Radiation protection in these procedures, which can be challenging from a fluoroscopic point of view, is essential. The success of the procedure is the result of skills and experience of all operators engaged: doctors, nurses, and radiology technicians. Figure 1 Use of pigtail to capture the catheter (left); catheter lasso (center); sheath extraction (right)

Suitability of the left internal jugular vein for CRT-D placement in the setting of extensive venous occlusion: Case report and review of the literature.

Placement of coronary sinus (CS) leads is predominantly accomplished via the left cephalic-axillary-subclavian venous system. However, vein stenosis or occlusion from long-term chronic hemodialysis (HD) in patients with end-stage renal failure can pose a challenge. Cannulation of the CS via the left internal jugular vein (IJV) is technically difficult but often feasible. We report a case in which a patient with end-stage renal disease (ESRD) had extensive left venous system occlusion from prior in dwelling HD catheters, and an AV fistula contralaterally, who underwent biventricular implantable cardioverter defibrillator placement with lead insertion through the left IJV.

Takotsubo Syndrome After Additional Right Ventricular Lead Insertion in a Pacemaker User.

Takotsubo Syndrome After Additional Right Ventricular Lead Insertion in a Pacemaker User.

Abstract 11015: Pacemaker Lead Insertion Sites Contribute to Regional and Global Ventricular Dysfunction

Introduction: Ventricular pacing can cause dysfunction but how the lead is anchored to the myocardium has not been studied. We evaluated patterns of regional and global ventricular function in patients with a ventricular pacemaker or defibrillator using cine cardiac CT (CCT). Methods: This was a single center retrospective study of patients with a ventricular pacemaker or defibrillator who underwent a cine CCT from September 2020 to June 2021. Regional wall motion abnormalities (RWMAs) were assessed in relation to lead insertion site (sew-on vs screw-in) and pacing activity (active vs. inactive). Results: A total of 122 ventricular lead insertion sites were analyzed in 43 patients (53% male, median age 20 years, range 3-57 years). Thirteen patients (30%) had palliated single ventricle physiology, twenty-nine patients had congenital heart disease with biventricular circulation (67%), and one patient had a structurally normal heart (2%). RWMAs were present in 51/122 (42%) lead insertion sites among 23/43 (53%) patients. The prevalence of a lead insertion site associated RWMA was higher with active pacing (54% vs 19%; p < 0.001) and highest for active epicardial sew-on sites ( Figure 1 ). RWMAs were not associated with position of the insertion site relative to the chest wall (p = 0.85) or the distance between the two heads of a bipolar lead (p = 0.23). Patients with lead insertion site associated RWMAs had a lower systemic ventricular ejection fraction (mean of 37.5% vs 52.5%, p < 0.001) compared to those without a RWMA. Conclusions: Pacemaker lead insertion site RWMAs are common and associated with systemic ventricular dysfunction. The mechanism and clinical significance of this regional and global dysfunction warrant further study.

