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PP-334 Breakage of an Extracted Pacemaker Lead in Patient with Infective Endocarditis: An Alternative Management Approach
MARCH 13e16, 2014 management, inotropic support and also helped clinical teams to evaluate prognosis (Table 1). Conclusion: Our real-world use of non-invasive bedside portable echocardiography system to compute haemodynamic parameters facilitated optimization of fluids and inotropic support. It also helped clinicians to monitor progress of patients and also provided them with prognostic information.
- PP-334 Breakage of an Extracted Pacemaker Lead in Patient with Infective Endocarditis: An Alternative Management Approach. Mehmet Emin Kalkan, Mustafa Akçakoyun, Serdar Demir, Elnur Alizade, Göksel Açar, Mehmet Yunus Emiroglu, Taylan Akgün, Selçuk Pala. Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
P O S T E R A B S T R A C T S
The expanded indications for cardiac rhythm devices (CRD) according to the current guidelines, increased the use of devices especially in the last ten years. As a result, consistent with this rise, an increasing number of lead extraction procedures are eventually required. Although simple manual retraction may be an effective way to extraction of the the leads implanted till one year ago, chronically implanted leads develop fibrous attachments to surrounding structures and require more improved extraction systems. We report a case of the extraction of 10 year-old leads in a patient with a DDD pacemaker and infective endocarditis. A 32-year-old male patient presented with complaints of fatigue, fever, and worsening health status. He had a ten-years history of DDD pacemaker implantation due to sick sinus syndrome. Echocardiographic examination revealed a vegetative mass on the tip of the lead in the right ventricle. After the infection has been controlled with medical therapy, removing of the pacemaker was planned, by the evolution mechanical dilator sheath (Cook Medical, Bloomington, IN, USA). It is a flexible long sheath with a sharp metal distal tip, which allows the system to pass through the fibrotic adhesions. Firstly, the atrial lead was extracted bodily with no-complication. Secondly, the ventricular lead was attempted to be extracted, but unfortunately it was broken in its middle region. Then we decided to use femoral venous approach to catch remnant lead fragmant. Therefore, the flexcath steerable sheath
(CryoCath Technologies/Medtronic, USA), designed for percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation. It was sent into the end region of the broken lead. The 8f Snare catheter via Flexcath sheath was directed into the right ventricle under the fluoroscopic guidance. Then, by the snare catheter, remnant lead was properly grasped inside the Flex-cath sheath and were successfully extracted from the patient, successfully. The purpose of our report is presentation of an experience in the management of a lead breakage caused by advanced extraction tool and a new alternative approach to solve this undesirable complication.
- PP-335 Atrial Conduction Times and Left Atrial Mechanical Functions in _ 1, A. Kırıs¸2, M. S¸ahin2, Patients with Active Acromegaly. A. Ilter N. Civan3, H. Bektas¸1, M. Öztürk4, O.E. Turan5, F. Kangül6, Ö. Gedikli2, C. Örem2, M. Kutlu2. 1Department of Cardiology, Kanuni Training and Research Hospital, Trabzon, Turkey; 2Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey; 3Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon, Turkey; 4Department of Cardiology, Caycuma State Hospital, Zonguldak, Turkey; 5Department of Cardiology, Aydın State Hospital, Aydın, Turkey; 6Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon, Turkey. Objective: The aim of this study was to evaluate atrial electromechanical delay (EMD), P wave dispersion and left atrial (LA) mechanical functions in patients with active acromegaly. Methods: Twenty- three patients with active acromegaly and 27 age and sex matched controls were included in this study. All atrial electromechanical interval parameters (PA lateral, PA septum, PA tricuspit, interatrial EMD, intra- left atrial EMD and intra-right atrial EMD ) were measured from mitral lateral anullus, mitral septal anullus and right ventricular tricuspit anullus by tissue doppler imaging. P wave dispersion (Pwd) was calculated by 12-lead electrocardiograms. Left atrial (LA) volumes were measured by the disc method in the apical fourchamber view and were indexed to the body surface area. Mechanical function parameters of LA were calculated. Results: Atrial electromechanical intervals (PA lateral, PA septum, PA tricuspit, interatrial EMD, intra- left atrial EMD, intra-right atrial EMD ) and P wave dispersion were similar between acromegalic patients and controls (All p > 0.05). Morever LA volumes (maximum, minimum and presistolic) and LA mechanical functions were not comparable between two groups (All p > 0.05). Additionally there were not significantly relationships between the levels of growth hormone/ insuline-like growth factor -1 and atrial electromechanical intervals or LA volumes and LA mechanical functions. Conclusions: It was first studied that atrial electrical conduction times and LA mechanical functions were not impared in patiens with active acromegaly.
- PP-336
Fluoroscopic and photographic images of breakage lead grasped by the 8f Snare catheter into the 10f Flex-cath steerable sheath, after the lead remnant were grasped by the snare catheter, remnant lead was pulled back into the flex-cath sheath and fully extracted from the patient, successfully (PanelA,B,C,D Respectively).
Assessment of Heart Rate Variability in Breath Holding Children By 24 Hour Holter Monitoring. O. Yilmaz1, M. Ciftel1, O. Ceylan2, H. Kahveci3, O. Kilic4. 1Department of Pediatric Cardiology, Erzurum District Training and Research Hospital, Erzurum, Turkey; 2 Department of Pediatric Cardiology, Suleymaniye Maternity Training and Research Hospital, Istanbul, Turkey; 3Department of Neonatology, Erzurum District Training and Research Hospital, Erzurum, Turkey; 4 Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey.
