Daniel Kiblboeck

Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation.

Leadless cardiac pacemaker (LCP) requires large‐caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18‐ to 23‐French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure.

Three Tesla cardiac magnetic resonance imaging in a patient with a leadless cardiac pacemaker system

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A misguided 'pill in the pocket' approach with flecainide leading to cardiac arrest.

A 67-year-old woman was initially complaining of breathlessness and had a single syncope before she went into cardiac arrest. First monitored rhythm was a slow pulseless electrical activity. Return of spontaneous circulation was achieved by cardiopulmonary resuscitation within 20 min. The ECG on admission to the intensive care unit showed an irregular rhythm due to intermittent high-degree atrioventricular block with very broad QRS …

Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements

Introduction Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). Materials and methods We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Results Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. Conclusion PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.

Reversible impairment of coronary flow reserve in acute myocarditis

Acute myocarditis is accompanied by an impaired coronary microcirculation. These microcirculatory disturbances are not well defined, and data are derived from complex invasive measurements. Therefore, this study aimed to evaluate the inflammation‐induced microcirculatory dysfunction including its reversibility and association with markers of inflammation severity (extent of LGE on CMR imaging and laboratory markers of myocardial necrosis) using the noninvasive technique of echocardiographic CFR measurement.

High-Molecular-Weight von Willebrand Factor Multimer Ratio: A Novel Biomarker for Low-Flow, Low-Gradient Aortic Stenosis Subclassification

Low-flow, low-gradient (LF/LG) aortic stenosis (AS) is a diagnostic dilemma [(1)][1] as routine work-up remains challenging. Dobutamine stress echocardiography (DSE) and multidetector computed tomography (MDCT) represent accepted imaging modalities for further subcategorization into a true severe (

Monocenter Investigation Micra® MRI study (MIMICRY): feasibility study of the magnetic resonance imaging compatibility of a leadless pacemaker system

Aims As in vivo real-life data are still scarce, we conducted a study to assess the safety and feasibility of cardiac magnetic resonance imaging (MRI) in patients with a leadless pacemaker system. Methods and results In this prospective non-randomized interventional trial, we enrolled 15 patients with an MRI conditional Micra® leadless pacemaker system to undergo either a 1.5 T or 3.0 T cardiac MRI scan. Clinical adverse events as well as device parameters such as pacing threshold, sensing, impedance, and battery life were assessed at baseline as well as 1 and 3 months after the scan. Device parameter changes between different time points were tested for statistical significance and compared with pre-set cut-off values. Fourteen patients underwent the cardiac MRI scan according to the protocol as well as the scheduled follow-up visits. One participant was excluded from analysis, as the MRI scan was not possible because of severe claustrophobia. Other clinical events did not occur during the scan and the follow-up period. Device parameters stayed stable and changes during the observational period were statistically not significant (changes vs. baseline: pacing threshold: 0.01 ± 0.05 V, P = 0.308, 0.01 ± 0.07 V, P = 0.419, sensing: -0.15 ± 1.11 mV, P = 0.658, -0.19 ± 1.17 mV, P = 0.800, impedance: -7.86 ± 30.7 Ohm, P = 0.447, -7.86 ± 25.77 Ohm, P = 0.183, at 1 and 3 months follow-up, respectively). Parameter changes were not statistically different between patients who underwent imaging at 1.5 T (n = 7) or 3.0 T (n = 7). Conclusion In our set of patients with a Micra® leadless pacemaker, cardiac magnetic resonance imaging at either 1.5 T or 3.0 T proved feasible and safe with no relevant changes in device parameters within 3 months of follow-up.

TCT-358 Bleeding and vascular complication rates before and after implementation of a radial coronary catheterization programme – an observational study in 12 745 patients

nos: 358 373

A novel approach to detect phrenic nerve stimulation in cardiac resynchronization therapy

A 79-year-old man was complaining about phrenic nerve stimulation (PNS) after implantation of a cardiac resynchronization therapy (CRT) device for cardiomyopathy. After electronic respositioning by changing the stimulation vector from LV tip to LV ring (T → R) to LV ring to RV coil …

Atypical recovery from stress induced cardiomyopathy in a patient with anorexia nervosa

A 39-year-old female was admitted to our hospital because of anorexia nervosa with a body mass index of 10.5 and severe obsessivecompulsive disorder. Due to a spontaneous severe hypoglycaemia of 22 mg/dl and electrolyte disorders (sodium 128 mmol/l, potassium 2.8 mmol/l, chloride 89 mmol/l) she was transferred to the medical intensive care unit. She was disorientated and presented with a slurred speech which recovered after intravenous glucose administration. Her blood tests showed leukopenia (2.9 G/l), thrombocytopenia (91 G/l) with elevated transaminases (AST 1487 U/l, ALT 1425 U/l, GGT 177 U/l), lactate dehydrogenase (732 U/l) and creatine kinase (1813 U/l), while troponin levels were within normal range. Chest X-ray was normal. An electrocardiogram (ECG) showed sinus bradycardia and T-waves inversion in lead II, III, aVF, and V4–V6. Echocardiography revealed wall motion abnormalities of the apical and midventricular segments, typical for Tako-Tsubo cardiomyopathy and a pre-existing pericardial effusion above the right ventricle. These wall motion abnormalities regressed completely over two weeks. However, enddiastolic apical wall thickness increased to 14 mm. Therefore, she was scheduled for cardiac magnetic resonance imaging which showed thickening of the apex of the left ventricle (apical interventricular septum 19 mm) mimicking an apical hypertrophic cardiomyopathy. There was no evidence of myocarditis or myocardial oedema.