Influence of radiotherapy on cardiac implantable device lead parameters

Abstract Purpose Incidences of both cardiac implantable electronic devices (CIED) and malignant tumors are rising, likewise the number of patients undergoing radiotherapy (RT) while having CIED increases. There is evidence that there is a higher failure rate with increasing cumulative dose at device and higher – neutron-inducing – photon beam energy above 10 MV. There is a paucity of data regarding lead function, lead insertion site dose and analysis of change of lead parameter during RT treatment. Aim of this work is a detailed analysis of CIED malfunctions and technical alterations in patients treated at our clinic with a special focus on device lead parameters. Methods In a total of 54 patients treated at our department, we evaluated the dose statistics for the leads and devices as well as lead parameters aggregated through telemetric device interrogations. Irradiation mostly took place in the thoracic (32%), pelvic (24%) and the head region (22%). A total of 80% of all patients had implanted a pacemaker and 17% an implantable cardioverter defibrillator. Two Patients (4%) were under cardiac resynchronization therapy. Overall 33% of patients were device-dependent. Dose statistics for myocardial lead insertion sites and CIED were calculated. We collected interrogation data (intrinsic pacing impedance, pacing threshold, signal amplitude) before and after RT treatment (median number of interrogations was 3, range 1–22) and information about any CIED malfunction. We assessed whether lead parameters changes exceeded predefined thresholds of 30% in pacing impedance, 50% in pacing threshold, or 50% in signal amplitude. Results 24 of the 54 patients received a measurable dose at the device (median dose of patients with thoracic RT: 1.82 Gy, range 0.18–14.88 Gy). Dose data was available for atrial leads of 12 patients (median dose 7.27 Gy, ranging from barely measurable to 46.02 Gy) and right-ventricular leads of 13 patients (median dose 0.83 Gy, range 0.004–42.66 Gy). There was no lead parameter threshold violation for pacing impedance detected, however predefined thresholds of signal amplitude and pacing threshold were exceeded in 14% and 15% of cases, respectively. These threshold violations did not compromise device function. There was no significant difference of lead parameter changes when patient groups receiving more and less than 10 Gy at lead insertion site were compared. Two CIEDs (4%) showed a malfunction (electric restart of device) during RT, however no clinically relevant complication was reported. Both patients underwent thoracic RT (esophageal cancer) with a beam energy of 10 and 15 MV. Conclusion In the observed patient group, lead parameter threshold violation was neither able to predict a device malfunction nor dependent of cumulative dose at myocardial insertion side. Device malfunction occurred rarely and only at higher beam energies, however with no life-threatening outcome. Funding Acknowledgement Type of funding sources: None.

Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction.

BackgroundLead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO.MethodsWe performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO.ResultsMild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees.ConclusionA total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.

ID:16465 Contralateral and Lateral Views: Analysis of the Technical Aspects of Spinal Cord Stimulator Lead Insertion

Spinal Cord Stimulation (SCS) is an established treatment modality for neuropathic pain. The critical part of this technique is safe access to the epidural space for lead placement. There have been innovations in radiological views, improving access to the epidural space. This study analyzes the adoption of these technical advantages in daily practice

Dural Puncture During Spinal Cord Stimulator Lead Insertion: Analysis of Practice Patterns.

BackgroundSpinal cord stimulation (SCS) is an important modality for intractable pain not amenable to less conservative measures. During percutaneous SCS lead insertion, a critical step is safe access to the epidural space, which can be complicated by a dural puncture.ObjectivesIn this review, we present and analyze the practices patterns in the event of a dural puncture during a SCS trial or implantation.MethodsWe conducted a survey of the practice patterns regarding spinal cord stimulation therapy. The survey was administered to members of the Spine Intervention Society and American Society of Regional Anesthesia specifically inquiring decision making in case of inadvertent dural puncture during spinal cord stimulator lead insertion.ResultsA maximum of 193 responded to a question regarding dural punctures while performing a SCS trial and 180 responded to a question regarding dural punctures while performing a SCS implantation. If performing a SCS trial and a dural puncture occurs, a majority of physicians chose to continue the procedure at a different level (56.99%), followed by abandoning the procedure (27.98%), continuing at the same level (10.36%), or choosing another option (4.66%). Similarly, if performing a permanent implantation and a dural puncture occurs, most physicians chose to continue the procedure at a different level (61.67%), followed by abandoning the procedure (21.67%), continuing at the same level (10.56%), or choosing another option (6.11%).ConclusionsWhereas the goals of the procedure would support abandoning the trial but continuing with the permanent in case of inadvertent dural puncture, we found that decision choices were minimally influenced by whether the dural puncture occurred during the trial or the permanent implant. The majority chose to continue with the procedure at a different level while close to a quarter chose to abandon the procedure. This article sets a time stamp in practice patterns from March 20, 2020 to June 26, 2020. These results are based on contemporary SCS practices as demonstrated by this cohort, rendering the options of abandoning or continuing after dural puncture as reasonable methods. Though more data is needed to provide a consensus, providers can now see how others manage dural punctures during SCS procedures.

A Systematic Review and Single-center Experience of Azygos Vein Defibrillator Lead Insertion.

