Search

Aims: To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems., Methods and Results: Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B., Conclusion: The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs., Competing Interests: Conflict of interest: The authors have no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: Due to the prolonged survival of patients with cardiovascular implantable electronic devices, leads often need to be removed in elderly individuals., Objectives: We aimed to analyze indications for transvenous lead extraction (TLE), procedure effectiveness and safety, as well as 30‑day follow‑up in younger patients (≤80 years) and octogenarians (>80 years)., Patients and Methods: This prospective study included 667 patients who underwent TLE: 90 octogenarians (13.5%) at a mean age of 83.8 (range, 80.4-93) years and 577 younger patients (86.5%) at a mean age of 64.2 (range, 18.9-79.9) years., Results: Octogenarians had a greater number of comorbidities, fewer implantable cardioverter‑defibrillators implanted, and more frequently had infection as an indication for TLE, as compared with younger patients (33.3% vs 17.1%; P <0.001). In octogenarians, 138 leads were extracted, as compared with 894 leads in younger patients. Octogenarians and younger patients had similar rates of complete lead removal (98.6% and 97.1%, respectively; P = 0.48), total procedural success (97.8% and 96%, respectively; P = 0.7), major complications (0% and 1.6%, respectively; P = 0.45), and minor complications (2.2% and 1.6%, respectively; P = 0.45). There was 1 death associated with TLE in younger patients. Non-procedure‑related deaths within 30 days after TLE were more frequent in octogenarians than in younger patients (5.6% vs 1.9%; P = 0.04)., Conclusion: We showed that TLE in patients older than 80 years seems to be as effective as in younger patients; however, it is associated with significantly higher non-procedure‑related 30‑day mortality.

Objective: To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) with mechanical systems of pacing leads older than 20 years (group A) versus younger leads (group B)., Methods: We performed TLE of 591 pacing leads in 377 patients. Fifty (8.5%) leads in 43 (11.4%) patients were implanted for equal to or more than 20 years. The mean dwell time of all extracted leads was 8.9 years (range, 0.1-36.0). Infection related to cardiovascular implantable electronic device was an indication for TLE in 18.3% of patients., Results: Complete lead removal and complete procedural success rates were similar between both groups (94.7% in group A vs 97.1% in group B, P = 0.445, and 90.7% in group A vs 95.8% in group B, P = 0.329, respectively). Incomplete lead removal in group A was observed only in leads older than 20 years. Removal of leads in group A was associated with significantly longer fluoroscopy time compared with group B (4.6 vs 1.9 minutes, P < 0.001). We did not find a significant difference in major and minor complication rates between groups (2.3% in group A vs 0.9% in group B and 2.3% in group A vs 2.2% in group B, P = 0.687, respectively). There were no deaths associated with the TLE procedure within 30 days after the procedure in either group., Conclusion: This study shows that TLE of leads older than 20 years conducted at an experienced center seems to be comparably safe and effective as extraction of younger leads but requires longer fluoroscopy time., (© 2019 Wiley Periodicals, Inc.)

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.

Background: It remains unknown whether and when the hosting of mega-sport events increases quality of life of host city residents. The aim of this study is to assess the changes in quality of life of host city residents over the course of hosting a mega-sport event until three months after the event, depending on residents' perception of the atmosphere during the event., Methods: The study was conducted in Rio de Janeiro, one of the host cities of the 2014 FIFA World Cup in soccer. Participants were recruited from a Brazilian market research agency's panel and surveyed online. The WHOQOL-BREF was used to measure quality of life of residents of Rio de Janeiro (n = 281) in three waves in the context of the 2014 FIFA World Cup. Perceived atmosphere at the event was measured via an established scale. Piecewise latent growth models were used to analyze individual changes in the four domains of quality of life per se and depending on perceived atmosphere., Results: There was no change in quality of life with respect to physical, social, psychological, and environmental health for all participants during the course of the event. However, residents who perceived a positive atmosphere rated the social and environmental domains of quality of life more positively right after the end (vs. at the beginning) of the World Cup. This increase sustained until three months after the event. Physical health (particularly at high levels of perceived atmosphere) and psychological health decreased from right after the event until three months after., Conclusions: There was no positive effect of the hosting of the mega-sport event on the four quality of life domains of the panel members (who were residents of a city hosting a mega-sport event) per se. The individual changes in quality of life vary by perception of atmosphere and by domain of quality of life.

