scholarly journals Combined vascular and neurologic injury after cephalic vein cutdown approach for ICD implantation

2017 ◽  
Vol 4 (1) ◽  
pp. 75 ◽  
Author(s):  
Jack Xu ◽  
Peyton Davis Card ◽  
Evan Watts ◽  
Guillermo A. Escobar ◽  
Gareth Tobler ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Literature Search ◽  
Brachial Plexus Injury ◽  
Cephalic Vein ◽  
Neurologic Injury ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
First Case

In this article we discuss two cases that highlight possible complications of cardiac device implantation. In particular, our first case involves a patient who, during implantable cardioverter defibrillator (ICD) implantation, sustained injuries to her subclavian artery and vein and subsequently developed a self-resolving neuropraxia of the brachial plexus. In our second case, the patient, also during ICD implantation, had his left cephalic vein nicked during cutdown. Post-op he then developed a hematoma-induced left brachial plexus injury that also eventually self-resolved. A literature search has not shown other incidences of iatrogenic brachial plexus injuries from ICD implantation as described.

Abstract 86: Rates and Association of Risk Factors with Device Infection in Veterans Undergoing Cardioverter-Defibrillator Implantation Enrolled in the OVID Registry

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Preston M Schneider ◽  
David F Katz ◽  
Cara N Pelligrini ◽  
Paul A Heidenreich ◽  
Ryan G Aleong ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
A Priori ◽  
Cox Proportional Hazards ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Increased Risk ◽  
Device Infection ◽  
Social Security Death Index

Introduction: Implanted cardiac device infections are a source of significant morbidity, mortality, and cost. The rates and predictors of device infection among patients undergoing implantable cardioverter defibrillator (ICD) implantation in the VA population have not been previously described. Methods: Among veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry between 2003 and 2009, 3,918 were identified as within 3 months of initial ICD implantation. Baseline clinical characteristics and clinical outcomes were abstracted from the electronic medical record and social security death index. The rates of device infection were calculated per 100 person years and a priori specified predictors of device infection were examined for association with device infection using Cox proportional hazards regression. Results: Over 11,290 person years of follow up, only 76 device infections were identified for a rate of 0.67 per 100 person years (95% CI 0.54 to 0.84). Among these, 21 (27.6%) occurred within 30 days of implantation, 19 (25.0%) occurred 30 to 90 days after implantation, 8 (10.5%) occurred 90 days to 1 year after implantation, and 28 occurred greater than 1 year after implantation. The most common type of infection was a pocket infection and it was most likely to occur within 30 days of implantation. Of the examined a priori specified predictors (age, generator change, diabetes mellitus, warfarin use, chronic kidney disease and congestive heart failure), only generator change was statistically significantly associated with device infection when adjusted for comorbidities (adjusted HR 2.95; 95% CI 1.42 - 6.12). The rate of device infection among those with a generator change was 1.26 per 100 person years compared to 0.60 per 100 person years for those without a generator change. Conclusions: The overall rate of device infection in this population is lower than previously published rates and only generator change was associated with an increased risk of device infection.

scholarly journals Predictors of venous stenosis or occlusion following first transvenous cardiac device implantation: Prospective observational study

2018 ◽  
Vol 20 (5) ◽  
pp. 495-500
Author(s):  
Andrzej Cacko ◽  
Eliza Kozyra-Pydyś ◽  
Monika Gawałko ◽  
Grzegorz Opolski ◽  
Marcin Grabowski
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Perioperative Complications ◽  
Lead Extraction ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
Venous Stenosis ◽  
Increased Risk