Defibrillation threshold (DFT) testing is performed in individuals with higher predicted risks of defibrillation failure. Many strategies have been explored to overcome the challenge of high DFT, including an insertion of a defibrillator lead into the azygos vein. We performed a systematic review of the literature to evaluate the safety and efficacy of azygos vein implantable cardioverter-defibrillator insertion for high DFT combined with the analysis of a single-center experience of the procedure at our institution. The literature search was performed in PubMed and Embase from database inception to December 2020 to identify all case reports and case series related to azygos vein defibrillator lead insertion. Our search identified 291 records. After excluding duplicate studies and those without DFT thresholds and non-azygos vascular destinations, 12 studies (23 cases) were reviewed from the current database. We also conducted a retrospective analysis of 5 cases performed at our institution, and a total of 28 patients were included in our final analysis. The mean age of the pooled cohort was 47 years (range, 17–88 years). Men composed 92% of the total cases, and the average body mass index was 34 kg/m2. The mean ejection fraction (EF) was 25%, with 78% having non-ischemic cardiomyopathy. The left axillary (36%) or subclavian (48%) vein was the common percutaneous access point. The mean duration of azygos vein access and lead delivery was 22 min (range, 13–60 min). The average DFT prior to azygos coil insertion was 35 J (range, 20–45 J). Fifty-seven percent of cases achieved substantial DFT improvement, whereas 18% achieved relative improvement compared to the pre-procedural threshold. No immediate or remote procedure-related complications were reported in 24 cases where data were available. During an average follow-up period of 18 months, 5 patients had ventricular arrhythmic events requiring device therapy and 4 had successful cardioversion from the device. One patient died from cardiac arrest with variable device therapies of both unsuccessful and successful events. In conclusion, azygos vein defibrillator lead insertion has a considerable rate of success, ease of vascular access with minimal procedural time, and lower risks and complications. Larger studies and longer follow-up periods are warranted to establish its efficacy and safety.

Contralateral and Lateral Views: Analysis of the Technical Aspects of Spinal Cord Stimulator Lead Insertion.

BackgroundSpinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. The critical part of this technique is safe access to the epidural space for lead placement. There have been innovations in radiological views, improving access to the epidural space.ObjectivesThis study analyzes the adoption of these technical advantages in daily practiceMethodsWe conducted a survey of members in the Spine Intervention Society and American Society of Regional Anesthesia in regard to the practice patterns in SCS therapy. Here we present our findings regarding the use of contralateral oblique (CLO) and lateral views as well direct upper thoracic or cervicothoracic access for SCS lead insertionResultsA total of 195 unique responses were received between March 20, 2020 and June 26, 2020. Forty-five percent of respondents “always used” the lateral view technique while 15% “always used” CLO view for SCS lead insertion. Overall, sixty-five percent of respondents used the CLO view with varying frequency. Cervical and upper thoracic approach for cervical SCS lead placement is always or often used by 66.8% of the respondents.ConclusionsA depth view (CLO or lateral) is always used by only 45 - 60% of the respondents and CLO view has been rapidly adopted in clinical practice for SCS lead insertion. Direct cervicothoracic and upper thoracic is the preferred approach for cervical lead placement by the majority.

Internal jugular vein perforation due to blind temporary pacing lead insertion: Pitfall of a blind procedure

Internal jugular vein perforation due to blind temporary pacing lead insertion: Pitfall of a blind procedure

616 Endocardial lead placement guided by high resolution voltage mapping in a patient with recurrent failure of transvenous pacing system

