Thomas Marynissen

Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience

AIMS Owing to the increasing use of cardiac implantable electronic devices, there is a growing need for safe and effective techniques to manage device-related complications and lead dysfunction. Lead extraction remains a challenging procedure with inherent risks. We present the 30-day and long-term outcomes of lead extractions in the University Hospitals Leuven. METHODS AND RESULTS We report a retrospective cohort study of 176 patients admitted to the University Hospitals Leuven between January 2005 and December 2011, for the transvenous extraction of 295 leads. Indications for extraction were lead dysfunction and device upgrade in 84 (47.7%), pocket infection in 61 (34.7%), and systemic infection in 31 patients (17.6%). Extraction was successful in 95.5% of patients with complete removal of the leads or only a minor fragment remaining. One fatal peri-procedural complication occurred. Thirty-day mortality was 3.4% (n = 6). Systemic infection was the only significant predictor of 30-day mortality [odds ratio (OR) 29.706; P = 0.029]. A lower level of haemoglobin prior to extraction also tended to be related with a higher mortality, but this was not significant (OR 2.024; P = 0.082). One-year mortality was 8.5% (n = 15). Systemic infection (OR 9.727; P = 0.009), a lower level of haemoglobin (OR 1.597; P = 0.05), and a higher level of ureum (OR 1.021; P = 0.017) prior to extraction were significant predictors of 1-year mortality. Systemic infection was associated with significantly higher 30-day (19%), 1-year (32%), and long-term (39%) mortality rates. CONCLUSION Lead extraction can be safely and successfully performed in the majority of patients, with limited life-threatening complications. However, lead extraction because of systemic infection is associated with a significantly higher risk of short- and long-term mortality.

Ictal asystole: case report with review of literature

Summary Cardiac arrhythmias are frequently observed during epileptic seizures. Mostly they are benign, but severe bradycardia and asystole occur in 0.27 - 0.5% of patients who have seizures on video-EEG monitoring units. Especially patients with partial seizures involving the insular, orbital frontal and anterior temporal lobe regions, are at risk. Ictal bradycardia could be a cause of SUDEP (sudden unexpected death in epilepsy) and pacemaker insertion might therefore improve survival in selected cases, although more research is needed to prove this. We present a case of prolonged ictal asystole in a patient with newly diagnosed partial epilepsy originating from the temporal lobe.

Changes in Implantation Patterns and Therapy Rates of Implantable Cardioverter Defibrillators over Time in Ischemic and Dilated Cardiomyopathy Patients.

Clinical guidelines on implantable cardioverter defibrillator (ICD) therapy changed significantly in the last decades with potential inherent effects on therapy efficacy. We aimed to study therapy rates in time and the association between therapies and mortality.

Early collapse causing stenosis in a resorbable magnesium scaffold

We report a case of early in‐stent restenosis due to collapse of a Magmaris resorbable magnesium scaffold.

Major adverse cardiovascular events while awaiting staged non-culprit percutaneous coronary intervention after ST-segment elevation myocardial infarction

Abstract Background: The optimal therapeutic strategy for ST-segment elevation myocardial infarction (STEMI) patients found to have multi-vessel disease (MVD) is controversial but recent data support complete revascularisation (CR). Whether CR should be completed during the index admission or during a second staged admission remains unclear. Our main objective was to measure rates of major adverse cardiovascular events (MACEs) during the waiting period in STEMI patients selected for staged revascularisation (SR), in order to determine the safety of delaying CR. For completeness, we also describe 30-day and long-term outcomes in STEMI patients with MVD who underwent in-hospital CR. Methods: A single-centre retrospective analysis of 931 STEMI patients treated by primary percutaneous coronary intervention (PCI) identified 397 patients with MVD who were haemodynamically stable and presented within 12 hours of chest pain onset. Of these, 191 underwent multi-vessel PCI: 49 during the index admission and 142 patients undergoing a strategy of SR. Results: Our main finding was that waiting period MACE were 2% (three of 142) in patients allocated to SR (at a median of 31 days). In patients allocated to in-hospital CR, 30-day MACE rates were 10% (five of 49). During a median follow up of 39 months, all-cause mortality was 7.0% vs. 28.6%, and cardiac mortality was 2% vs. 8%, in patients allocated to SR or CR, respectively. Conclusions: Patients with STEMI and MVD who, based on clinical judgement, were allocated to a second admission SR strategy had very few adverse events during the waiting period and excellent long-term outcomes.