Spanish Heart Rhythm Association member´s perspectives on implantable cardiac device reuse in developing countries.

a) Introduction and objectives Postmortem explanted cardiac implantable electronic devices (CIEDs) from developed countries could provide patients unable to afford new devices in developing countries a treatment they lack nowadays. This study describes the preferences of cardiac electrostimulation specialists from Spain on the management of explanted CIEDs and opinions and concerns regarding reuse in developing countries. b) Methods A nationwide self-administered questionnaire was sent to Spanish members of the XXXX1 (n=1110), between December 2020 and January 2021. c) Results Forty-three responses were obtained (response rate 4%). There was a strong preference to donate explanted devices for reuse in humans (61.9%). The group of age younger than average was more against storing explanted CIEDs (p= 0.014). 57.1% considered it would be beneficial for patients to have a document so they could reflect their wishes regarding device handling after their death. 88.1% indicated that they would strongly agree or to implant postmortem resterilized pacemakers or ICDs (Implantable cardioverter defibrillator) containing >70% of the original battery life in patients who were unable to obtain a new one, the older than average age group was showed more agreement with this statement (p=0.02). The most mentioned concerns were device malfunction (57.1%) and infection (54.8%). d) Conclusions The majority of respondents support reusable CIEDs donation to developing countries. It would be interesting to study the feasibility of a nationwide CIED reutilization programme.

Educational technology for people living with implantable heart device

Objective: To develop an educational technology for people living with an implantable heart device.Methods: This is a methodological study carried out in the period from August 2020 to April 2021, carried out in two stages: integrative literature review and elaboration of educational technology.Results: Based on the evidence, it was possible to list generating themes such as the perception of people living with an implantable cardiac device, which served as the basis for the creation of a podcast entitled “Alphabet of the pacemaker”, with self-care guidelines from A to Z for the after time implantation of the device.Conclusions: The construction of evidence-based educational technology is a strategy to subsidize health educational practices and pacemaker users' understanding of health care after device deployment.

Percutaneous aspiration of vegetation from tricuspid valve infective endocarditis

We present a novel minimally invasive percutaneous approach for the surgical treatment of tricuspid valve infective endocarditis. In this case, the patient presented with a malfunctioning implantable cardiac device, right ventricle implantable cardiac device lead infection, and infective endocarditis of the tricuspid valve. The infective endocarditis vegetations were removed via a percutaneous approach using the AngioVac suction device. The device was modified by the surgeon, who sutured 2 threads to the head of the device in order to allow adjustments to be made to the angle of suction by applying tension on the suture. Real-time visualization of the procedure was achieved via transesophageal echocardiography. This approach, utilizing the AngioVac device, is a feasible and effective treatment strategy for endocarditis vegetation removal in selected patients who would otherwise be unsuitable candidates for open heart surgery.

An unusual case of Scedosporium apiospermum fungaemia in an immunocompetent patient with a left ventricular assist device and an implantable cardiac device

Left ventricular assist device (LVAD)-related infections are a leading cause of morbidity and mortality, with fungal infections being particularly difficult to manage. We report a case of an immunocompetent 39-year-old male with an LVAD and an implantable cardiac device (ICD) who developed fatal Scedosporium apiospermum fungaemia. To the best of our knowledge, this is the first reported case of LVAD-related S. apiospermum fungaemia.

Abstract 23: Detection of Atrial Fibrillation by Implantable Cardiac Monitoring After Acute Central Retinal Artery Occlusion

Introduction: Central retinal artery occlusion (CRAO) is a form of ischemic stroke and necessitates a comprehensive workup, including for cardioembolic sources such as atrial fibrillation (AF). However, the incidence of new AF diagnosed after CRAO is unknown. We aimed to examine the incidence of new, cardiac device-detected AF after CRAO in a large population-based cohort. Methods: Using patient-level data from the Optum® de-identified EHR dataset (2007-2017) linked with Medtronic implantable cardiac device data, we identified patients that had a diagnosis-code corresponding to CRAO and no known history of AF, and who also had either a device in-situ at the time of CRAO or implanted ≤1 year post-CRAO with continuous AF monitoring data available. AF incidence was defined as ≥2 minutes of device-detected AF in a day. Results: Of 467,167 patients screened, 246/433 (56.8%) with CRAO had no history of AF, of whom 39 had an eligible implantable cardiac device (mean age 66.7±14.8, 41.0% female). Prevalence of vascular risk factors was high (hypertension, 71.8%; hyperlipidemia, 61.5%; coronary artery disease, 46.2%). Within 3 months, 7.7% of these patients (n=3) had device-detected AF. At 36 months, 33.3% of patients (n=13). The maximum daily AF burden post CRAO ranged from 2 minutes to 24 hours with a mean of 390±530 minutes. Of the patients with device-detected AF, 9 were found by an implantable cardiac monitor and 4 by pacemaker or defibrillator. Discussion: The rate of long-term AF detection after CRAO was high in patients with implanted cardiac devices, and appears comparable with rates seen after cryptogenic ischemic stroke and in other high-risk populations. Our findings warrant future prospective studies not limited by selection bias.