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OP-100 TRANSVENOUS EXTRACTION OF PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS USING NEW TECHNOLOGY; EVOLUTION MECHANICAL DILATOR SHEATH
Oral Presentations / International Journal of Cardiology 155S1 (2012) S1–S89
analysis to compare the percentages of relaxation for 2 groups was used SPSS for Windows (SPSS Inc., Chicago, IL, USA) was performed using a computer program version 13.0. Between the two groups, Mann-Whitney U-test was used to determine statistical values. P value less than 0.05 was considered significant. Results: For 10–4 M the relaxant percentage was found for levosimendan %92.33 and for dobutamin 82.48%. This couldn’t prove a statistically significant difference (P = 0.059, P > 0.05). EC50 value calculated for levosimendan and dobutamine 6.605×10−6 M and 5.093×10−5 M, respectively. PD2 value for the Levosimendan is 5.18±0.41 and for dobutamine 4.29±0.17 was found. Conclusions: Levosimendan and dobutamine molecules in vitro rat aortic rings has similar vasorelaxant effects. Thursday, 1 March 2012
12:00–13:30
Diagnostic and Therapeutic Advances in Arrhythmias OP-099 A CARDIAC ARREST/RESUSCITATION MODEL IN MOUSE FOR STEM CELL THERAPY Z. Arslan1 , H. Shelat2 , A.E. Denktas2 , Y.J. Geng2 . 1 Gelibolu Asker Hastanesi, Kardiyoloji Servisi, Canakkale, ¸ Turkey; 2 The University of Texas Medical School at Houston, Texas, USA Objective: Cardiac arrest is frequently the first presentation of myocardial ischemia and infarction. Hypoxia and hypoperfusion during the arrest causes multiple organ systems to fail. Transplanted stem cells (SC), which are capable of renewing themselves and giving rise to all specialized tissue cell types, have been recently shown to survive, proliferate and connect with the host myocardium in animal and human studies. But there are only limited data about the beneficial effects of SCs on CA survival patients or animals. Our proposed study is expected to provide valuable information about the SCs impact on recovery of damaged myocardium and organs. Methods: GFP mice mesenchymal SC were prepared prior to delivery through intravenous (IV) route to C57 BL/6 mice, for easy detection in the tissues. Animals are randomly assigned into SC and sham groups (1: CA/CPR procedure with SC injection; 2: CA/CPR procedure WITHOUT SC injection; 3: without CA/CPR procedure and red blood cell injection). Physiological parameters and cardiac functions are evaluated by echocardiography (Vivo SONIC) before and after cardiac arrest (cold KCL induces CA, wait for 5 minutes in VF, then CPR begins and connected to ventilator followed by SC administration after 30 minute recovery period). Histopathological studies were planned to determine if the presence of SCs in the heart, brain, lung, aorta, kidney and the liver after at least 7 day survival period. Results: In this continuing study, we have so far completed 19% of the animal experiments. The success rate of CA/CPR procedure is 53%. We could do 19 baseline and 10 control echocardiography exams, which showed 30% LVEF reduction from baseline (from 74% to 52%). SCs were successfully delivered into 10 mice. 3 of them died possibly due to myocardial ischemia or pulmonary embolism, although we infused one million cells in 200 ml during the 30 minutes slowly. Following 7 day of monitoring with pain relief, the animals were sacrificed. The last average of LVEF value was 62%; however, we don’t know the control group yet. At the end of the recovery period, we have had 4 animals survived ready for histopathological study. Conclusions: This will be the first study on the mice about the effects of SC on the recovery of CA induced damage of organs; and fulfillment of this project is anticipated to shed new insight into the impacts of IV SC injection into patients who survived after sudden cardiac arrest.
