Search

In young patients with transvenous implantable cardioverter defibrillations (TV-ICDs), the possibility of device infection or lead fracture would be high in their long lifetimes. Furthermore, the risk of lead removal will gradually increase over the years. We reported two cases of subcutaneous ICDs implantation following removal of TV-ICDs. Patient 1, 35-year-old man, underwent TV-ICD implantation 9 years ago for idiopathic ventricular fibrillation, and Patient 2, 46-year-old man, underwent TV-ICD implantation 8 years ago for asymptomatic Brugada syndrome. In both cases, the electrical performance was stable, and there was no incidence of arrythmia or no pacing demand during the follow-up duration. Considering future risk of device infection or lead fracture, and difficulty in future lead removal, TV-ICDs were removed with sufficient informed consent, and then, subcutaneous ICDs (S-ICDs) implantation were performed as an alternative to them. Although indication of the TV-ICD removal should be carefully considered in individual cases, long-term risks leaving it in place should be also considered in the management of young patient. LEARNING OBJECTIVE: In young patient with TV-ICD, even for a normally functioning non-infected lead, S-ICD implantation following removal of the TV-ICD would represent a strategy associated with less long-term risks than leaving it in place.

Background The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. Methods We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. Results A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07‐1.17; P, The extraction of cardiac implantable electronic device leads due to infections, malfunctions, and recalls is common, and can lead to complications such as lead break resulting in incomplete lead removal and cardiac tamponade. We found that older lead age, co‐radial leads, passive leads, and non‐polyurethane leads were independent predictors of lead break during extraction. These findings will guide clinicians to make appropriate choices of procedure and take greater care when these risk factors are present.

Background:There is discordance regarding the effect of symptom status before aortic valve replacement (AVR) on long-term outcome after AVR in severe aortic stenosis (AS). Methods and Results:The CURRENT AS registry is a multicenter retrospective registry enrolling 3, 815 consecutive patients with severe AS. Among 1, 196 patients managed with the initial AVR strategy, long-term clinical outcomes were compared between the symptomatic patients (n=905), and asymptomatic patients (n=291). Median follow-up interval was 1337 days with a 91% follow-up rate at 2 years. AVR was performed in 886 patients (98%) in the symptomatic group and in 287 patients (99%) in the asymptomatic group. Symptomatic patients were older and more often had comorbidities than asymptomatic patients with similar echocardiographic AS severity. The cumulative 5-year incidences of all-cause death and heart failure (HF) hospitalization were significantly higher in symptomatic patients than in asymptomatic patients (25.6% vs. 15.4%, P=0.001, and 14.2% vs. 3.8%, P