Introduction: Venous stenosis or occlusion related to an intracardiac device is a well-known complication of that procedure. There are numerous studies tried to determine predictors of venous stenosis or occlusion; however, most of them investigate the venous system prior to device upgrade, generator replacement, or transvenous lead extraction. Therefore, we aimed to assess the prevalence and determine the predictors of venous stenosis or occlusion following first transevnous cardiac device implantation. Methods: Observational, prospective study included 71 consecutive patients admitted for first transvenous cardiac device implantation. All patients were followed up for 6 months after operation. Results: Implanted device systems comprised cardioverter defibrillator (n = 26), single-chamber or dual-chamber pacemakers (n = 34), and biventricular pacemakers (n = 11); 88.5% of implantable cardioverter defibrillator leads were single-coils and 11.5% were dual-coils. The incidence of venous stenosis or occlusion within 6-month follow-up was 21.1%. Multivariate logistic regression showed that only diabetes or prediabetes (p = 0.033, odds ratio: 0.17, 95% confidence interval: 0.04–0.87), prolonged procedure time (p = 0.046, odds ratio: 4.54, 95% confidence interval: 1.01–20.12), and perioperative complications (p = 0.021, odds ratio: 7.04, 95% confidence interval: 1.35–36.85) were predictors of venous stenosis or occlusion. Conclusion: Prolonged implantation time (>60 min) and perioperative complications are associated with an increased risk of venous stenosis or occlusion, whereas diabetes and prediabetes significantly reduce the risk of venous stenosis or occlusion.

scholarly journals Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable Cardioverter Defibrillator

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Zhi-wei Hou ◽  
Hai-bo Yu ◽  
Yan-chun Liang ◽  
Yang Gao ◽  
Guo-qing Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Implantable Cardioverter Defibrillator ◽  
Severe Heart Failure ◽  
Icd Implantation ◽  
Soluble St2 ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
All Cause Mortality

Background. Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings. Aims. This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation. Methods. Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint. Results. During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034 ). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002 ). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02–10.67]). Age (HR: 1.06 [95% CI: 1.01–1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01–1.03]) were also associated with all-cause mortality in ICD patients. Conclusions. sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.

scholarly journals Implantation of a VDD implantable cardioverter-defibrillator lead via a persistent left superior vena cava

2022 ◽  
Author(s):  
Mate Vamos ◽  
Laszlo Saghy ◽  
Gabor Bencsik
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Current Case ◽  
Persistent Left Superior Vena ◽  
Cardioverter Defibrillator

AbstractA persistent left superior vena cava (LSVC) represents a challenging congenital abnormality for transvenous cardiac device implantation. In the current case a secondary prophylactic VDD implantable cardioverter-defibrillator (ICD) implantation was planned in a 75-year-old woman presenting with ischemic cardiomyopathy and elevated stroke risk. Since no venous communication to the right side was identified intraoperatively, the lead was placed via the persistent LSVC. The far-field signal on the floating atrial dipole could be successfully blanked out, and appropriate device function with high and stable atrial sensing was demonstrated at follow-up.

scholarly journals Subcutaneous Implantable Cardioverter Defibrillator Explantation -- A Single Tertiary Center Experience

2021 ◽  
Author(s):  
Naga Venkata Pothineni ◽  
Tharian Cherian ◽  
Neel Patel ◽  
Jeffrey Smietana ◽  
David Frankel ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Tertiary Referral ◽  
Icd Implantation ◽  
Tertiary Referral Center ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
Tertiary Center ◽  
Qrs Duration ◽  
The Mean ◽  
Selection For

Background: The subcutaneous implantable-cardioverter defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. Objectives: To assess incidence and indications for S-ICD explantation at a large tertiary referral center. Methods: We conducted a retrospective study of all S-ICD explantations performed from 2014 to 2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation, were collected. Results: A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7±20.1 months. The mean age of the patients at explantation was 44.8±15.3 years, and 42% (n=27) were female. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of the patients. The most common reason for explantation was infection (32.8%) followed by abnormal sensing (25%) and need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7±13.6 vs 42.3± 14.6 years, p = 0.005) with a wider QRS duration (111±19 ms vs 98±19 ms, p = 0.03) at device implantation compared to patients who underwent explantation for other indications. Conclusion: Incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for a third of the explantations, a significant number were due to sensing abnormalities and need for pacing. These data may have implications for patient selection for S-ICD implantation.

scholarly journals Cardiac device implantation and device usage in Fabry and hypertrophic cardiomyopathy

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Ravi Vijapurapu ◽  
William Bradlow ◽  
Francisco Leyva ◽  
James C. Moon ◽  
Abbasin Zegard ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Premature Death ◽  
Shock Therapy ◽  
Risk Models ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Device Implantation ◽  
Potential Risk Factors ◽  
The Uk

