May 12, 2018 - Suture and pacemaker generator pocket technique in relation to ... plantation,the use of a temporary pacemaker,chronic corticosteroid therapy, pro- cedure time and post-operative haematoma were all associated with ...
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Antibradycardia pacing
Conclusion: This comprehensive meta-analysis demonstrates lower risk for pneumothorax and lead failure associated with CVC as compared to SP in patients receiving CIEDs.
P1669 | BEDSIDE The importance of arterial bridges and axillary artery/vein cross- over to avoid bleeding during safe axillary venous access S. Sert, A. Kepez, H. Atas, B. Mutlu, O. Erdogan. Marmara University, Cardiology, Istanbul, Turkey Background: A growing body of evidence suggest that intra-cardiac device implantation can be safely performed on continued oral anti-coagulants (OAC). However, bleeding due to inadvertent axillary artery puncture and/or laceration of small arterial bridges over axillary vein may occur during safe axillary venous access although it has not been investigated before. Purpose: To reduce the risk of inadvertent arterial puncture and bleeding we aimed to perform an anatomical study by radiologically investigating the course and relation of axillary artery and vein, the presence and location of small arterial bridges, as well as to validate the relation between the course of the axillary vein and previously defined safe puncture sites. Methods: The anatomical course and relation as well as cross-over points of axillary artery and vein, the presence of small arterial bridges over axillary vein and validation of previously defined safe axillary venous puncture sites were determined in patients (n=111; 80 men, age 60±10 years) who will undergo coronary angiography by radial artery access along with simultaneous ipsilateral venography (Figure-1). At the end of the study the data were reanalyzed and compared by gender, left or right sided approach and body mass index (BMI). Results: Interestingly, small arterial bridges over the axillary vein were detected in 77% of patients and more frequently observed in men and BMI ≥25 kg/m2 (p=0.034 and p=0.03, respectively). Axillary artery and vein cross-over was observed in 24% of patients and almost always within the intrathorasic region close to the first rib-clavicular intersection site. The course of the axillary vein was located at the first costa-clavicular intersection in only 62% and at the second anterior costa- third posterior costal intersection in 60% of patients.
cardial involvement, systemic signs or symptoms of infection or positive blood cultures. Purpose: Male sex,COPD, renal impairment, lack of antimicrobial prophylaxis, re-intervention prior to discharge, number of prior procedures, fever prior to implantation,the use of a temporary pacemaker,chronic corticosteroid therapy, procedure time and post-operative haematoma were all associated with infection. Our objectives were to study whether suture technique and pacemaker generator pocket toileting by antibiotics have any influence in pacemaker infection rate or not. Methods: We have studied 2200 patients over a period of five years from 2011 to 2016. Both the study and control group were randomized. Nonabsorbable suture was used for lead fixation and absorbable suture was used for skin closure. We have used interrupted suture technique in control group and continuous suture technique in study group. We used betadine and gentamicin for pocket toileting in control group but nothing in study group. Results: Chronic renal failure patients were 130 in study group and 124 in control group. It was around11. 5%. There were 356 diabetic patients in study group and 350 in control group. Incidence was about 32%. Repeat procedure was done in 95 patients in study group and 90 patient in control group. Incidence was around 9%. Chronic obstructive airway disease patients were 86 in study group and 82 were in control group. Incidence was 7%. Patients on immunosuppressive therapy was 14 in study group and 10 in control group. Pacemaker pocket infection occurred in 33 patients only. Incidence is around 1.5%. Infection occurred in 17 patients in study group and 16 patients were in control group. There were no statistical difference between the study and control group. Conclusion: Our experience suggests that suture technique does not alter pacemaker generator pocket infection rate. Pacemaker pocket toileting by antibiotics is a popular practice. But our data suggest that it does not have a role in pacemaker pocket infection rate. Our experience tells that pocket haemostasis is the most important factor for prevention of pacemaker pocket infection as well as proper surgical asepsis practice and preoperative antibiotic use.
P1671 | BEDSIDE Incidence of subclinical cardiac perforation by cardiac implantable electronic device leads in cardiac CT J.-S. Uhm, Y.M. Lim, P.S. Yang, J.Y. Kim, H.N. Pak, H.T. Yu, T.H. Kim, B. Joung, M.H. Lee. Yonsei University, Severance Hospital, Seoul, Korea Republic of Background: MR-conditional lead is stiffer and transfers more torque than other modern previous pacing or defibrillation lead. A currently using MR-conditional pacing system in CIED has been demonstrated to be safe, but study about lead perforation using cardiac CT is rare. There are concerns on cardiac perforation by magnetic resonance (MR)-conditional leads. This study aimed to compare the incidence of subclinical cardiac perforation among various cardiac implantable electronic device (CIED) leads. Methods: Cardiac computed tomographic (CT) images of 401 CIED leads with 240 consecutive patients (age: 68.1±15.2 years, 43.6% male) who underwent cardiac CTs were reviewed. We compared cardiac perforation rate between MRconditional and MR-unsafe leads, between atrial and ventricular leads, between pacing and defibrillator leads, and between screw and tined leads. Each CT was reviewed for presence of lead perforation, presence of MRI conditioning pacing lead and detailed lead profile. Results: 194 patients had permanent pacemaker and 45 patients had ICD or CRT-D. Cardiac perforation was shown in 10.4% of total leads. Cardiac perforation was more frequent in ventricular leads than atrial leads (14.6% and 5.2%, respectively, p=0.003). There are no significant difference in cardiac perforation between pacing and defibrillator leads (14.1% and 15.2%, respectively, p=0.756), between MR-conditional and MR-unsafe leads (8.8% and 11.8%, respectively, p=0.291), between Medtronic 5086 and 5076 leads (9.5% and 16.6%, respectively, p=0.419). Conclusion: Subclinical cardiac perforation by CIED leads is not rare. Cardiac perforation risk of MR-conditional leads is not higher than MR-unsafe leads.
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Conclusions: To avoid inadvertent arterial puncture and reduce the risk of bleeding complications, especially in patients on continued OAC we recommend contrast guided extrathorasic axillary venous approach by aiming second anterior costa and third posterior costal intersection site where cross-over of axillary artery and vein as well as arterial bridges over the axillary vein are less frequently observed.
P1670 | BEDSIDE Suture and pacemaker generator pocket technique in relation to pacemaker infection rate G. Datta. Burdwan Medical College, Cardiology, Calcutta, India Background: Cardiac implantable electronic devices (CIEDs) infections now constitute ∼10% of all endocarditis cases.The incidence of CIEDs that become infected is usually