Abstract Methods and results A 58 years-old man was admitted to our intensive care unit for syncope due to inconstant capture of epicardial ventricular lead. His cardiovascular history began 20 years before when he underwent single chamber pacemaker implantation with insertion of a passive fixation ventricular lead for symptomatic complete atrio ventricular block (AVB). Electrical parameters were good at implantation. However, during follow-up a gradual and progressive increase of pacing threshold occurred, with no changes in impedance values, finally leading to complete loss of ventricular capture. Hence, 2 years later, the lead was extracted and a new transvenous ventricular lead was placed in septal position. All electrical parameters were optimal at the end of the procedure. However, in the following months threshold values gradually increased as previously observed. The referring clinicians decided to surgically extract both the device and transvenous lead and to implant an epicardial ventricular lead connected to an abdominal generator. The pacemaker worked properly for about 17 years until he was transferred to our institution with evidence of inconstant lead capture at maximum pacing outputs. A temporary transvenous pacemaker was immediately inserted. Clinical examination, laboratory exams, and echocardiography were normal. Cardiac magnetic resonance (MRI) was not feasible due to the epicardial lead. Thus, in order to obtain cardiac substrate characterization, we decided to perform high density multielectrode voltage mapping of the right ventricular endocardium with HD Grid multielectrode mapping catheter (HD Grid mapping catheter sensor enabled, Abbott Technologies, Minneapolis, MN). Electroanatomic voltage map allows distinction of areas of healthy myocardium (>1.5 mV) from scar tissue (<0.5 mV). Unexpectedly, voltage mapping highlighted no scar zones, showing a globally normal endomyocardial surface. Therefore, a new endocavitary pacemaker was inserted in right prepectoral region and an active fixation right ventricular lead was placed on mid-ventricular septum. A backup pacing lead was placed in a more apical position in an area of endocardial healthy myocardium. Post-procedural sensing, impedance and capture threshold were optimal (0.3 V × 0.4 ms for mid-septal lead and 0.3 × 0.4 ms for the other one). At 1 month follow-up mid-septal lead’s threshold was slightly increased (1.0 V × 0.4 ms) and further increase was observed at 3-month outpatient visit (1.75 V × 0.4 ms). Capture threshold of the other lead and other parameters were stable. The patient received remote monitoring for home surveillance of the implanted system. Home monitoring shows a trend toward a progressive increase of pacing threshold of the mid-septal lead and stable value of the other electrode. Conclusions The present report suggests an innovative use of high-density mapping with HD Grid catheter to characterize endocardial right ventricular myocardium in a patient with contraindication to cardiac MRI and recurrent failure of previous implanted pacing systems for unknown reason and to guide effective lead placement in areas of normal endocardial voltage. Combined use of telemedicine and high-resolution mapping technique allowed us to avoid unnecessary high risk reintervention for novel epicardial lead placement.

390 Late pleuro-pericardial effusion after atrial fibrillation radiofrequency ablation

Abstract Aims Post-cardiac injury syndrome (PCIS) is an inflammatory state involving pericardium, epicardium, and myocardium causing a clinical picture in which epicardial and pericardial symptoms are prevalent. It appears mediated by autoimmune mechanisms and may appear as late post myocardial infarction pericarditis (Dressler’s Syndrome) or as a post traumatic pericarditis in the case of spontaneous thoracic trauma or iatrogenic pericarditis. Apart from the acute setting, pericardial effusion can be a manifestation of PCIS after interventional procedures. Methods and results A 57 years old hypertensive woman suffering from recurrent atrial fibrillation episodes underwent a technically difficult radio-frequency catheter ablation because of complex pulmonary veins anatomy and wide scar in the left atrial wall. During the procedure she developed cardiac tamponade and 410 ml of blood were drained by pericardiocentesis and re-infused without recurrent pericardial effusion during further in-hospital stay. She was discharged on apixaban 5 mg b.i.d. with Hb value of 10.2 g/dl. Two weeks later the patient was hospitalized for worsening cough, atypical chest pain, dyspnoea and modest orthopnea. C-reactive protein levels were 8.7 mg/dl, Hb was 9.9 g/dl and platelet count 484 000/ml; blood cultures were negative. An urgent thoracic CT scan showed bilateral pleural effusion and ubiquitous pericardial effusion (2.5–3 cm), without signs of active bleeding from the cardiac chambers into the pericardium. After stopping apixaban, the patient was given colchicine (1 mg/die). A total of 1200 ml of hematic pericardial fluid was drained from the pericardium over a 5-day period. Autoimmune blood tests were negative, as well as antibodies to pericardiotropic viruses. Pericardial fluid was negative for quantiferon and direct BK. On day 9, the drain was removed and steroidal treatment was started (prednisone 25 mg/die with scheduled tapering). Further echocardiographic exams were stable without pericardial effusion; a chest X-ray scan (at day 16) showed reversal of the water bottle shaped heart and of the pleural effusion. Conclusions Early myocardial infarct-associated pericarditis and Dressler’s syndrome account for about 20% of cases of PCIS accompanied by symptoms of epicardial and pericardial origin. PCIS is quite common after cardiac surgery, but it may be also observed even after iatrogenic trauma occurring during cardiac interventions: PCI, pacemaker lead insertion, radiofrequency ablation and Swan–Ganz catheterization. Blood entering the pericardium is thought to play a pivotal etiological role in iatrogenic PCIS, with consequent huge inflammatory reaction in the mesothelial tissue resulting in clinical manifestations of pericarditis. In animal models of PCIS, systemic release of cardiac antigens and self-antigen specific responses has been hypothesized. In our case cardiac tamponade complicating the ablation procedure probably initiated the epicardial and pericardial inflammatory response. Even if based on few data, the patient was treated with colchicine first, avoiding aspirin because of the hemorrhagic pericardial fluid; glucocorticoids were then started when symptoms and signs of PCIS slowly resolved despite colchicine treatment. The pericardial fluid was hemorrhagic (Hb 5.9 g/dl) and treatment with apixaban, in the context of an inflammatory mesothelial response, could have caused this peculiar, hemorrhagic, pericardial reaction.

