Search

Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients. Materials and methods: We retrospectively analyzed all 228 resynchronization patients implanted at the Timisoara Institute of Cardiovascular Medicine between January 1st, 2000 and January 1st, 2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulation-detection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients). Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12.5%) in group A, 8 (9.87%) in group B and 5 (6.75%) in group C (p = 0.51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p = 0.36). Cephalic vein was of high quality in 59.8% of cases. Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique. [ABSTRACT FROM AUTHOR]

Le bloc atrio-ventriculaire complet (BAV3) peut être une situation urgente potentiellement létale. Notre objectif était de décrire la gestion quotidienne des BAV3 en France, en insistant notamment sur les aspects organisationnels. De septembre 2019 à November 2019, une enquête nationale prospective (comprenant 28 questions) a été envoyée par voie électronique à 100 médecins (Google Form). Les réponses ont été recueillies auprès de 93 cardiologues (taux de réponse 93 %). L'implantation stimulateur cardiaque permanent pendant la nuit ou le week-end (après 20 heures) est possible pour 49 % des opérateurs (< 5 fois par an), pour 15 % (> 5 fois par an), impossible pour 36 % des opérateurs. En cas de BAV3 ne répondant pas à l'isoprotérénol survenant la nuit, une sonde d'entraînement électro-systolique (SEES) est implantée par : le personnel médical de garde sur place (27 %), le cardiologue interventionnel d'astreinte (21 %), le rythmologue d'astreinte (19 %), un stimulateur cardiaque permanent est implanté par le rythmologue (12 %), la stratégie n'est pas standardisée (15 %). 80 (86 %) cardiologues interrogés ont déjà observé un déplacement de SEES, une perforation cardiaque a déjà été observée par 57 (61 %), un hématome inguinal chez 35 (38 %), et cette technique a été interdite pour 4 % des opérateurs. Une sonde à fixation active (SFA) extériorisée pour BAV3 a déjà été implantée par 50 % des opérateurs. Notre enquête montre d'importantes disparités en termes de prise en charge des BAV3 parmi les différents centres. Une SFA avec batterie de récupération a déjà été utilisée par la moitié des centres. Complete atrioventricular block (AVB3) may be an urgent potentially lifethreatening situation. Our objective was to describe the routine management of AVB 3, with emphasis on the organizational aspects. From September 2019 to November 2019, a prospective national survey including 28 questions was electronically sent to 100 physicians (Google Form). The answers were collected from 93 physicians (response rate 93%). Permanent pacemaker implantation during weekends and nights (after 8PM) is possible for 49% of the operators (< 5 times a year), for 15% (> 5 times a year), impossible for 36% of the operators. For AVB3 nonresponsive to isoproterenol occurring during the night, a temporary pacing lead (TPL) is implanted by: the on-site medical staff on-duty (27%), the on-call interventional cardiologist (21%), the on-call electrophysiologist (19%), a permanent pacemaker is implanted by the electrophysiologist (12%), the strategy is not standardized (15%). An externalized active fixation lead (AFL) for AVB3 has already been implanted by 50% of the operators. 80 (86%) have already observed a dislocation of the TPL, a cardiac perforation already occurred in 57 (61%), a groin hematoma in 35 (38%), and this technique was proscribed for 4% of the operators. Our survey shows important disparities in terms of management of AVB3 among the different centers. An externalized AFL with a reusable generator was used by half of the centers. [ABSTRACT FROM AUTHOR]