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Lead extraction with the "pisa technique" - experience of a portuguese tertiary care center
Session:
Painel 5 - Arritmologia 6
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Posters
FP Number:
---
Authors:
João Pedro Reis; Bruno Tereno Valente; Guilherme Portugal; André Viveiros Monteiro; Ana Lousinha; Paulo Osório; Pedro Silva Cunha; Mário Martins Oliveira
Abstract
<p>Background: The "Pisa Technique" (PT) is an increasingly used method of lead extraction (LE) that has shown excellent results in terms of clinical (Cs) and radiological success (Rs) associated with the lowest rate of complications reported in ELECTRa Registry.</p> <p>Purpose: To characterize the adult population submitted to LE with the PT and evaluate its short-term results.</p> <p>Methods: a single-center prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, and P related variables, mortality (M) and reimplantation (R) data were assessed.</p> <p>Results: 320 electrodes (E) were removed in a total of 171 Ps and 159 patients (pts). 80.7% of these P's were due to CIED infection (55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both local and systemic infection, with 44% of pts presenting with valvular/ lead vegetation) and the remainder due to E dysfunction or venous occlusion. Pts averaged 67.7 years of age, 71.9% were male with a mean left ventricular ejection fraction of 47.8%. 19.3% presented coronary artery disease, 42.1% overt heart failure and 43.9% atrial fibrillation. 29 pts had cardiac resynchronization devices, 20 pts implantable cardioverter-defibrillator devices and 110 pts pacemaker systems (mostly DDD). The mean "age" of the extracted E's was 83.2 months, 244 of which were atrial or ventricular pacing, 26 pacing E's via the coronary sinus and 50 shock E's. In 31.0% of the cases, the E's were of active fixation, with 42.7% of the pts being pacing dependent. 14% of pts had a previous attempt of LE, 37.4% had already been submitted to generator replacement and a third to CIED upgrade. In 66.7% of pts, a new contralateral CIED was implanted during the hospital stay - H -(mean time for R of 6 days) and in 19% of R's an antibacterial envelope was used. The Rs and Cs rates were 91.2% and 98.3%, respectively. There was 1 case of cardiac tamponade during LE, which was stabilized by pericardiocentesis and 2 pocket site hematomas requiring surgical drainage. There were no deaths during the P. During a mean follow-up (FU) of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfections. The M rate during FU was 24.2% (37 pts), with 8 pts (5.0%) dying during H, mostly due to septic shock, and 19 pts during the first year post-P.</p> <p>Conclusion: Our center's experience with the PT confirms the method's high efficacy and safety in the percutaneous extraction of E's in pts with CIED.</p>
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