The incidence of cardiac perforation related to pacing and defibrillation leads is low. The use of active fixation leads is associated with an increased risk of cardiac perforation. We did not find any correlation between the perforation rate and any particular model of the implanted lead.

ICD therapy is effective in SCD prevention in patients with HCM, although the complication rate is significant. Nonsustained ventricular tachycardia seems to be the most predictive RF for appropriate device discharges. Number of RF did not impact the incidence of appropriate ICD interventions.

Intravenous antazoline was effective and safe in the rapid conversion of non-valvular paroxysmal atrial fibrillation to sinus rhythm in patients without heart failure. Clinical Trial Registration number: NCT01527279.

Antitachycardia pacing therapy is rarely effective and often harmful in young ICD recipients. In most patients, programming ICD for only VF therapy is sufficient. Routine pre-discharge programming against inappropriate interventions (especially T-wave over-sensing) helps to reduce the incidence of discharges during the follow-up. The incidence of complications and inappropriate therapies is high in young ICD recipients and affects 50% of patients.

(Cardiol J 2014; 21, 4: 419-424)

Endocardial ICD implantation in children and young adults is a feasible and life-saving procedure, according to the present 15 year follow up. The rate of complications including IT was high: 72.8% in the young ICD recipients. Re-implantation of a new system was often required due to ventricular lead dysfunction or infection in 25% of the patients.

The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess peri-procedural practices, implantation techniques, and short-term procedure-related complications associated with implantation of subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across tertiary European electrophysiology centres. An internet-based electronic questionnaire concerning implantation settings, peri-procedural routines, techniques, personnel, complications, and patient outcomes was sent to the centres routinely implanting both TV-ICDs and S-ICDs. The centres were requested to prospectively include consecutive patients implanted with either TV-ICD or S-ICD during the 8-week enrolment period. Overall, 20 centres from 6 countries enrolled 429 consecutive patients. Subcutaneous implantable cardioverter-defibrillators (20%) compared with TV-ICD were implanted mainly under general anaesthesia (72% vs. 14%), in the surgical operation room settings (69% vs. 43%), with more frequent prophylactic antibiotic administration (82% vs. 91%), and post-implant defibrillation testing (85% vs. 7%, all P < 0.05). Feasibility (implantation duration of 45 min) and short-term complication rates (4%) were comparable for S-ICDs and TV-ICDs, but the spectrum of complications varied, despite different baseline characteristics of patients undergoing the S-ICD vs. TV-ICD implantation. This EHRA snapshot survey provides important insights into the implantable cardioverter-defibrillator implantation routines and patient outcomes. Our study showed differences between the S-ICD and TV-ICD implantation routines with respect to implantation settings, peri-procedural management, and pre-defined procedural endpoints. However, the comparable duration of S-ICD or TV-ICD implantation and similar rates of peri-procedural complications indicate that both devices can be routinely used in clinical practice.

IntroductionVenous occlusion is a relatively common complication of endocardial lead implantation. It may cause a critical problem when implantation of a new lead is needed. Traditional methods result in leaving abandoned leads. The optimal approach seems to be the extraction of the damaged or abandoned lead, regaining venous access and implantation of a new lead.AimTo assess the efficacy and safety of new lead implantation by the method of lead extraction.Material and methodsAll transvenous lead extraction procedures (203 patients) between 1 August 2008 and 15 October 2012 were assessed. The analysis included cases with leads implanted for at least 6 months prior to extraction.ResultsRegaining venous access was the main indication for lead extraction in 5 patients (4.9%). The reason for new lead implantation was lead damage (n = 7) and system up-grade to cardiac resynchronization therapy (CRT) (n = 3). In total, 23 leads were extracted (9 defibrillation leads, 12 pacing leads and 2 left ventricular leads). The mean time from the implantation was 92.2 ±43.2 (48-152) months. In all cases Cook mechanical sheaths were applied. The use of the Evolution system was necessary to extract 3 leads. In all cases the new leads were successfully implanted as planned. No serious complications occurred.ConclusionsDiagnosis of venous occlusion should not be a contraindication for ipsilateral implantation of the new lead, because the techniques of transvenous lead extraction enable successful regaining of venous access.