SAFETY AND EFFECTIVENESS OF ENDOVASAL LEAD EXTRACTION IN PATIENTS WITH BACTERIAL ENDOCARDITIS: THE OLOMOUC LEAD EXTRACTION STUDY.
Tématický okruh: Poruchy rytmu, kardiostimulace | |
| Typ: Ústní sdělení - lékařské , Číslo v programu: 113 | |
Etický kodex: Konzultant: Bayer, Boehringer-Ingelheim, MSD, Pfizer, Amgen, SanofiPřednášková činnost: Bayer, Boehringer-Ingelheim, MSD, Pfizer, Amgen, Sanofi Člen poradních sborů (advisory boards): Bayer, Boehringer-Ingelheim, MSD, Pfizer, Amgen, Sanofi Jiné honoráře (např. za klinické studie či registry): Biotronik, Bayer | |
| Fedorco M.1, Táborský M.2, Richter D.2, Grofkova H.3, Skála T.4, Klimeš D.4, Rohánek P.4, Novák M.5, Kozák M.6, Látal J.7 1 Klinika kardiologie, FN Ol, Olomouc, 2 I. interní klinika, FN Olomouc, Olomouc, 3 I. IKK, FNOL, OLomouc, 4 Klinika kardiologie, 5 I.interní kardio-angiologická klinika, FNUSA, Brno, 6 I. IKK, FN Brno Bohunice, Brno, 7 I. IKK, FNOL, Olomouc | |
Aim of the study: Removal of the chronically implanted transvenous lead system can be a significantly complex procedure. The major barrier to removal of these leads is fibrosis that progressively grows around the lead body and electrode tip, securing leads to the venous endothelium and to the myocardium. The aim of Olomouc Lead Extraction Study was to compare the safety and effectiveness of endovasal lead extraction in patients with a bacterial endocarditis (Class IA indication) using only the excimer laser (SpectraneticsTM) Fig.1 or combined technique - laser plus mechanical extraction (Evolution TM, Needle's Eye TM Snare, Dotter helical BaskettTM, Amplatz gooseneck snare TM, Cook Vascular). Methods and Results: 471 patients with ICD and evidence of bacterial endocarditis (TEE) with a clear indication for endovasal lead extraction were randomized to one of the above defined techniques. Average time from ICD implantation was 8.3 ± 8.7 years, average number of electrodes was 2.3 ± 1.8, 229 patients had a dual coil ICD electrode (48.6%), 187 patients had CRT-D (39.7%) 77 (16.3%) it was fully dependent on pacing. The procedures were carried out on the hybrid OR using direct monitoring of blood pressure, in all cases under control of ICE, and the stand-by cardiac surgery . Conclusions: The combination technique involving the excimer laser and mechanical extraction had the same number of serious complications but significantly higher efficiency in terms of complete lead extraction as the primary goal of effective bacterial endocarditis treatment. On the other hand, it is necessary to accentuate that combination technique had more small complications and a increased need for blood transfusion. Monitoring and periprocedural control by ICE significantly increases safety of endovasal lead extraction and should be standard for all complex procedures | |
