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Experience of a tertiary center in lead extraction with the "PISA TECHNIQUE"
Session:
CO 09 - Arritmologia
Speaker:
Bruno Tereno Valente
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno Tereno Valente; José Manuel Conceição; Pedro Silva Cunha; Ana Lousinha; André Viveiros Monteiro; Guilherme Portugal; Luisa Moura Branco; Manuel Nogueira Da Silva; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p>The "Pisa Technique" is a method of lead extraction that has shown excellent results in terms of clinical and radiological success associated with a very low rate of complications. It is therefore placed in a privileged position for increasing use in this complex area of ??interventional cardiology where safety is seen as a decisive factor to consider while planning the therapeutic orientation of these patients.</p> <p>Objective: analysis of the results regarding lead extraction with the Technique of Pisa in Portugal.</p> <p>Methods: a single-center prospective study of consecutive patients (P) who underwent lead extraction using the Pisa Technique between February 2013 and October 2017. Demographic variables, clinical indications, type of devices, age electrodes, number and type of electrodes extracted, clinical and radiological success of the procedure, rate of minor and major complications, pacing dependence and number of reimplantations.Results: 190 electrodes were removed in 101 P (78.9% by DCEI associated infection, 69.4% by locus infection and the rest by endocarditis, and 21.1% by electrode dysfunction or venous occlusion). The mean age of the population was 68.5 years (min 19, max 94), 71.5% were males, the mean body mass index was 29.2 and the mean left ventricular ejection fraction was 40.9%. Nineteen P patients had cardiac resynchronization devices, 9 P cardioverter-defibrillator and 73 P pacemaker (DDD-48, VVI-14, VDD-11) systems. The mean "age" of the extracted electrodes was 91.44 months (max 360 and min.9), 158 of which were atrial pacing or ventricular pacing, 11 pacing via the coronary sinus and 21 shock electrodes. In 24.3% of the cases the electrodes were of active fixation. In 44.8% of the P there was dependence on pacing. New implanted cardiac electronic devices (ICED) were reimplanted in 58.4% of the P. The radiological success rate was 95.0% and the clinical success rate was 99.1%. One cardiac tamponade occurred during the extraction procedure, which was stabilized by pericardiocentesis, after was surgically removed, and a P with a pocket hematoma. There were no venous lacerations. During a clinical follow-up of 36 months (max 55 and min 1) two reinfections of the locus were recorded in a cardiac resynchronization device and pacemaker reimplanted 45 and 15 days respectively on the contralateral side. Conclusion: The results of the Pisa Technique in this population confirm the high efficacy and safety of the method in the percutaneous extraction of electrodes in patients with ICED.</p> <p> </p>
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