Extraction of permanent pacing leads: there are still controversies.

Hayes, David L.

doi:10.1136/hrt.75.6.539

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…One-axis accelerometer-based systems have been integrated in a permanent pacemaker lead-the SonRtip (Sorin Group, Italy) [4][5][6]-for endocardial placement (attached to the inside of the heart) ( Figure 1, bottom row). The drawback of this device is that not every patient needs a permanent pacemaker lead and the extraction of such leads can be dangerous [7]. We have previously developed a monitoring system based on a 3-axis accelerometer, with dimensions of 14 Â 11.5 Â 5.2 mm 3 ( Figure 1, second row).…”

Section: Introductionmentioning

confidence: 99%

Fabrication and assembly of MEMS accelerometer-based heart monitoring device with simplified, one step placement

Tjuļkins

Nguyen

Andreassen

et al. 2014

Journal of Medical Engineering & Technology

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An accelerometer-based heart monitoring system has been developed for real-time evaluation of heart wall movement. In this paper, assembly and fabrication of an improved device is presented along with system characterization and test data from an animal experiment. The new device is smaller and has simplified the implantation procedure compared to earlier prototypes. Leakage current recordings were well below those set by the corresponding standards.

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Section: Introductionmentioning

confidence: 99%

Fabrication and assembly of MEMS accelerometer-based heart monitoring device with simplified, one step placement

Tjuļkins

Nguyen

Andreassen

et al. 2014

Journal of Medical Engineering & Technology

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Endocardial Lead Extraction

Belott

2008

Cardiac Pacing for the Clinician

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This work is a commercial publication and video. It includes a 160-page manual and a 22minute video. The points the author makes are well illustrated in the manual and demonstrated by performing the procedures on the video. The strong parts of this effort are the emphasis on safety issues, an excellent description ofthe preparation of tbe patient, the composition ofthe extraction team, the surgical instruments and extraction tools needed in the procedure room, and a detailed discussion of each type procedure. There is also a very good discussion of the issues a cardiologist faces extracting leads in an operating room verses a catheterization or electrophysiology laboratory.Conventional lead extraction techniques are based upon counterpressure and countertraction. Only counterpressure is defined in this work. However, counterpressure and countertraction techniques are correctly demonstrated in the video examples of leads extracted via the vein entry site (superior approach). The rationale for the nomenclature "superior and inferior approaches" is not given. This terminology is based upon the venous anatomy, not on one being superior or inferior to the other. An approach to the heart through the superior vena cava is called a superior approach, and through the inferior vena cava it is called an inferior approach. An approach through the right atrium is called a transatrial approach.Three examples of femoral extraction techniques were shown on the video. In this reviewer's opinion, proper technique was not used in these examples. In the video, the proximal and distal portions of the lead are both pulled into the workstation at the same time, subjecting the electrode and proximal lead to the same pulling force. In each example, it resulted in the electrode being removed from the heart by simple traction (pulling on the electrode) and not by countertraction. The proximal portion of the lead embedded in the superior veins should be pulled free using snares before attempting to remove the electrode from the heart wall. Countertraction is applied by advancing the workstation over the lead to a site near the heart wall where traction is applied to the electrode, countered by the sheath. Also in contention are the comments in both the manual and video that the Dotter snare-deflection catheter combination are not always reversible. This combination was chosen because it was always reversible and is still used in those situations where the new needle's-eye-snare is not applicable.The comment that all infected debrided subcutaneous tissue pockets cannot be closed in my experience is not true. Even submuscular pockets in the abdomen, which cannot be completely debrided because the posterior tissue is near the peritoneum, can be closed. If a closed incision does not heal, healing by second intention is not adversely affected by the initial primary closure.Some discussion and video sequences taken from the author's experiences and from the literature are confusing or, in my opinion, untrue. Fortunately, these statements are few ...

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Suga

Hayes

Hyberger

et al. 2000

Journal of Interventional Cardiac Electrophysiology

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1. With only 5.5% of patients having had pacemaker-related complications, the adverse outcome of APL is small. 2. Clinical clues to the possible occasion for pacemaker-related complications include three or more APLs, four or more total leads, three or more procedures of new lead placement, and a younger age at initial pacemaker implantation. 3. Patients with a large number of APLs, total lead implantations, and procedures of new lead placement should be carefully observed to detect possible pacemaker-associated complications.

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Extraction of permanent pacing leads: there are still controversies.

Cited by 3 publications

References 7 publications

Fabrication and assembly of MEMS accelerometer-based heart monitoring device with simplified, one step placement

Fabrication and assembly of MEMS accelerometer-based heart monitoring device with simplified, one step placement

Endocardial Lead Extraction

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