Exposure Optimization Trial for Patients With Medical Implants During MRI Exposure: Balance Between the Completeness and Efficiency

Elongated conductors, such as pacemaker leads, can couple to the MRI radio-frequency (RF) field during MRI scan and cause dangerous tissue heating. By selecting proper RF exposure conditions, the RF-induced power deposition can be suppressed. As the RF-induced power deposition is a complex function of multiple clinical factors, the problem remains how to perform the exposure selection in a comprehensive and efficient way. The purpose of this work is to demonstrate an exposure optimization trail that allows a comprehensive optimization in an efficient and traceable manner. The proposed workflow is demonstrated with a generic 40 cm long cardio pacemaker, major components of the clinical factors are decoupled from the redundant data set using principle component analysis, the optimized exposure condition can not only reduce the in vivo power deposition but also maintain good image quality.

296 Case Report: Pacemaker Lead-Induced Fibrosis Resulting in Right Atrial and Tricuspid Stenosis Managed with An Open Surgical Approach

Pacemaker leads can result in localised inflammation and, over time, fibrosis. Rarely, this can significantly alter the anatomy of the heart and impair cardiac function. In this case, a fifty-year-old female had undergone pacemaker placement in her teens having experienced symptomatic bradycardia. Due to pacemaker pocket erosion, she had undergone a lead extraction where lead fragments had been left in-situ. Years after a new generator and leads were placed, she presented with symptoms of proximal venous congestion and superior vena cava (SVC) syndrome. A venogram demonstrated completely occluded brachiocephalic and innominate veins with significant adjacent venous collateralization. Computed tomography showed partial obstruction of the SVC and tricuspid stenosis. Initially, a decision was made not to intervene. After developing abdominal distension, she was diagnosed with hepatic congestion and cirrhosis secondary to elevated right sided pressures and right atrial congestion due to tricuspid stenosis. It was concluded that the patient’s symptoms were the result of occluded proximal veins, SVC syndrome, and functional tricuspid stenosis, all of which were likely the result of fibrotic tissue secondary to pacemaker lead-induced inflammation. Due to the severity of her symptoms, the patient accepted the risks associated with surgical management. Intra-operatively, electrocautery was used to debride the fibrotic tissue inhibiting the leaflets of the tricuspid valve. This worked to great effect and additional valve repair/replacement was not necessary. Whilst the patient has been left with SVC syndrome, her tricuspid stenosis symptoms are greatly improved. To our knowledge, such a case has not been previously described.

Cost-Utility Analysis of Percutaneous and Surgery Methods in Extraction of Cardiac Leads Infection

Introduction: Cardiovascular diseases are currently major concern in the world and It is expected that Until 2030, 7 out of 10 deaths in world will be related to cardiovascular diseases. Despite the increase in Pasemaker and ICD implants in recent years, the complications of this devices are increasing. One of the most important complications is the pulsating lead infection. The purpose of this study was to analyze the cost-effectiveness of percutaneous and surgical method in extracting pacemaker leads with Qaly index.Methods: In this cross-sectional article (descriptive-analytical) using the Markov model, for compare the two methods of percutaneous and surgery for infectious lead. Sampling was census and ( sample size for percutaneous included 57 people) and information about utility was extracted by the SAQ questionnaire. A systematic review was performed to calculate utility of the surgical Cost from the perspective of the service provider. data analysis by SPSS software, and TreeAge software was used for Markov modeland and sensitivity analysis .Results: Changes in quality of life score in both intervention were incremental and significant and intervention is the only effective factor in changes in quality of life score (P <0.05). The ICER was 5470.44$.Conclusion: The results of the study show that utility and cost of surgery are higher than the percutaneous method.Sensitivity analysis shows If the cost of surgery increases more than 806.52$ (discount rate of 0.06), the percutaneous method dominates the surgery method.