Introduction: Transvenous lead extraction (TLE) is a recognized method of treatment in the case of permanent stimulation complication., Objectives: The objective of this study was to analyse the indications and presentation of the early experience of TLE procedures in a group of patients with old pacing systems., Patients and Methods: Patients with a relevant history of stimulation (at least 12 months in case of a pacemaker) qualified for the research. Indications, effectiveness and complications of TLE procedures were analysed., Results: Two hundred patients at the age of 66.4 (19.1-86.2 years) were enrolled and 278 leads with dwell time 76.2 months (2.1-327.4) were removed. The indications for TLE were: lead-dependent infective endocarditis in 13 cases (6.5%), pocket infection in 29 cases (14.5%), lead damage in 120 cases (60.0%), and upgrade of device system in 38 cases (19.0%). Manual traction was used to remove 66 active fixation leads (23.7%). A femoral approach was required to extract 4 leads (1.4%). Two hundred and eight leads (74.8%) were extracted using the mechanical (Cook) system and subclavian approach. Laser technique, and an electrosurgical sheath were not used. Complete procedural success was achieved in 96% of cases and overall clinical success was 98.5%. Complication rate was 5.5% (11 patients): minor and major complication rate was 3.0% (6 patients) and 2.5% (5 cases), respectively. Low body mass index (BMI) was associated with a higher rate of complications., Conclusions: The dominant indication to TLE procedures was lead dysfunction. Transvenous lead extraction has a high success rate and a low complication rate. Low BMI increased the complication rate.

Unlabelled: Atrial septal defect (ASD) is one of the most common congenital heart diseases found in adolescents and adults. Shunt may lead to serious further complications, such as pulmonary hypertension and right heart chambers overload. The aim of this study was the analysis of the population of adult patients with ASD together with the frequency of the annuloplasty tricuspid ring implantation in ASD II and the necessity of anterior mitral valve cusp suturing due to the cleft accompanying ASD I., Materials and Methods: The study group consisted of 58 males and 122 females aged 17 to 77. Individuals were divided into three age brackets: 17-30 years old--22%; 31-50--38,5% and 51-77--39,5%., Results: In 92,8% of cases median sternotomy was performed. Other approaches were: right mini- thoracotomy 5%, 2,2% underwent lower hemisternotomy. There were 16 annuloplasties accompanying ASD closure: 13 in ASD II patients, 1 in PFO patient, 2 in ASD I patients. Average size of the pericardiac patch used to ASD type II correction was bigger in patients, who also underwent annuloplasty tricuspid ring implantation (Mann- Whitney U test: -2,25, p=0,024)., Conclusion: Repair of ostium secundum and sinus venosus ASD can be performed safely via minithoracotomy endoscopic approach with similar outcomes as sternotomy. Beside the mitral cleft suturing in ASD I patients, annuloplasty tricuspid ring implantation is the most common additional procedure. ASD II patients, who had undergone such annuloplasties needed the bigger pericardial patches., (© 2015 MEDPRESS.)

Introduction: Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (minithoracotomy and ministernotomy) have become a valuable alternative to conventional surgical treatment of severe aortic stenosis (AS) in high-risk patients., Objectives: The aim of the study was to evaluate long-term results and complications in patients with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy, or ministernotomy., Patients and Methods: A total of 173 patients with symptomatic AS were enrolled to the study between the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method separately. Differences in clinical outcomes between patients treated with TAVI and those treated with surgical methods were adjusted for propensity scores using a logistic regression analysis and presented as adjusted odds ratios with 95% confidence intrervals., Results: A median follow-up was 583.5 days (interquartile range, 298-736 days). Before aortic valve replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups. At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8% ±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the longest available follow-up mortality, left ventricular (LV) function, complications after the procedure, and conduction disturbances and arrhythmias after the procedure., Conculsions: Patients undergoing TAVI show more beneficial long-term outcomes in comparison with patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase in EF in comparison with the surgical methods.

Recent research has highlighted limitations of studying complex systems with time-varying topologies from the perspective of static, time-aggregated networks. Non-Markovian characteristics resulting from the ordering of interactions in temporal networks were identified as one important mechanism that alters causality and affects dynamical processes. So far, an analytical explanation for this phenomenon and for the significant variations observed across different systems is missing. Here we introduce a methodology that allows to analytically predict causality-driven changes of diffusion speed in non-Markovian temporal networks. Validating our predictions in six data sets we show that compared with the time-aggregated network, non-Markovian characteristics can lead to both a slow-down or speed-up of diffusion, which can even outweigh the decelerating effect of community structures in the static topology. Thus, non-Markovian properties of temporal networks constitute an important additional dimension of complexity in time-varying complex systems.