Abstract Background Fabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. Results Indications for ICD in FD varied with 72% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2, p < 0.001). VT requiring therapy was more common in FD (HR 4.5, p = 0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5, p < 0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2, p = 0.004, NSVT: HR 3.1, p < 0.001). Conclusion This study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more ‘arrhythmogenic’ than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.

scholarly journals A case of reversible upper brachial plexopathy following CRT-P implantation

2018 ◽  
Vol 6 (11) ◽  
pp. 3770
Author(s):  
Dolly Mathew ◽  
S. G. Shyam Lakshman
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Implantation Rate ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Brachial Plexopathy ◽  
Nerve Structure ◽  
Device Implantation ◽  
Ventricular Lead ◽  
Left Subclavian Vein

Brachial plexus injury is a challenging field of hand and upper extremity surgery. Presently available microsurgical techniques and functional gains are rewarding in upper plexus injuries. Cardiac electronic devices implantation rate is the required to manage long-term complications. Cardiac resynchronization therapy (CRT) implantation is a commoner procedure done for severe ischaemic and non ischaemic cardiomyopathy. A 65-year-old male patient underwent CRT device implantation via utilizing his left subclavian vein with a classical incision over the delto pectoral groove, with right ventricular lead on the inter ventricular septum and left ventricular lead into the posterolateral branch of coronary sinus with RA threshold, impedance and amplitude (P) of 1V and 690ohm and 7.8mv respectively. CRT with adjacent nerve structure is carefully selected for vein puncture to minimize the risk of Brachial plexus injury, i.e. pacing lead induces nerve injury. Peripheral nerve injuries are sparsely reported due to procedural as well as indwelling trans venous pacing leads and isolated posterior cord involvement is a rarer presentation hence is reported.

Case study: A myoelectrically controlled shoulderelbow orthosis for unrecovered brachial plexus injury

2000 ◽  
Vol 24 (3) ◽  
pp. 252-255 ◽  
Author(s):  
F. Ögce ◽  
H. Özyalçin
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Full Range ◽  
Neutral Position ◽  
Hand Motion ◽  
First Case ◽  
Active Range Of Motion ◽  
Shoulder Paralysis

Two myoelectrically controlled battery powered shoulderelbow orthoses manufactured individually for two traumatic unilateral brachial plexus injury cases are reported. The first case was 24 years old and the other was 6 years old. Both patients had undergone unsuccessful microsurgical nerve repair procedures leaving them with elbow and shoulder paralysis and some residual hand motion. Manufactured orthoses were made of lightweight thermoplastic polyethylene. They stabilised the affected shoulder joint in the neutral position. Elbow extension and flexion were activated by a myoelectrically controlled battery powered orthosis, and the active range of motion of the elbow was between 60 and 140 degrees. These orthoses achieved elbow motions at a speed of 16 degrees per second. The rehabilitation time was 3 months in both patients. The older patient was rehabilitated using a 1kg mass, and the younger one with 0.5kg mass, throughout the full range of active elbow motions. After 21 months it was found, in both cases, that the orthotic treatment had been successful and that the patients had been given the ability to engage in twohanded activities of daily living.

scholarly journals Outcomes in Women Undergoing Electrophysiological Procedures

2013 ◽  
Vol 2 (1) ◽  
pp. 41 ◽  
Author(s):  
Pasquale Santangeli ◽  
Luigi Di Biase ◽  
Eloisa Basile ◽  
Amin Al-Ahmad ◽  
Andrea Natale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Biventricular Pacing ◽  
Persistent Atrial Fibrillation ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Severe Left Ventricular Dysfunction ◽  
Device Implantation ◽  
Electrophysiological Procedures

The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

scholarly journals Cardiac Device Implantation and Device Usage in Fabry and Hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Ravi Vijapurapu ◽  
William Bradlow ◽  
Francisco Leyva ◽  
James C Moon ◽  
Abbasin Zegard ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Premature Death ◽  
Shock Therapy ◽  
Risk Models ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Device Implantation ◽  
Potential Risk Factors ◽  
The Uk

Abstract BackgroundFabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. ResultsIndications for ICD in FD varied with 82% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2,p<0.001). VT requiring therapy was more common in FD (HR 4.5,p=0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5,p<0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2,p=0.004, NSVT: HR 3.1,p<0.001). ConclusionThis study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more ‘arrhythmogenic’ than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.

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