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Indications for cardiac implantable electronic devices (CIEDs) are increasing. Almost one-third of device-related infections are endocarditis. Transvenous lead extraction (TLE) has emerged as an effective and safe approach for treating device-related infections and complications. Multiple types of extraction tools are being used worldwide. Our goal is to evaluate the safety and effectiveness of TLE using non-powered extraction tools. The study included patients between October 2018 and July 2022 requiring TLE according to EHRA expert consensus recommendations on lead extraction. A total of 88 consecutive patients were included. Indications for TLE included device-related infections in 74% of the patients. Of those, 32% had device-related endocarditis with or without sepsis. Staphylococcus Aureus was the most frequent pathogen in patients with endocarditis and positive bacteremia, and 57% had negative bloodstream cultures. A total of 150 cardiac pacing and defibrillator leads were targeted for extraction. The mean dwell time for leads was 6.92 ± 4.4 years; 52.8% were older than 5 years, 15.8% were older than ten years, and the longest lead dwell time was 26 years. Patients' age varied between 18 and 98, with a mean age of 66 ± 16 years. Sixty-seven percent of patients were males. Using only non-powered extraction tools, we report 93.3% complete lead removal and 99% clinical success with partial extraction. We report no procedure-related death nor major complications. Minor complication incidence was 6.8%, and all complications resolved spontaneously. The 30-day mortality rate was 3.4%. TLE using non-powered extraction tools is safe and effective even without surgical backup on site. [ABSTRACT FROM AUTHOR]

Aims - Frequent premature ventricular complexes (PVCs) may induce/aggravate LV systolic dysfunction (LVD) by tachy(dyssynchrono)cardiomyopathy (tCMP) in patients with/without previous structural heart disease. High arrhythmic burden (i.e. >26%) is the main predictor of tCMP development in patients with previously normal LV function. However, its predictive power is reduced once the arrhythmic burden is below 26%, with considerable overlap between patients at risk for tCMP and those who will maintain normal LV function. We sought to evaluate the predictive power of a composite index that includes PVC burden, PVC duration and PVC coupling interval. Methods - 61 patients referred for radiofrequency ablation (RFA), with frequent PVCs refractory to at least one antiarrhythmic drug (AAD), symptomatic and/or with LV systolic dysfunction (LVEF < 50%) were retrospectively studied. Patients with structural lesions on transthoracic echocardiography (TTE) and/or cardiac magnetic resonance imaging (c-MRI), with sustained ventricular tachycardia/supraventricular tachycardia or severe valvular disease were excluded. A composite parameter dependent on PVC burden, PVC duration and PVC coupling interval was defined. Results - Mean PVC burden was 25.80% ± 11.64 (35% ± 8.16 in tCMP subgroup). Chronic PVC suppression was achieved in 89.6% of patients with a mean of 1.44 ± 0.7 procedures with 86.4% of patients requiring one procedure. Septal right ventricular outflow tract (RVOT) was the most frequent PVC origin (36.1%). Mean left ventricular ejection fraction (LVEF) in the tCMP group (7 patients) was 38% ± 5.26 which increased 1 month after RF ablation to 54.6% ± 3.64 (87.35% of recovered LVEF), at 3 months to 56% ± 2.23 and at 6 months 57% ± 2.73. LVEF recovery was also present in non-tCMP subgroup, yet statistically insignificant. There was no procedure-related mortality. Retrograde ventriculo-atrial (VA) conduction, male gender, non-sustained VT (NSVT), a higher BMI and a higher PVC burden were associated with tCMP development. ROC curve analysis appears to demonstrate higher sensitivity of tCMP prediction by the composite index in comparison to PVC burden in patients with 16.93-25.93% PVCs (i.e. below the formerly described tCMP PVC% cut-off). Conclusions - In patients with a PVC burden lower than the previously described cut-offs (i.e. with ~17-25% PVCs) PVC mediated systolic dysfunction seems to be predicted with higher sensitivity by a composite index accounting for PVC burden, PVC duration and PVC coupling interval. [ABSTRACT FROM AUTHOR]

Curative radiofrequency catheter modifi cation of the slow pathway is the recommended therapy for atrioventricular nodal reentry tachycardia (AVNRT) which is usually performed via femoral vein through inferior vena cava (IVC) approach. Diagnostic and ablation procedures are difficult when this approach is not possible due to congenital or acquired obstruction of the IVC. Here, we report a case with IVC anomaly (left IVC with interruption after receiving the renal veins and hemi-azygous continuation) in whom AVNRT ablation was achieved without complications via the azygous system using a remote-controlled magnetic navigation system. [ABSTRACT FROM AUTHOR]

Introduction-Remotely-controlled navigation (MNS) has emerged as a novel concept aimed to improve outcomes of catheter ablation for ventricular arrhythmias It has the potential to increase procedural success, decrease procedure time and minimise catheter-related complications. MNS ablation was proved to be as effective and fast compared with manual radiofrequency (RF) but the results regarding unstable and highly mobile cardiac regions are controversial. Purpose-We aimed to describe our experience using magnetic navigation for ablation of ventricular arrhythmias (premature ventricular complexes, sustained ventricular tachycardias or electric storm) in ischaemic and non-ischaemic patients and compare procedural outcomes in relation with arrhythmia type and etiology. Methods-A total of 57 patients (57% males, mean age 51±17 years) with ventricular arrythmias who underwent RF ablation using MNS and CARTO 3 were retrospectively analyzed. Left ventricular sites were targeted by transseptal approach in 53% of the cases, retrograde transaortic in 24% and 8% required epicardial acces via pericardial puncture. Clinical and paraclinical variables as well as procedural aspects were noted and short term screening for reccurence was performed. Results-Acute procedural succes was achieved in 95% of the cases (elimination of clinical arrythmias). Non-inducibility was documented after programmed ventricular stimulation in 80% of the cases. A third of the patients had structurally normal hearts (34%). Among those that had a subsiding cardiopathy, the ischaemic etiology acounted for 68% of the cases where as dilated idiopathic cardiomyopathy was encoutered in 13% of the cases, arrhytmogenic right ventricular cardiopathy 8%, left ventricular non-compaction 5%, postmyocarditis-scar or post-surgical scars in 3%. Diffi cult ablation sites, such as the proximity of the right bundle branch, coronary cusp or papilary muscle had more frequently previous unsuccessful manual ablations, in all of these cases acute succes was obtained with MNS and the non-inducibility rate was 90% (9 out of 10 patients). Acute succes rates were higher for ischaemic cases but the difference was not statistically signifi cant. Periprocedural complications were noted in 3.5%. Conclusion-MNS is a safe and effective method for catheter ablation for ventricular arrhythmias regardless of etiology or clinical form, with possible superior effects in ischaemic cardiomyopthy with extensive scar and severly dilated LV and for ablation in unstable locations (coronary cusp, papilary muscle). [ABSTRACT FROM AUTHOR]