Introduction: Extended immunosuppressive treatment in patients after heart transplantation modifies etiopathogenesis and occurrence of many diseases in this population. The aim of the present study was to evaluate the frequency and to define risk factors for cholelithiasis after heart transplantation (HTX)., Material and Methods: The study population consisted of 176 subjects. Of them, 24 patients (group A) presented with symptomatic cholelithiasis. Another group of 24 patients without cholelithiasis (group B) served as controls. Both groups were similar with respect to age, gender and follow-up after the transplant. Clinical interview, surgical and hospitalization data were collected from medical records., Results: The groups did not differ in demographic features. There were statistical differences (p < 0.05) between group A and B in rejection reaction, doses of immunosuppressive drugs, type 2 diabetes, serum lipid disorders and acute rejection episodes. These events were caused by modification of treatment, especially the immunosuppressive regimen. Group A consisted of 75% men and 25% women. The frequency of symptomatic cholelithiasis was 11.7% in men and 27.3% in women, on average 19.5%. Mean time to cholelithiasis following HTX was 37.9 ±4.9 (Me = 41.5) months, 27.7 ±8.2 (Me = 30.0) months in women and 41.3 ±5.9 (Me = 41.5) months in men. The female to male ratio was 2.3: 1., Conclusions: Cholelithiasis following HTX was significantly more frequent as compared with the non-transplant population. Patients with cholelithiasis required more aggressive immunosuppression because of more frequent episodes of acute transplant rejection. Patients with cholelithiasis significantly more frequently showed increased glycemia and blood lipids, which could be the side effect of intensive immunosuppressive therapy.

Introduction: Surveillance of physical activity (PA) is increasingly based on accelerometry. However, data management guidelines are lacking. We propose an approach for combining accelerometry and diary based PA information for assessment of PA in adolescents and provide an example of this approach using data from German adolescents., Methods: The 15-year-old participants comprised a subsample the GINIplus birth cohort (n = 328, 42.4% male). Data on PA was obtained from hip-worn accelerometers (ActiGraph GT3X) for seven consecutive days, combined with a prospective activity diary. Major aspects of data management were validity of wear time, handling of non-wear time and diary comments. After data cleaning, PA and percentage of adolescents meeting the recommendations for moderate-to-vigorous activity (MVPA) per day were determined., Results: From the 2224 recorded days 493 days (25%) were invalid, mainly due to uncertainties relating to non-wear time (322 days). Ultimately, 269 of 328 subjects (82%) with valid data for at least three weekdays and one weekend day were included in the analysis. Mean MVPA per day was 39.1 minutes (SD ±25.0), with boys being more active than girls (41.8±21.5 minutes vs. 37.1±27.8 minutes, p<0.001). Accordingly, 24.7% of boys and 17.2% of girls (p<0.01) met the WHO recommendations for PA. School sport accounted for only 6% of weekly MVPA. In fact, most MVPA was performed during leisure time, with the majority of adolescents engaging in ball sports (25.4%) and endurance sports (19.7%). Girls also frequently reported dancing and gymnastics (23%)., Conclusion: For assessment of PA in adolescents, collecting both accelerometry and diary-based information is recommended. The diary is vital for the identification of invalid data and non-compliant participants. Preliminary results suggest that four out of five German adolescents do not meet WHO recommendations for PA and that school sport contributes only little to MVPA.

We study correlations in temporal networks and introduce the notion of betweenness preference. It allows us to quantify to what extent paths, existing in time-aggregated representations of temporal networks, are actually realizable based on the sequence of interactions. We show that betweenness preference is present in empirical temporal network data and that it influences the length of the shortest time-respecting paths. Using four different data sets, we further argue that neglecting betweenness preference leads to wrong conclusions about dynamical processes on temporal networks.

Aim of the Study: This expert survey analyzed the application and perceived usefulness of knowledge transfer methods for disease prevention and health promotion research., Methods: 302 experts from 70 administratively distinct projects sponsored under the German federal prevention research program received a questionnaire on transfer methods used for preparation, dissemination and implementation of their project results and the perceived expediency of these methods. 130 experts (43%) from 59 projects (84.3%) responded. 40% were cooperation partners from health care suppliers or practitioners, and 60% worked in research institutions. Descriptive statistics and ANOVA were used for data analysis., Results: The experts had wide range of transfer methods at their disposal. The main implementation barriers were scarce funding and the complexity of disease prevention and health promotion programs. The predominant channels of dissemination were scientific media (congresses, journals) and the Internet. Manuals and handouts were the most common methods of processing of research results for facilitators. Regarding implementation, two-thirds of the projects conducted user training, integrated experts in program development, and co-operated with important institutions. Most of the transfer methods implemented were perceived as useful, but some rated as useful were rarely used, e. g. health economics and quality assurance in wide-scale rollout. There were no substantial rating differences between experts from research and user institutions., Conclusions: In view of the fundaments for the broad application of knowledge transfer technologies laid by prevention scientists, health care suppliers and decision-makers should support the transfer of prevention research, and precendence should be given to evidence-based programs with quality assurance in the implementation stages. Prevention researchers, in turn, should further develop health economics evidence and quality assurance for effective interventions. The rich skills available for knowledge transfer in disease prevention and health promotion can be systematically developed and disseminated in the future., (© Georg Thieme Verlag KG Stuttgart · New York.)