Aims The Cardiac Resynchronization Therapy (CRT) Survey II was conducted between October 2015 and December 2016 and included data from 11088 CRT implantations from 42 countries. The survey's aim was to report on current European CRT practice. The aim of this study was to compare the Croatian national CRT practice with the European data. Methods Five centres from Croatia recruited consecutive patients, in a 15-month period, who underwent CRT implantation, primary or an upgrade. Data were collected prospectively by using online database. Results A total of 115 patients were included in Croatia, which is 33.2% of all CRT implants in Croatia during the study period (total n=346). Median age of the study population was 67 (61–73) years, and 21.2% were women. Primary heart failure (HF) aetiology was nonischemic in 61.1% of patients, and HF with wide QRS was the most common indication for the implantation (73.5%). 80% of patients had complete left bundle branch block, and over two-third had QRS ≥150 ms. Device-related adverse events were recorded in 4.3% of patients. When compared with European countries, Croatian patients were significantly younger (67 vs. 70 years, p=0.012), had similar rate of comorbidities with the exception of higher prevalence of hypertension. Croatian patients significantly more often received CRT-pacemaker when compared with European population (58.3 vs. 29.9%, OR 3.27, 95%CI 2.25–4.74, p < 0.001). Conclusion Our data indicate strict selection of patients among HF population and adherence to guidelines with exception of higher proportion of CRT-pacemaker implantation. This is likely to be influenced by healthcare organization and reimbursement issues in Croatia.
SAŽETAK: Posljednih godina dolazi do znatnog porasta broja implantiranih elektrostimulatora srca.Posljedično tomu raste i broj mogućih komplikacija te potreba za njihovom ekstrakcijom. Najčešća indikacija za ekstrakciju elektrostimulatora jest lokalizirana ili sustavna infekcija. S obzirom na to da je riječ o najkompleksnijim i najrizičnijim zahvatima iz područja kardiologije, iz godine u godinu razvijaju se nove tehnike i alati koji znatno olakšavaju ekstrakciju i smanjuju rizik od nastanka mogućih, pokatkad i vrlo teških komplikacija. S obzirom na navedeno, potrebno je organizirati dovoljan broj adekvatnih centara u kojima bi djelovao specijalizirani multidisciplinarni tim educiran za provođenje navedenih zahvata.Od početka 2013. godine na Odjelu za aritmije i elektrostimulaciju Zavoda za kardiovaskularne bolesti Kliničkog bolničkog centra Rijeka započeo je program ekstrakcija elektroda. U razdoblju od dvije i pol godine učinjeno je ukupno 27 zahvata te je uklonjena ukupno 51 elektroda, od čega su dvije bile defibrilatorske. Glavni uzrok ekstrakcije elektroda bila je lokalizirana infekcija / dekubitus lože, dok je sustavna infekcija bila mnogo rjeđa. U postupku ekstrakcije prevladava tehnika trakcije i "locking" stileta. Najznačajnija je komplikacija razvoj simptomatskoga perikardijalnog izljeva. Smrtnih ishoda nije bilo.SUMMARY: During recent years there has been a significant increase in pacemaker implantation. Consequently, the number of possible complications and the need for pacemaker lead extraction has grown as well. The most common indication for pacemaker lead extraction is localized or systemic infection. Since lead extraction is among the most complex and dangerous cardiologic procedures, new techniques and tools are being developed on a yearly basis that significantly facilitate extraction and reduce the risk of possible, often very severe, complications. Considering the above, it is necessary to organize enough appropriate centers with specialized multidisciplinary teams trained for the performance of these procedures.Since early 2013, a pacemaker lead extraction program was started at the Department for Arrhythmia and Electrical Stimulation at the University Hospital Centre Rijeka. Over a period of two and a half years, a total of 27 procedures have been performed and 51 pacemaker leads were extracted, of which two were defibrillator leads. The main cause of lead extraction was localized infection/pocket decubitus, while the incidence of systemic infection was much lower. Extraction techniques used were predominantly traction and locking stylet extractions. The most significant complication was the development of symptomatic pericardial effusion. There were no fatal outcomes.KljUčnE RijEči: elektrostimulator, elektroda, infekcija, ekstrakcija, komplikacije.
primjena epikardijalne elektrode danas Application of epicardial electrode nowadays U početku razvoja uređaja za elektrostimulaciju srca trajna srčana stimulacija bila je moguća samo preko epikardijalne ili miokardijalne elektrode koje su postavljane transtorakalnim putem. Daljnim razvojem medicinske i tehničke znanosti ostvarena su postignuća uvođenjem endokardijalne elektrode u kliničku praksu te je endokardijalna metoda stimulacije srca stekla veliku popularnost i vrlo brzo potpuno zamijenila miokardijalne elektrode.Unatoč mnogim prednostima endokardijalne elektrode, epikardijalna srčana stimulacija nije posve napuštena te je i dalje medicinski indicirana za mnoge pacijente, osobito u djece.U ovom se radu prikazuje slučaj bolesnice s implantiranim elektrostimulatorom srca koja je hospitalizirana zbog teš-ke trikuspidalne insuficijencije. Liječenje se sastojalo od kirurškog odstranjenja endokardijalne elektrode, zamjene trikuspidalne valvule te inplantacijom nove, epikardijalne elektrode.At the beginning of the development of cardiac pacing devices, the permanent cardiac stimulation was possible only by the epicardial or myocardial electrode that was introduced through the thorax. With the further development of medical and technical science, some achievements were accomplished by introducing endocardial electrodes in clinical practice where the method of endocardial heart stimulation gained great popularity and soon completely replaced the myocardial electrodes.Despite many benefits of endocardial electrodes, epicardial cardiac stimulation has not been entirely abandoned and it continues to be medically indicated for many patients, particularly in children.This paper presents a case of a patient with implanted pacemaker who was hospitalized for severe tricuspid regurgitation. The treatment encompassed surgical removal of endocardial electrode, tricuspid valve replacement and implantation of a new epicardial electrode. 5th Congress of the Croatian Association of Cardiology NursesCardiologia Croatica
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