S142 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
- PP-334 Breakage of an Extracted Pacemaker Lead in Patient with Infective Endocarditis: An Alternative Management Approach. Mehmet Emin Kalkan, Mustafa Akçakoyun, Serdar Demir, Elnur Alizade, Göksel Açar, Mehmet Yunus Emiroglu, Taylan Akgün, Selçuk Pala. Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
P O S T E R A B S T R A C T S
The expanded indications for cardiac rhythm devices (CRD) according to the current guidelines, increased the use of devices especially in the last ten years. As a result, consistent with this rise, an increasing number of lead extraction procedures are eventually required. Although simple manual retraction may be an effective way to extraction of the the leads implanted till one year ago, chronically implanted leads develop fibrous attachments to surrounding structures and require more improved extraction systems. We report a case of the extraction of 10 year-old leads in a patient with a DDD pacemaker and infective endocarditis. A 32-year-old male patient presented with complaints of fatigue, fever, and worsening health status. He had a ten-years history of DDD pacemaker implantation due to sick sinus syndrome. Echocardiographic examination revealed a vegetative mass on the tip of the lead in the right ventricle. After the infection has been controlled with medical therapy, removing of the pacemaker was planned, by the evolution mechanical dilator sheath (Cook Medical, Bloomington, IN, USA). It is a flexible long sheath with a sharp metal distal tip, which allows the system to pass through the fibrotic adhesions. Firstly, the atrial lead was extracted bodily with no-complication. Secondly, the ventricular lead was attempted to be extracted, but unfortunately it was broken in its middle region. Then we decided to use femoral venous approach to catch remnant lead fragmant. Therefore, the flexcath steerable sheath
(CryoCath Technologies/Medtronic, USA), designed for percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation. It was sent into the end region of the broken lead. The 8f Snare catheter via Flexcath sheath was directed into the right ventricle under the fluoroscopic guidance. Then, by the snare catheter, remnant lead was properly grasped inside the Flex-cath sheath and were successfully extracted from the patient, successfully. The purpose of our report is presentation of an experience in the management of a lead breakage caused by advanced extraction tool and a new alternative approach to solve this undesirable complication.
- PP-335 Atrial Conduction Times and Left Atrial Mechanical Functions in _ 1, A. Kırıs¸2, M. S¸ahin2, Patients with Active Acromegaly. A. Ilter N. Civan3, H. Bektas¸1, M. Öztürk4, O.E. Turan5, F. Kangül6, Ö. Gedikli2, C. Örem2, M. Kutlu2. 1Department of Cardiology, Kanuni Training and Research Hospital, Trabzon, Turkey; 2Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey; 3Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon, Turkey; 4Department of Cardiology, Caycuma State Hospital, Zonguldak, Turkey; 5Department of Cardiology, Aydın State Hospital, Aydın, Turkey; 6Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Trabzon, Turkey. Objective: The aim of this study was to evaluate atrial electromechanical delay (EMD), P wave dispersion and left atrial (LA) mechanical functions in patients with active acromegaly. Methods: Twenty- three patients with active acromegaly and 27 age and sex matched controls were included in this study. All atrial electromechanical interval parameters (PA lateral, PA septum, PA tricuspit, interatrial EMD, intra- left atrial EMD and intra-right atrial EMD ) were measured from mitral lateral anullus, mitral septal anullus and right ventricular tricuspit anullus by tissue doppler imaging. P wave dispersion (Pwd) was calculated by 12-lead electrocardiograms. Left atrial (LA) volumes were measured by the disc method in the apical fourchamber view and were indexed to the body surface area. Mechanical function parameters of LA were calculated. Results: Atrial electromechanical intervals (PA lateral, PA septum, PA tricuspit, interatrial EMD, intra- left atrial EMD, intra-right atrial EMD ) and P wave dispersion were similar between acromegalic patients and controls (All p > 0.05). Morever LA volumes (maximum, minimum and presistolic) and LA mechanical functions were not comparable between two groups (All p > 0.05). Additionally there were not significantly relationships between the levels of growth hormone/ insuline-like growth factor -1 and atrial electromechanical intervals or LA volumes and LA mechanical functions. Conclusions: It was first studied that atrial electrical conduction times and LA mechanical functions were not impared in patiens with active acromegaly.
- PP-336
Fluoroscopic and photographic images of breakage lead grasped by the 8f Snare catheter into the 10f Flex-cath steerable sheath, after the lead remnant were grasped by the snare catheter, remnant lead was pulled back into the flex-cath sheath and fully extracted from the patient, successfully (PanelA,B,C,D Respectively).
Assessment of Heart Rate Variability in Breath Holding Children By 24 Hour Holter Monitoring. O. Yilmaz1, M. Ciftel1, O. Ceylan2, H. Kahveci3, O. Kilic4. 1Department of Pediatric Cardiology, Erzurum District Training and Research Hospital, Erzurum, Turkey; 2 Department of Pediatric Cardiology, Suleymaniye Maternity Training and Research Hospital, Istanbul, Turkey; 3Department of Neonatology, Erzurum District Training and Research Hospital, Erzurum, Turkey; 4 Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey.
S142 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster