Jun 14, 2018 - block in 72% of the patients, 2/1 AV block in 11%, sinus node dysfunction in 5.5%, symptomatic trifascicular block in 3% and others in 8,5%.
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lead in 11 cases, upsizing in 10 cases, mechanical sheath in 4 cases. No SVC or innominate vein lacerations were observed. No extraction related mortality occurred. CONCLUSIONS: SVC intraoperative selective venography can be used to define and visualize adhesions during TLE of chronically implanted pacing and ICD leads. Our experience suggests that changing the extraction strategy due to new intraoperative findings allows for safe and successful TLE.
P1519 Five years of re-use of explanted pacemakers in Senegal: a single center experience in 93 patients A. Kane1; A. Tabane2; SM. Beye1; SA. Sarr1; M. Job1; P. Defaye2; SA. Ba1 CHU Le Dantec, Cardiology, Dakar, Senegal; 2University Hospital of Grenoble, Department of Cardiology, Grenoble, France
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Introduction: Re-use of explanted pacemakers (PM) is a potentially beneficial technique for patients living in countries with low levels of health care. We proposed to share the Senegalese experience in this field. Methods: We conducted a retrospective study from 2010 to 2015 of all patients implanted with re-used PMs. Criteria for PM re-use were : normal electronic functioning and residual battery capacity over 5 years. Re-used PM were obtained after death or extraction. News leads were implanted in all patients. Sterilization was carried out using a solution of phenoxypropanol, benzalconium chloride and ethylene oxide. Results: A total of 93 patients were implanted with re-used PM (45 men, 48 women). The mean age was 65 626 years old. Indications for implantion were : complete AV block in 72% of the patients, 2/1 AV block in 11%, sinus node dysfunction in 5.5%, symptomatic trifascicular block in 3% and others in 8,5%. Clinical symptoms were : syncope in 54% of the patients, dizziness in 25%, dyspnea in 10%. 11% were asymptomatic. For 91.5% of the patients, it was a primary implantation and for 8,5% of the patients PM replacement. A cephalic vein approach was used in 49,5% of the patients to limit the costly need for introducer. Temporary PM were used in 58% of the patients (between 24h to 21 days after diagnosis) and mean time from temporary pacemaker to definitive PM implantation was 72 hours (extremes : 1-21 days). Single chamber PM was used in 60% of the patients and dual chamber in 40%. Major complications rate at 6 months was : infections (3%), PM syndrome (1,5%) and PM dysfunction (1%). Conclusion: Re-used PM appears to be safe and economically useful in least developed countries with an acceptable rate of complications during long-term follow-up. We recommend developing this approach in order to allow populations to benefit from cardiac pacing in these countries.
Abstract P1517 Figure. Intraoperative selective venography.
P1518 Left ventricular strain as a sensitive predictor for the decline of left ventricular function in patients with chronic right ventricular pacing P. Lacour; P. Attanasio; AS. Parwani; M. Huemer; L-H Boldt; B. Pieske; W. Haverkamp; F. Blaschke Charite - Campus Virchow-Klinikum (CVK), Abteilung fu¨r Innere Medizin mit Schwerpunkt Kardiologie, Berlin, Germany Background: Chronic right ventricular (RV) pacing leads to ventricular dyssynchrony with possible subsequent detrimental effects on cardiac structure and function. The most commonly used parameter for the evaluation of left ventricular (LV) function is LV ejection fraction (LVEF). Left ventricular global longitudinal systolic strain (LV Strain) is a new sensitive and accurate parameter to evaluate LV systolic function. The aim of the study was to analyse the effects of RV pacing on LV function comparing LVEF and LV strain. Methods and Results: We enrolled 71 patients with sinus rhythm or paroxysmal atrial fibrillation (73.7 6 9.7 years, 45.1 % male) with baseline preserved left ventricular ejection fraction (LVEF at baseline 61.2 6 9.7 %) with respect to the degree of right ventricular pacing. Follow-up was performed at 6 weeks and every 6 months after device implantation. LV function was analysed by echocardiography using LVEF and longitudinal LV strain. LV function was correlated with right ventricular pacing (VP) rates. High VP rates were defined as > 30 %. Of these 71 patients, 65 patients remained with preserved LVEF and 39 patients with preserved LV strain through the end of the follow-up period. A drop in LVEF 10 % or LV strain 10 % was defined as relevant. Patients with known reasons for a deterioration of the LVEF, e.g. myocardial infarction or tachycardia induced cardiomyopathy, during the follow-up period were excluded. In patients with high VP rates, 12 months after implantation the percentage of reduced LVEF >10 % increased compared to early follow up after 3 months (4 vs. 1 patient, 18.2 % vs.6.7 %). LV strain reduction >10 % was present in 8 patients (53.3 %) after 3 months and in 16 (72.7 %) after 12 months. The control group (patients with low VP rates) showed less decrease of LVEF (no patient (0 %) at 3 months, 1 patient (3.7 %) at 12 months) and LV strain (2 patients (8.7 %) at 3 and 6 patients (22.2 % at 12 months) than patients with high VP rates. All patients with reduced LVEF also showed a lower LV strain. Conclusion: Our data demonstrate that 18.2 % of the patients with VP rates over 30% showed a reduced LVEF > 10% after 12 months whereas LVEF was preserved in most of the patients during the first months after implantation. However, at the 3month follow-up LV strain was already reduced in 53.3 % of this group. Thus, LV strain seems to be a sensitive parameter for negative cardiac remodelling due to chronic RV pacing and could be used to identify patients who may profit from a cardiac resynchronization therapy.
P1520 Evaluation of a score to predict the need for permanent pacemaker in the emergency department based on atrioventricular blocking drugs and kalemia C. Santos1; JB. Augusto2; M. Santos2; H. Ferreira2; N. Martins2; D. Faria2; D. Roque2; J. Urzal2; M. Faustino2; N. Faustino2; F. Madeira2; C. Morais2 1 Hospital Santo Andre, Leiria, Portugal; 2Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal Background: The presence of symptomatic bradycardia is a frequent reason for recurrent admissions on the emergency department (ED). In the presence of AVblocking drugs (AV-BDs) or hyperkalemia (K), the need for permanent pacemaker (PPM) is only assessed after correction of these factors, which may prolong hospitalization unnecessarily. Purpose: The objective of our study is to validate a new score, ABS-K (AV-blocking drug potency score and K level), to predict the need for PPM in these patients at the time of hospital admission. Methods: Retrospective study of 186 consecutive patients evaluated in the ED with symptomatic bradycardia between January 2015 and August 2016. The ABS score was previously described and includes the number of AV-BDs (digoxin and antiarrhythmics agents classes II-IV) and the percentage of their maximum dose; the higher the value of the ABS score, the greater the bradycardic power in the patient. The new ABS-K score was determined by the product of the ABS score by the serum K level (in mmol/L), on admission. The ABS-K score was evaluated for the prediction of PPM need at admission. The impact of conventional risk factors were also assessed: age, previous syncope, heart rate and length QRS, for the same endpoint. Results: A total of 186 patients were evaluated (mean age 78.7 6 9.8 years, 54.1% male). Among them, 113 patients (61.7%) required PPM implantation. A higher level of ABS-K at admission was a predictor of less need for PPM (p
