Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

The study demonstrated a high rate of patients with non-infectious complications referred for TLE and very high effectiveness of the procedure. The worse long-term survival of patients with infectious complications, as well as increased risk for such complications due to the greater number of prior procedures, should prompt the consideration of early referral for TLE in the case of lead dysfunctions.

In the past years we have been observing the dynamic development of electrotherapy, as evidenced by the steadily rising number of implanted pacemakers (PM), as well as devices used in the treatment of dangerous arrhythmia and heart failure, such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT-P/D). This is a consequence of the ageing of the populations of the majority of developed countries and also the gradually widening indications for the use of such devices. Along with the observed rise in the number of new implantations, the number of complications of electrotherapy is rising as well. In view of the increase in the incidence of complications, it is necessary to systematize the knowledge on this subject, because there is still no official classification of this type of complication and guidelines for dealing with such cases do not appear to cover the scale of the problem. In addition, late complications of electrotherapy play the most important role, in which case the removal of the entire pacing system, transvenous lead extraction (TLE), is a challenge due to the older age of leads strongly attached to the venous walls and endocardium of the heart cavity. The present paper presents a modern classification of electrotherapy complications and discusses the types of complications according to the most recent literature reports. Moreover, the diagnosis and management of particular types of complications with the assessment of indications for TLE are discussed.

For a long time the AAI pacing mode was commonly used in patients with sick sinus syndrome, who were treated with pacemaker. After the guideline recommendations were updated in 2013 the AAI mode was displaced by the DDDR mode, especially with atrioventricular delay management. The most important argument for this change was the risk of the development of advanced atrioventricular block in long-term observation. This situation may require changing the pacing mode to DDD and implanting a ventricular lead. However, the AAI pacing mode has many forgotten advantages and it could still be successfully used in well selected patients with sick sinus syndrome. StreszczeniePrzez wiele lat tryb stymulacji AAI był powszechnie używany u pacjentów z zespołem chorej zatoki, którzy wymagali implantacji kardiostymulatora. Po zmianie wytycznych w 2013 r. rozruszniki AAI zostały niemal całkowicie wyparte przez DDD, zwłaszcza z programowanym czasem opóźnienia przedsionkowo-komorowego. Argumentem za taką zmianą postępowania było głównie ryzyko rozwoju zaawansowanego bloku przedsionkowo-komorowego w długoterminowej obserwacji. Taka sytuacja może skutkować koniecznością zmiany trybu stymulacji, a co za tym idzie -koniecznością implantacji elektrody komorowej. Należy jednak pamiętać, że stymulacja w trybie AAI ma także wiele zapomnianych korzyści, które powodują, że nadal może ona być z powodzeniem stosowana w dobrze dobranej grupie pacjentów z objawową chorobą węzła zatokowego.

Sudden cardiac death (SCD) is an important clinical problem with a complex and multifactor background. Trends in its prevention have been dynamically developing over the last decades. Patients with ischemic heart disease, especially after myocardial infarction, represent the largest group at an elevated risk of SCD. Many congenital and hereditary diseases are associated with an increased risk of SCD, particularly among young people. Although far from perfect, left ventricular ejection fraction remains the only widely recognized, relatively objective and credible method of assessing the risk of SCD among patients with heart failure. Other methods for assessing the risk are waiting for the final confirmation of their usefulness in clinical trials. The implantable cardioverter-defibrillator (ICD) and its newer version-totally subcutaneous S-ICD-remain the most effective methods of SCD prevention. The only class of drugs with well-proven efficiency in most patients at risk of SCD is β-blockers. Streszczenie Nagły zgon sercowy (sudden cardiac death-SCD) stanowi istotny problem kliniczny o wieloczynnikowym podłożu. W ciągu ostatnich dekad dynamicznie rozwijają się trendy w zakresie zapobiegania SCD. Największą grupą pacjentów o podwyższonym ryzyku wystąpienia SCD są osoby z chorobą niedokrwienną serca, szczególnie po przebytym zawale serca. Wiele wrodzonych i dziedzicznych schorzeń wiąże się z podwyższonym ryzykiem wystąpienia SCD, przede wszystkim wśród osób młodych. U pacjentów z niewydolnością serca pomiar frakcji wyrzutowej lewej komory jest jedyną powszechnie uznaną, względnie obiektywną i wiarygodną, choć daleką od doskonałości, metodą oceny ryzyka SCD. Pozostałe metody wymagają ostatecznego potwierdzenia swojej przydatności w badaniach klinicznych. Najskuteczniejszą metodą profilaktyki jest wszczepialny kardiowerter-defibrylator (implantable cardioverter-defibrillator-ICD) oraz jego nowsza, całkowicie podskórna wersja S-ICD. Jedyną grupą leków o dobrze udowodnionej skuteczności znajdującą zastosowanie u większości chorych zagrożonych SCD są β-adrenolityki.