scholarly journals Influence of the type of pathogen on the clinical course of infectious complications related to cardiac implantable electronic devices

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Polewczyk ◽  
Wojciech Jacheć ◽  
Luca Segreti ◽  
Maria Grazia Bongiorni ◽  
Andrzej Kutarski
Keyword(s):  
Clinical Course ◽  
Electronic Devices ◽  
High Volume ◽  
Infectious Complications ◽  
Lead Extraction ◽  
Gram Positive ◽  
Cardiac Implantable Electronic Devices ◽  
Long Term Prognosis

AbstractThe specific role of the various pathogens causing cardiac implantable electronic devices-(CIEDs)-related infections requires further understanding. The data of 1241 patients undergoing transvenous lead extraction because of lead-related infective endocarditis (LRIE-773 patients) and pocket infection (PI-468 patients) in two high-volume centers were analyzed. Clinical course and long-term prognosis according to the pathogen were assessed. Blood and generator pocket cultures were most often positive for methicillin-sensitive Staphylococcus aureus (MSSA: 22.19% and 18.13% respectively), methicillin-sensitive Staphylococcus epidermidis (MSSE: 17.39% and 15.63%) and other staphylococci (11.59% and 6.46%). The worst long-term prognosis both in LRIE and PI subgroup was in patients with infection caused by Gram-positive microorganisms, other than staphylococci. The most common pathogens causing CIED infection are MSSA and MSSE, however, the role of other Gram-positive bacteria and Gram-negative organisms is also important. Comparable, high mortality in patients with LRIE and PI requires further studies.

scholarly journals A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

2021 ◽  
Vol 18 (19) ◽  
pp. 10416
Author(s):  
Łukasz Tułecki ◽  
Anna Polewczyk ◽  
Wojciech Jacheć ◽  
Dorota Nowosielecka ◽  
Konrad Tomków ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Clinical Success ◽  
Major Complication ◽  
High Volume ◽  
Vascular Wall ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices ◽  
Study Population ◽  
Procedural Success

Background: Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Methods: Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Results: Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Conclusions: Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools.

Current Approaches to Management of Attention Deficit Hyperactivity Disorder

1996 ◽  
Vol 13 (1) ◽  
pp. 46-55 ◽  
Author(s):  
Frederick C. Jarman
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Stimulant Medication ◽  
Scientific Evidence ◽  
Behaviour Modification ◽  
Hyperactivity Disorder ◽  
School Based ◽  
Long Term Prognosis

AbstractThe last five years in Australia have been marked by an explosion in the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). The use of stimulant medication for ADHD has increased exponentially across all states, raising questions about the appropriate role of drug treatment and its relationship to other therapies in these children. Despite widespread consensus that multimodal therapy is the preferred option for intervention, many treatments advocated for ADHD lack scientific evidence to support their use. Because no two children with ADHD or their families are the same, an individualised approach to management is advocated that targets both the primary symptoms of the disorder, its cornorbid pathology, and the secondary problems that have developed. Evidence indicates that stimulant medication used in conjunction with parent training, family support, and school based behaviour modification offers the best prospects for improving the disturbing long-term prognosis in these children.

The role of imaging tests in electrotherapy

2020 ◽  
Vol 1 (54) ◽  
pp. 23-29
Author(s):  
Łukasz Mazurek ◽  
Agnieszka Kotalczyk ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej
Keyword(s):  
Sensitivity And Specificity ◽  
Therapeutic Process ◽  
Electronic Devices ◽  
Diagnosis And Treatment ◽  
Imaging Methods ◽  
Cardiac Implantable Electronic Devices ◽  
Wide Range

We currently have a wide range of different imaging tests that are constantly improving and developing. Each test has its sensitivity and specificity and is used in various fields of medicine. Knowledge of the possibilities of using imaging tests in electrotherapy is an important element of the diagnostic and therapeutic process. This article presents selected issues regarding the use of imaging methods in the diagnosis and treatment of patients with cardiac implantable electronic devices.

No-reflow in native coronaries and vein grafts: the role of drugs and distal protection

2018 ◽  
pp. 557-568
Author(s):  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Treatment Strategies ◽  
Coronary Intervention ◽  
Vein Grafts ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Long Term Prognosis ◽  
Distal Protection ◽  
Successful Prevention

Restoration of normal coronary bloodflow and relieving myocardial ischaemia is the main goal of percutaneous coronary intervention (PCI). However, whilst reducing an epicardial coronary stenosis by balloon dilatation may appear to be a relatively easy task, subsequent detrimental changes in bloodflow can paradoxically result in reduced/impaired myocardial perfusion. This condition of mismatch between post-PCI epicardial coronary patency and impaired myocardial reperfusion is defined as slow-flow or no-reflow. It is typically caused by and related to the presence of a damaged, dysfunctional, and/or obstructed coronary microvasculature. When no-reflow occurs, it has an adverse effect on the subsequent mid- and long-term prognosis as it is associated with a higher risk of reinfarction, arrhythmias, heart failure, and a higher in-hospital and long-term cardiac mortality. Frustratingly, nearly four decades after the first PCI, there is still uncertainty about the pathophysiology of no-reflow and a need to define successful prevention and treatment strategies.

scholarly journals Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 566
Author(s):  
Nesterovics ◽  
Nesterovics ◽  
Stradins ◽  
Kalejs ◽  
Ansabergs ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Devices ◽  
Positive Culture ◽  
Major Complication ◽  
Heart Rhythm ◽  
University Hospital ◽  
Lead Extraction ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Implantable Electronic Devices ◽  
Common Location

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

scholarly journals Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1097-1102
Author(s):  
Anders Fyhn Elgaard ◽  
Jens Brock Johansen ◽  
Jens Cosedis Nielsen ◽  
Christian Gerdes ◽  
Sam Riahi ◽  
...  
Keyword(s):  
Clinical Success ◽  
Extraction Procedure ◽  
Clinical Success Rate ◽  
High Volume ◽  
Lead Extraction ◽  
Related Data ◽  
Major Complications ◽  
Long Term Follow Up

Abstract Aims  Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. Methods and results  All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. Conclusion  More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.

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