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2. Evaluation of common suturing techniques to secure implantable cardiac electronic device leads: Which strategy best reduces the lead dislodgement risk?

Author

Rezazadeh, Saman, Wang, Samuel, and Rizkallah, Jacques

Subjects
Defibrillators -- Usage, Dislocations -- Risk factors, Implantable cardioverter-defibrillators -- Usage, Clothing, Prostheses and implants, Pacemakers, Infection, Comorbidity, Health, Health care industry
Abstract

Implantable cardiac electronic device lead dislodgment is a relatively common complication and carries significant comorbidities. A potential cause of lead dislodgement includes inadequate anchoring along the lead suture sleeve at the venous insertion site. We assessed which of the 3 commonly applied knot-tying techniques results in the most effective anchoring of a pacing lead along its suture sleeve, which could be associated with minimized lead motion post-implant. Following controlled traction force measurements, the anchor knot technique offered the greatest amount of lead stability when compared with the simple knot and the looping knot techniques., During implantation of cardiac electronic devices, such as pacemakers and defibrillators, leads are commonly inserted transvenously along upper-extremity veins, such as the axillary, cephalic, or subclavian veins. After their fixation [...]

Published
2019
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3. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial

Author

Andrade, Jason G., Champagne, Jean, Dubuc, Marc, Deyell, Marc W., Verma, Atul, Macle, Laurent, Leong-Sit, Peter, Novak, Paul, Badra-Verdu, Mariano, Sapp, John, Mangat, Iqwal, Khoo, Clarence, Steinberg, Christian, Bennett, Matthew T., Tang, Anthony S.L., Khairy, Paul, Parkash, Ratika, Guerra, Peter, Dyrda, Katia, Rivard, Lena, Racine, Normand, Sterns, Lawrence, Leather, Rick, Seifer, Colette, Jolly, Umjeet, Raymond, Jean-Marc, Roux, Jean-Francois, Nault, Isabelle, Sarrazin, Jean-Francois, Ramanathan, Krishnan, Cheung, Christopher, Fordyce, Christopher, McKinney, Jimmy, Luong, Christina, Rizkallah, Jacques, Angaran, Paul, Ha, Andrew, Glover, Benedict, Skanes, Allan, and Gula, Lorne

Published
2019
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4. Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads

Author

Perino, Alexander C, Wang, Paul J, Lloyd, Michael, Zanon, Francesco, Fujiu, Katsuhito, Osman, Faizel, Briongos-Figuero, Sem, Sato, Toshiaki, Aksu, Tolga, Jastrzebski, Marek, Sideris, Skevos, Rao, Praveen, Boczar, Krzysztof, Yuan-Ning, Xu, Wu, Michael, Namboodiri, Narayanan, Garcia, Rodrigue, Kataria, Vikas, De Pooter, Jan, Przibille, Oliver, Gehi, Anil K, Cano, Oscar, Katsouras, Grigorios, Cai, Binni, Astheimer, Klaus, Tanawuttiwat, Tanyanan, Datino, Tomas, Rizkallah, Jacques, Alasti, Mohammad, Feld, Gregory, Barrio-Lopez, Maria Teresa, Gilmore, Mark, Conti, Sergio, Yanagisawa, Satoshi, Indik, Julia H, Zou, Jiangang, Saha, Sandeep A, Rodriguez-Munoz, Daniel, Chang, Kuan-Cheng, Lebedev, Dmitry S, Leal, Miguel A, Haeberlin, Andreas, Forno, Alexander R J Dal, Orlov, Michael, Frutos, Manuel, Cabanas-Grandio, Pilar, Lyne, Jonathan, Leyva, Francisco, Tolosana, Jose Maria, Ollitrault, Pierre, Vergara, Pasquale, Balla, Cristina, Devabhaktuni, Subodh R, Forleo, Giovanni, Letsas, Konstantinos P, Verma, Atul, Moak, Jeffrey P, Shelke, Abhijeet B, Curila, Karol, Cronin, Edmond M, Futyma, Piotr, Wan, Elaine Y, Lazzerini, Pietro Enea, Bisbal, Felipe, Casella, Michela, Turitto, Gioia, Rosenthal, Lawrence, Bunch, T Jared, Baszko, Artur, Clementy, Nicolas, Cha, Yong-Mei, Chen, Huang-Chung, Galand, Vincent, Schaller, Robert, Jarman, Julian W E, Harada, Masahide, Wei, Yong, Kusano, Kengo, Schmidt, Constanze, Hurtado, Marco Antonio Arguello, Naksuk, Niyada, Hoshiyama, Tadashi, Kancharla, Krishna, Iida, Yoji, Mizobuchi, Mashiro, Morin, Daniel P, Cay, Serkan, Paglino, Gabriele, Dahme, Tillman, Agarwal, Sharad, Vijayaraman, Pugazhendhi, and Sharma, Parikshit S

Subjects
Physiology (medical), 610 Medicine & health, Cardiology and Cardiovascular Medicine
Abstract

BACKGROUND Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p

Published
2023

6. Getting by with less--the 'frugal tie'

Author

Rizkallah, Jacques, Rothschild, John M., and Exner, Derek V.

Subjects
Knots and splices -- Methods, Surgeons -- Practice, Surgery -- Methods, Health, Health care industry
Abstract

The ability to tie surgical knots efficiently and effectively is an essential surgical skill for medical procedures, especially pacemaker implantation. Device generators and their leads need to be safely anchored with sutures during implantation to prevent dislodgement and inadequate packaging in the pacemaker pocket. With most knot tying techniques, a generous amount of suture slack is required. We introduce a new technique that is a variation of the 2-handed surgical square knot and the 1-handed surgeon's knot that allows one to finish or tie a knot when left with little slack., There are many ways to tie a suture during a surgical procedure. (1-3) Depending on the surgeon's experience and familiarity with a technique, most knots can be completed fairly rapidly. [...]

Published
2014
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8. Troubleshooting during a challenging high-risk pacemaker lead extraction: a case report and review of the literature

Author

Rizkallah, Jacques, Kent, William, Kuriachan, Vikas, Burgess, John, and Exner, Derek

Subjects
Medicine(all), Pacemaker, Artificial, Lead extraction, Biochemistry, Genetics and Molecular Biology(all), Case Report, Laser sheath, Infections, Sternotomy, Surgical Procedures, Operative, Humans, Device infection, Female, Hybrid surgery, Aged
Abstract

Background The use of cardiac implantable electrical devices continues to increase with the validation of new beneficial indications. While the risks of device implantation decreased significantly over time, significant risk remains associated with their extraction when indicated. A high-risk pacemaker lead extraction case is described, wherein a chronically implanted lead that had perforated the right atrium was successfully removed without the need for cardiopulmonary bypass. In this report we share our approach to this challenging extraction case and describe an infrequently utilized off-pump hybrid technique that we term the “lead-inverting stitch”. Case presentation A 74 year-old Caucasian woman with complete heart block and remote pacemaker implantation presents with a swollen and erythematous infected pacemaker pocket necessitating device extraction. Chest computerized tomographic imaging revealed a chronically perforating right atrial lead tip approximately 2 cm within the pericardial space. A successful hybrid transvenous and open surgical extraction approach was undertaken without the need for cardiopulmonary bypass; this was made possible due to a successfully positioned “lead-inverting stitch”. Conclusion Implantable cardiac electrical device infections are amongst the most dreaded post implant complications. Risks of device extraction are further complicated in cases of chronic lead perforations. Extraction strategies that avoid cardiopulmonary bypass initiation are preferred.

Published
2015

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