Blind temporary pacemaker lead insertion using femoral access when fluoroscopy is unavailable: A case report

The temporary pacemaker (TPM) insertion must be done in symptomatic bradycardia to provide adequate heart rate and stable hemodynamic. Transvenous TPM is inserted under fluoroscopy guidance. However, in an extraordinary situation, such as the unavailability of the catheterization laboratory, transvenous TPM insertion can be performed using the blind approach. This case report focused on the procedural aspects of blind transvenous TPM insertion using femoral vein access when fluoroscopy is unavailable. By performing the blind transvenous TPM insertion, the patient should be stabilized as soon as possible. The confirmation of the lead placement using fluoroscopy was needed to ensure that the tip of the electrode was in the proper position.

C93. Temporary Pacemaker Lead Insertion with Echocardiography Guided Technique in Emergency Setting: a Case Report

Abstract Background The implantation of the temporary pacemaker (TPM) must be done in symptomatic bradycardia to provide adequate heart rate and stabilize hemodynamic. Transvenous TPM is inserted under the fluoroscopy guidance. However, in an extraordinary situation, such as the unavailability of the catheterization laboratory, transvenous TPM insertion can be performed with echocardiography guiding. Case Summary A 27 years old male came to our ER with symtomatic bradicardia. Emergency procedure like medical treatment and transcutaneous pacing were done, but failed to increase heart rate. We planned transvenous pacing with fluoroscopy but the catheterization laboratory was not immediately available. Echocardiography guided temporary pacemaker were done in ER successfully and the patient was strabilized. Discussion Emergency transvenous pacemaker implantation with echocardiography guiding can be accomplished successfully in our case without complication. There are several techical aspect that we should consider in temporary pacemaker insertion without fluoroscopy. We use femoral access and with echocardiography guided in our case. The confirmation of the lead placement using fluoroscopy was needed to ensure that the tip of the electrode was in the proper position. Future research that focuses on the safety and effectiveness of the technique across the range of operator skill levels is needed.