Pacemaker lead related severe tricuspid stenosis and a history of severe COVID-19 pneumonia: A case report

Tricuspid stenosis occurs after the implantation of a ventricular pacemaker lead and is a rare complication. An inflammatory response is stimulated when the pacemaker leads are passing through the tricuspid valve which leads to fibrosis in the long-term. In our case report, we aim to present a patient with asymptomatic multiple pacemaker lead related tricuspid stenosis and with a history of severe COVID-19 pneumonia.

RENEDI: Results of the first observational and prospective registry of transvenous lead extraction in Argentina. Inter-societary Working Group.

Background and aim: RENEDI (“Registro Nacional de Extracción de Dispositivos”) is the first registry on Transvenous Lead Extraction (TLE) designed in Argentina with the objective of providing data on lead extraction real-world practice. Methods: An online database platform was designed. Data referred to patients, leads and extraction procedures were compiled and reviewed by a Committee. Results: A total of 621 leads were extracted from 325 patients (average age of 59 years; 71% male). The targeted leads included 374 pacemaker leads (61%), 176 implantable cardioverter-defibrillator leads (28%) and 71 cardiac resynchronization therapy devices (11%). Two hundred and thirty-three (38%) atrial, 367 (59%) ventricular and 21 (3%) coronary sinus leads placement. The average lead dwell time was 105. 9 months. The commonest indication for removal was infection (68%-Local 71%). Cardiovascular surgeons were usually the primary operator (81%). The presence of cardiovascular stand-by was reported in 72% of cases. Percutaneous approach (98%) was predominant. A total of 158 (25%) leads with a median dwell time of 33.3 months were extracted using simple traction. Overall complication rate was 4%. Only one major complication and no deaths were informed. Minor complications occurred in 3.6% of procedures. Complete procedural success was 96.2%. Incomplete extraction was obtained in 23 leads. No permanent disabling complications or procedure-related deaths were reported. Conclusions: Current Argentinian practice has demonstrated that TLE is a safe and effective procedure associated with a low incidence of complications and high success rate when it is performed in well-trained hands.

Pacemaker-related Candida parapsilosis fungaemia in an immunosuppressed renal transplant recipient

Renal transplant recipients are at risk for opportunistic infections due to their immunosuppressed state. We describe the case of a 59-year-old renal transplant recipient who presented with sepsis and bilateral pulmonary emboli due to Candida parapsilosis. She was treated with intravenous caspofungin and had a transoesophageal echocardiogram, which revealed vegetations on her pacemaker leads. She then underwent surgery to replace her pacemaker; however, her blood cultures remained positive for C. parapsilosis postoperatively. Her antifungal was switched to liposomal amphotericin B and flucytosine for 6 weeks, which yielded sterile blood cultures, and she was then initiated on lifelong fluconazole. Her recovery was complicated by tacrolimus toxicity 1 month after discharge due to fluconazole-induced CYP3A inhibition.

Case Report: Assessing the Position of Pacemaker Leads via Transthoracic Echocardiography: Additional Value of the Subcostal En Face View

There is an association between presence of cardiac implantable electronic devices (CIED) and development of tricuspid regurgitation (TR). Mechanisms proposed to explain CIED-induced TR can be classified as implantation-related, lead-related, and pacing-related. Lead-related TR results from the direct interaction of the lead with the tricuspid valve (TV). The localization of the lead at the TV level directly influences the probability of subsequent development of significant TR. A transthoracic subcostal en face view of the TV can be acquired in most patients through a 90° rotation from the subcostal 4-chamber view with clear anatomic delineation of the TV and the commissures including lead position. This case-series presents three examples where the transthoracic en face view could add incremental information on the position of the pacemaker leads and on the mechanism of TR.Conclusion: When performing transthoracic echocardiography in patients with trans-tricuspid CIED lead(s), an en face view of the TV with exact reporting of the position of the lead(s) should be included.

Upper Extremity Deep Vein Thrombosis: Current Knowledge and Future Directions

Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. We review current evidence in primary and secondary UEDVT, highlighting areas in need of further research. We also explore the entity of venous thoracic outlet syndrome, which is said to be a risk factor for recurrent primary UEDVT and is the rationale behind surgical interventions.