Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed.

MANAJEMEN ANESTESI PADA PASIEN DENGAN TOTAL AV BLOK YANG MENJALANI OPERASI SECTIO CAESARIA

Abstrak Blok jantung merupakan salah satu kelainan sistem konduksi jantung dengan karakteristik gejala berupa ketidakharmonisan antara irama atrial dengan irama ventricular. Total Atrio-Ventricular blok (AV blok) pada anak dan dewasa muda umumnya terjadi secara kongenital. Seorang wanita hamil dengan blok jantung bawaan dapat tidak menimbulkan gejala, namun dapat terjadi kondisi kolaps pembuluh darah secara mendadak terutama selama masa persalinan. Dilaporkan sebuah kasus pasien Perempuan, 21 tahun, hamil 31-32 minggu, dengan Total AV Blok yang akan menjalani tindakan Sectio caesaria. Pasien mengeluhkan sesak nafas yang makin memberat sesuai usia kehamilan. Sebelum tindakan pembedahan, pasien dilakukan pemasangan temporary pace maker. Selanjutnya tindakan pembiusan menggunakan teknik anestesi spinal. Selama operasi, hemodinamik pasien relatif stabil. Setelah operasi, pasien ditangani di unit perawatan intensif. Dua hari setelah operasi, pasien dilakukan pemasangan permanent pace maker.Keyword :AV Blok, Pace Maker, Manajemen Anestesi Abstract Heart block is a disorder of the cardiac conduction system with symptoms characterized by disharmony between atrial rhythms and ventricular rhythms. Total Atrio-Ventricular Blocks (AV Blocks) in children and young adults generally occur congenitally. A pregnant woman with a congenital heart block may produce no symptoms, but there may be a sudden collapse of blood vessels, especially during labor. Reported A case of patient, Women, 21 years old, 31-32 weeks pregnant, with Total AV Block who will undergo the action Sectio-caesaria. Patients complain of shortness of breath that is more burdensome according to gestational age. Before surgery, the patient implanted with the temporary pace maker. Further action of anesthesia using spinal anesthesia techniques. During surgery, the patient's hemodynamics are relatively stable. After surgery, the patient was treated in intensive care unit. Two days after surgery, the patient implanted with the permanent pace maker. Keyword: AV Block, Pace Maker, Anesthesia Management

Permanent Pace Maker Lead Vegetation along with Tricuspid Valve Leaflets Involvement - A Case Report

Permanent pace maker (PPM) lead vegetation is a rare condition. Diagnosis is made by persistent fever after PPM lead implantation, blood culture,2D & M-mode Echocardiography and confirmed by Transoesophageal echocardiography. Many literatures showed that Staphylococcus epidermidis is the most responsible organism as it can grow on plastic material. In this case, we confirmed the vegetations in PPM lead and Tricuspid valve (TV) leaflets by Transoesophageal echocardiography. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16088 University Heart Journal Vol. 8, No. 2, July 2012

Transient cardiac arrhythmias related to lopinavir/ritonavir in two patients with HIV infection

A 42-year-old Thai man was administered the combination drugs liponavir/ritonavir and abacavir/lamivudine. On day 3 he was admitted and his electrocardiogram demonstrated sinus arrest with junctional escape rhythm with a rate of 42 min−1. Three days after stopping the medication he reverted to normal sinus rhythm. A 55-year-old Caucasian man was admitted to hospital with triple vessel disease. He had a permanent pace maker inserted 4 years previously for Mobitz type II AV block detected on stress electrocardiogram, which developed 1 month after initiation of lopinavir/ritonavir. These two cases highlight the importance of considering lopinavir/ritonavir induced arrhythmias when dealing with HIV-positive individuals.