S17
OP-100 TRANSVENOUS EXTRACTION OF PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS USING NEW TECHNOLOGY; EVOLUTION® MECHANICAL DILATOR SHEATH A. Oto1 , K. Aytemir1 , U. Canpolat1 , H. Yorgun2 , H. Sunman1 , 1 1 ¨ A. Ulgen , E. Demiri1 , K.M. Gurses1 , L. Sahiner ¸ , E.B. Kaya1 , L. Tokgozoglu1 , G. Kabakci ¸ 1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Develi State Hospital, Kayseri, Turkey Objective: Transvenous lead extraction (TLE) has undergone an explosive evolution by increasing technology due to incremental problem of lead infections and malfunctions. We aimed to present our experience in TLE with Evolution® Mechanical Dilator Sheath. Methods: Between June 2009 and November 2011, Evolution® Mechanical Dilator Sheath was used for extraction of 140 pacemaker (PM) and implantable cardioverter-defibrillator (ICD) leads in 66 patients in our center. Indications for extraction, procedural success and complications were defined according to Heart Rhythm Society Guidelines. Results: Indications for TLE were infection in 39 patients (59.1%), lead malfunction in 26 patients (39.4%) and lead displacement in 1 patient (1.5%). Extracted devices were PM in 28 cases (42.3%), ICD in 26 cases (39.4%) and CRT-D in 12 cases (18.2%). Among 140 leads, 31 (22.1%) were right ventricular, 49 (35.0%) were defibrillator coil, 47 (33.6%) were atrial and 13 (9.3%) were coronary sinus electrodes. Median time from the preceding procedure was 85 months (22–240 months). Clinical success was 98.5% and complete procedural success with Evolution system alone was 87.9% (58 patients). Four leads were completely removed with the help of femoral snare and partial success was achieved in 3 leads with remaining small ventricular tip. Major complications were observed in 1 (1.5%) patients without any mortality. Conclusions: Our experience has confirmed that the hand powered Evolution system is an effective extraction tool for chronically implanted pacemaker/ICD leads. Randomized controlled studies are required to evaluate success and complication rates in comparison to other techniques.
Figure 1. Evolution mechanical dilator sheath. OP-101 AGING DOES NOT AFFECT THE RATE OF COMPLICATION OF PACEMAKER IMPLANTATION PROCEDURE S. Altay, K.S. Ozcan, D. Osmonov, E. Yildirim, C. Turkkan, A. Ekmekci, ¸ I. Erdinler. Department of Cardiology, Dr. Siyami Ersek Hospital, Istanbul, Turkey Objective: To evaluate the safety of pacemaker implantation in elderly patients. Methods: We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic
analysis to compare the percentages of relaxation for 2 groups was used SPSS for Windows (SPSS Inc., Chicago, IL, USA) was performed using a computer program version 13.0. Between the two groups, Mann-Whitney U-test was used to determine statistical values. P value less than 0.05 was considered significant. Results: For 10–4 M the relaxant percentage was found for levosimendan %92.33 and for dobutamin 82.48%. This couldn’t prove a statistically significant difference (P = 0.059, P > 0.05). EC50 value calculated for levosimendan and dobutamine 6.605×10−6 M and 5.093×10−5 M, respectively. PD2 value for the Levosimendan is 5.18±0.41 and for dobutamine 4.29±0.17 was found. Conclusions: Levosimendan and dobutamine molecules in vitro rat aortic rings has similar vasorelaxant effects. Thursday, 1 March 2012
12:00–13:30
Diagnostic and Therapeutic Advances in Arrhythmias OP-099 A CARDIAC ARREST/RESUSCITATION MODEL IN MOUSE FOR STEM CELL THERAPY Z. Arslan1 , H. Shelat2 , A.E. Denktas2 , Y.J. Geng2 . 1 Gelibolu Asker Hastanesi, Kardiyoloji Servisi, Canakkale, ¸ Turkey; 2 The University of Texas Medical School at Houston, Texas, USA Objective: Cardiac arrest is frequently the first presentation of myocardial ischemia and infarction. Hypoxia and hypoperfusion during the arrest causes multiple organ systems to fail. Transplanted stem cells (SC), which are capable of renewing themselves and giving rise to all specialized tissue cell types, have been recently shown to survive, proliferate and connect with the host myocardium in animal and human studies. But there are only limited data about the beneficial effects of SCs on CA survival patients or animals. Our proposed study is expected to provide valuable information about the SCs impact on recovery of damaged myocardium and organs. Methods: GFP mice mesenchymal SC were prepared prior to delivery through intravenous (IV) route to C57 BL/6 mice, for easy detection in the tissues. Animals are randomly assigned into SC and sham groups (1: CA/CPR procedure with SC injection; 2: CA/CPR procedure WITHOUT SC injection; 3: without CA/CPR procedure and red blood cell injection). Physiological parameters and cardiac functions are evaluated by echocardiography (Vivo SONIC) before and after cardiac arrest (cold KCL induces CA, wait for 5 minutes in VF, then CPR begins and connected to ventilator followed by SC administration after 30 minute recovery period). Histopathological studies were planned to determine if the presence of SCs in the heart, brain, lung, aorta, kidney and the liver after at least 7 day survival period. Results: In this continuing study, we have so far completed 19% of the animal experiments. The success rate of CA/CPR procedure is 53%. We could do 19 baseline and 10 control echocardiography exams, which showed 30% LVEF reduction from baseline (from 74% to 52%). SCs were successfully delivered into 10 mice. 3 of them died possibly due to myocardial ischemia or pulmonary embolism, although we infused one million cells in 200 ml during the 30 minutes slowly. Following 7 day of monitoring with pain relief, the animals were sacrificed. The last average of LVEF value was 62%; however, we don’t know the control group yet. At the end of the recovery period, we have had 4 animals survived ready for histopathological study. Conclusions: This will be the first study on the mice about the effects of SC on the recovery of CA induced damage of organs; and fulfillment of this project is anticipated to shed new insight into the impacts of IV SC injection into patients who survived after sudden cardiac arrest.
S17
OP-100 TRANSVENOUS EXTRACTION OF PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS USING NEW TECHNOLOGY; EVOLUTION® MECHANICAL DILATOR SHEATH A. Oto1 , K. Aytemir1 , U. Canpolat1 , H. Yorgun2 , H. Sunman1 , 1 1 ¨ A. Ulgen , E. Demiri1 , K.M. Gurses1 , L. Sahiner ¸ , E.B. Kaya1 , L. Tokgozoglu1 , G. Kabakci ¸ 1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Develi State Hospital, Kayseri, Turkey Objective: Transvenous lead extraction (TLE) has undergone an explosive evolution by increasing technology due to incremental problem of lead infections and malfunctions. We aimed to present our experience in TLE with Evolution® Mechanical Dilator Sheath. Methods: Between June 2009 and November 2011, Evolution® Mechanical Dilator Sheath was used for extraction of 140 pacemaker (PM) and implantable cardioverter-defibrillator (ICD) leads in 66 patients in our center. Indications for extraction, procedural success and complications were defined according to Heart Rhythm Society Guidelines. Results: Indications for TLE were infection in 39 patients (59.1%), lead malfunction in 26 patients (39.4%) and lead displacement in 1 patient (1.5%). Extracted devices were PM in 28 cases (42.3%), ICD in 26 cases (39.4%) and CRT-D in 12 cases (18.2%). Among 140 leads, 31 (22.1%) were right ventricular, 49 (35.0%) were defibrillator coil, 47 (33.6%) were atrial and 13 (9.3%) were coronary sinus electrodes. Median time from the preceding procedure was 85 months (22–240 months). Clinical success was 98.5% and complete procedural success with Evolution system alone was 87.9% (58 patients). Four leads were completely removed with the help of femoral snare and partial success was achieved in 3 leads with remaining small ventricular tip. Major complications were observed in 1 (1.5%) patients without any mortality. Conclusions: Our experience has confirmed that the hand powered Evolution system is an effective extraction tool for chronically implanted pacemaker/ICD leads. Randomized controlled studies are required to evaluate success and complication rates in comparison to other techniques.
Figure 1. Evolution mechanical dilator sheath. OP-101 AGING DOES NOT AFFECT THE RATE OF COMPLICATION OF PACEMAKER IMPLANTATION PROCEDURE S. Altay, K.S. Ozcan, D. Osmonov, E. Yildirim, C. Turkkan, A. Ekmekci, ¸ I. Erdinler. Department of Cardiology, Dr. Siyami Ersek Hospital, Istanbul, Turkey Objective: To evaluate the safety of pacemaker implantation in elderly patients. Methods: We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic