Current Issues and Recent Advances in Pacemaker Therapy

doi:10.5772/2618

Cited by 4 publications

References 21 publications

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Outcomes of chlorhexidine lavage without capsulectomy versus complete capsulectomy after lead extraction for the treatment of cardiac implantable electronic device infection

Díaz¹,

Marín

Aristizábal

et al. 2023

Cardiovasc electrophysiol

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Introduction Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time‐consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) lavage in lieu of capsulectomy for the treatment of CIED infections. Methods This retrospective study included patients who underwent TLE for CIED‐related infections in two institutions in Colombia. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, exhaustive lavage of the generator pocket with 20 cc of CHG at 2% followed by irrigation with approximately 500 cc of normal saline (0.9% sodium chloride) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included the occurrence of any adverse reaction to chlorhexidine, the need for reintervention, infection‐related mortality, and total procedural time. Results A total of 102 patients (mean age 67.2 ± 13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n = 54) or CHG (n = 48) lavage. Hematoma formation was significantly higher in the capsulectomy group versus the CHG group (13% vs. 0%, p = .014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7 ± 78.5 vs. 89.9 ± 51.8 min, p = .002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: three in the capsulectomy group and one in the CHG group (p = .346). Conclusions In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.

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Outcomes of chlorhexidine lavage without capsulectomy versus complete capsulectomy after lead extraction for the treatment of cardiac implantable electronic device infection

Díaz¹,

Marín

Aristizábal

et al. 2023

Cardiovasc electrophysiol

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Practical Approaches to Transvenous Lead Extraction Procedures—Clinical Case Series

Boarescu

Popa²,

Trifan

et al. 2022

IJERPH

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Transvenous lead extraction (TLE) is regarded as the first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIEDs), when lead removal is mandatory. The decision to perform a lead extraction should take into consideration not only the strength of the clinical indication for the procedure but also many other factors such as risks versus benefits, extractor and team experience, and even patient preference. TLE is a procedure with a possible high risk of complications. In this paper, we present three clinical cases of patients who presented different indications of TLE and explain how the procedures were successfully performed. In the first clinical case, TLE was necessary because of device extravasation and suspicion of CIED pocket infection. In the second clinical case, TLE was necessary because occlusion of the left subclavian vein was found when an upgrade to cardiac resynchronization therapy was performed. In the last clinical case, TLE was necessary in order to remove magnetic resonance (MR) non-conditional leads, so the patient could undergo an MRI examination for the management of a brain tumor.

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Contactless Electrocatheter Tracing within Human Body via Magnetic Sensing: A Feasibility Study

Andreozzi

Esposito

Bifulco

2022

Sensors

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During surgical procedures, real-time estimation of the current position of a metal lead within the patient’s body is obtained by radiographic imaging. The inherent opacity of metal objects allows their visualization using X-ray fluoroscopic devices. Although fluoroscopy uses reduced radiation intensities, the overall X-ray dose delivered during prolonged exposure times poses risks to the safety of patients and physicians. This study proposes a potential alternative to real-time visualization of a lead inside the human body. In principle, by making a weak current flow through the lead and measuring the related magnetic field generated outside the body, it is possible to trace the position of the lead. This hypothesis was verified experimentally via two tests: one carried out on a curved copper wire in air and one carried out on a real pacemaker lead in a saline solution. In the second test, a pacemaker lead and a large return electrode were placed in a tank filled with a saline solution that reproduced the mean resistivity of the human torso. In both tests, a current flowed through the lead, which consisted of square pulses with short duration, to avoid any neuro-muscular stimulation effects in a real scenario. A small coil with a ferrite core was moved along a grid of points over a plastic sheet and placed just above the lead to sample the spatial amplitude distribution of the magnetic induction field produced by the lead. For each measurement point, the main coil axis was oriented along the x and y axes of the plane to estimate the related components of the magnetic induction field. The two matrices of measurements along the x and y axes were further processed to obtain an estimate of lead positioning. The preliminary results of this study support the scientific hypothesis since the positions of the leads were accurately estimated. This encourages to deepen the investigation and overcome some limitations of this feasibility study.

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Current Issues and Recent Advances in Pacemaker Therapy

Cited by 4 publications

References 21 publications

Outcomes of chlorhexidine lavage without capsulectomy versus complete capsulectomy after lead extraction for the treatment of cardiac implantable electronic device infection

Outcomes of chlorhexidine lavage without capsulectomy versus complete capsulectomy after lead extraction for the treatment of cardiac implantable electronic device infection

Practical Approaches to Transvenous Lead Extraction Procedures—Clinical Case Series

Contactless Electrocatheter Tracing within Human Body via Magnetic Sensing: A Feasibility Study

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