C93. Temporary Pacemaker Lead Insertion with Echocardiography Guided Technique in Emergency Setting: a Case Report

Abstract Background The implantation of the temporary pacemaker (TPM) must be done in symptomatic bradycardia to provide adequate heart rate and stabilize hemodynamic. Transvenous TPM is inserted under the fluoroscopy guidance. However, in an extraordinary situation, such as the unavailability of the catheterization laboratory, transvenous TPM insertion can be performed with echocardiography guiding. Case Summary A 27 years old male came to our ER with symtomatic bradicardia. Emergency procedure like medical treatment and transcutaneous pacing were done, but failed to increase heart rate. We planned transvenous pacing with fluoroscopy but the catheterization laboratory was not immediately available. Echocardiography guided temporary pacemaker were done in ER successfully and the patient was strabilized. Discussion Emergency transvenous pacemaker implantation with echocardiography guiding can be accomplished successfully in our case without complication. There are several techical aspect that we should consider in temporary pacemaker insertion without fluoroscopy. We use femoral access and with echocardiography guided in our case. The confirmation of the lead placement using fluoroscopy was needed to ensure that the tip of the electrode was in the proper position. Future research that focuses on the safety and effectiveness of the technique across the range of operator skill levels is needed.

Sex-related differences regarding cephalic vein lead access for CIEDs implantation

BackgroundMinimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes.Methods and resultsThis single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (p-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group.ConclusionFemale patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.

Abstract 13768: Gender Differences in ICD-Related Complications in the PRAETORIAN Trial

Introduction: The PRAETORIAN trial has investigated the difference in complications between the subcutaneous implantable cardioverter-defibrillator (S-ICD) and the transvenous ICD (TV-ICD). Retrospective studies suggest that women experience more ICD-related complications, specifically related to the lead, than men. We aimed to evaluate this gender difference as a subanalysis of the PRAETORIAN trial. Methods: The PRAETORIAN trial (NCT01296022) is an international multicenter randomized trial. Patients with a class I or IIa ICD indication with no need for pacing therapy were randomized 1:1 to receive either an S-ICD or a TV-ICD and followed for a median of 49.1 months. ICD-related complications included all complications related to the lead or generator that led to medical or surgical intervention. Lead-related complications were defined as complications directly caused by insertion or chronic placement of the ICD lead, or leading to extraction, repositioning or replacement of the ICD lead. Results: A total of 849 patients were included, of whom 167 (19.7%) were female. ICD-related complications occurred in 6/89 women in the S-ICD group and 11/78 women in the TV-ICD group (HR 0.46, 95%CI 0.17-1.25). In men, 25/337 in the S-ICD group and 33/345 in the TV-ICD group had an ICD-related complication (HR 0.77, 95%CI 0.46-1.29). Kaplan Meier curves of both genders are shown in the figure. In Cox regression analysis, women had a higher risk of lead-related complications (HR 2.1, 95%CI 1.04-4.16, p = 0.04). Conclusions: Our prospective data show a more prominent trend in women to experience more ICD-related complications with the TV-ICD. This difference may be due to a significantly higher risk of lead-related complications in women. However, numbers are low and more research is needed to gain more insight into the gender-specific risks and benefits of ICD therapy.

Is Cochlear Implantation Effective for Auditory Rehabilitation Following Vestibular Schwannoma Treatment?

Is Cochlear Implantation Effective for Auditory Rehabilitation Following Vestibular Schwannoma Treatment?

Post cardiac injury syndrome successfully treated with medications: a report of two cases

BackgroundPost cardiac injury syndrome (PCIS) is induced by myocardial infarction or cardiac surgery, as well as minor insults to the heart such as percutaneous coronary intervention (PCI), or insertion of a pacing lead. PCIS is characterized by pericarditis after injury to the heart. The relatively low incidence makes differential diagnosis of PCIS after PCI or implantation of a pacemaker a challenge. This report describes two typical cases of PCIS.Case presentationThe first patient presented with signs of progressive cardiac tamponade that occurred two weeks after implantation of a permanent pacemaker. Echocardiography confirmed the presence of a moderate amount of newly-formed pericardial effusion. The second patient underwent PCI for the right coronary artery. However, despite an uneventful procedure, the patient experienced dyspnea, tightness of chest and cold sweats, and bradycardia two hours after the procedure. Echocardiography findings, which showed a moderate amount of newly-formed pericardial effusion, suggested acute cardiac tamponade, and compromised hemodynamics. Both patients recovered with medication.ConclusionThese cases illustrated that PCIS can occur after minor myocardial injury, and that the possibility of PCIS should be considered if there is a history of possible cardiac insult.