Transvenous lead extraction (TLE) for cardiac implantable electric device (CIED) infection is becoming increasingly common, but is believed to be particularly risky in elderly patients. This study ...aimed to clarify the safety and effectiveness of TLE in the elderly, evaluating the use of both non-laser and laser extraction tools. We retrospectively analyzed the characteristics, device type, indications, procedures, and clinical results in younger (YG; age: 15–79 years;
n
= 48) and elderly groups (EG; age: ≥ 80 years;
n
= 27) of patients who underwent percutaneous TLE between April 2014 and December 2019 at our hospital. The average age was 68 and 88 years in the YG and EG, respectively. Indications for TLE were infection in 33 (68.8%) patients and other in 15 (30.6%) patients in the YG, and infection in all 27 (100%) EG patients. Bloodstream infection was detected in 9 and 4 patients in the YG and EG, respectively, with methicillin-resistant
Staphylococcus epidermidis
being the most common causative pathogen. All TLE procedures were performed under general anesthesia in an operating room with cardiovascular surgeon backup. An excimer laser sheath (76 leads), a laser followed by a mechanical sheath (45 leads), Evolution RL
®
(17 leads), a mechanical sheath (9 leads), and manual traction (one lead) were employed to extract a total of 148 leads (98 and 50 in the YG and EG, respectively). A mechanical sheath or Evolution RL
®
was more frequently used in the YG. The respective average implantation durations in the YG and EG were 5.3 and 5.0 years, respectively, which were comparable (
p
= 0.46). Procedural success rates were identical between the YG and EG (99% vs. 100%, respectively). There was only one procedure-related complication in the entire cohort (cardiac tamponade in a YG patient). Taken together, the success rates of TLE were high in the EG, with no complications, with extraction being the indication for infection in all EG patients. Percutaneous TLE was safe and effective in elderly patients using both non-laser and laser techniques.
The aim of this study was to investigate the prognostic significance of high-sensitivity troponin T (hs-TnT) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We enrolled ...consecutive patients admitted to Shinshu University Hospital for HF treatment between July 2014 and March 2017 and stratified them into HF with reduced ejection fraction and HFpEF groups (left ventricular ejection fraction, < 50% and ≥ 50%, respectively). Hs-TnT was evaluated at discharge, and patients were prospectively monitored for all-cause mortality, non-fatal myocardial infarction, stroke, and HF hospitalization. In 155 enrolled patients (median age 76 years), during a median follow-up of 449 days, 60 experienced an adverse event. Hs-TnT was significantly higher in patients with adverse events than in those without in HFpEF (
p
= 0.003). Hs-TnT did not significantly correlate with age, sex, hemoglobin, albumin, eGFR, or BNP. In Kaplan–Meier analysis, high hs-TnT predicted a poor prognosis in HFpEF (
p
= 0.003). In multivariate Cox regression analysis, hs-TnT levels independently predicted adverse events in HFpEF (
p
= 0.003) after adjusting for age and eGFR HR, 1.015 (95% CI, 1.005–1.025),
p
= 0.004, and age and BNP HR 1.016 (95% CI 1.005–1.027),
p
= 0.005. Elevated hs-TnT at discharge predicted adverse events in HFpEF.
Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system ...and injury to the veins or heart, have been reported.
The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported.
In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction.
Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted.
All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.
Background: Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure ...(ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF.Methods and Results: We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5–9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio HR per additional increase in the number of medications, 1.05; 95% confidence interval CI, 1.01–1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02–1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92–1.10; P=0.95).Conclusions: Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.
Background: Acute decompensated heart failure (ADHF) has a poor prognosis and common comorbidities may be contributory. However, evidence for the association between dementia and clinical outcomes in ...patients with is sparse and it requires further investigation into risk reduction.Methods and Results: We assessed the clinical profiles and outcomes of 1,026 patients (mean age 77.8 years, 43.2% female) with ADHF enrolled in the CURE-HF registry to evaluate the relationship between investigator-reported dementia status and clinical outcomes (all-cause death, cardiovascular (CV) death, non-CV death, and HF hospitalization) over a median follow-up of 2.7 years. In total, dementia was present in 118 (11.5%) patients, who experienced more drug interruptions and HF admissions due to infection than those without dementia (23.8% vs. 13.1%, P<0.01; 11.0% vs. 6.0%, P<0.01, respectively). Kaplan-Meier analysis revealed that dementia patients had higher mortality rates than those without dementia (log-rank P<0.001). After multivariable adjustment for demographics and comorbidities, dementia was significantly associated with an increased risk of death (adjusted hazard ratio, 1.43; 95% confidence interval, 1.06–1.93, P=0.02) and non-CV death (adjusted hazard ratio, 1.65; 95% confidence interval, 1.04–2.62, P=0.03), but no significant associations between dementia and CV death or HF hospitalization were observed (both, P>0.1).Conclusions: In ADHF patients dementia was associated with aggravating factors for HF admission and elevated risk of death, primarily non-CV death.
The composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with ...advanced heart failure (HF). However, its prognostic ability remains unclear in elderly HF patients.
From July 2014 to July 2018, patients hospitalized for HF were prospectively recruited at 16 centers. Clinical features, laboratory findings, and echocardiography results were assessed prior to discharge. Cardiovascular (CV) death and HF re-hospitalization were recorded. Of the 676 patients enrolled, 264 (39.1%) experienced CV events throughout a 1-year median follow-up period. Patients with high MELD-XI were predominantly male and had a higher prevalence of NYHA III/IV, history of HF admission, hyperuricemia, ventricular tachycardia, anemia, and ischemic heart disease. In Kaplan-Meyer analysis, patients with higher MELD-XI (≥11) scores showed a worse prognosis than did those with lower (<11) scores (log-rank p≤0.001). Multivariate Cox proportional hazards testing revealed MELD-XI as an independent predictor of CV events (HR: 1.033, 95% CI: 1.006-1.061, p = 0.015) after adjusting for age, gender, body mass index, NYHA III/IV, prior HF hospitalization, systolic blood pressure, ischemic etiology, ventricular tachycardia, anemia, BNP, and left ventricular ejection fraction.
Cardio-renal and cardio-hepatic interactions predicted CV events in aged HF patients.
Background : Recently, several echocardiographic parameters have been proposed as predictors of the recurrence of persistent atrial fibrillation (psAF) after catheter ablation (CA). This study aimed ...to evaluate whether a decrease in inter-atrial septum (IAS) motion was associated with recurrence of psAF after CA. Methods : A total of 103 consecutive patients who underwent CA for psAF were retrospectively reviewed. IAS motion was measured 48-72 hours before CA using transesophageal echocardiography. The primary outcome was AF recurrence beyond 3 months post-ablation. The follow-up period was 12 months after CA. Results : PsAF recurrence after CA occurred in 29 (28.2％) patients. The median value of IAS motion was 4.1mm (interquartile range 2.4, 5.4), and the decline in IAS motion was an independent predictor of AF recurrence in a multivariate analysis of various models. Kaplan-Meier analysis showed that AF recurrence was significantly higher in the low IAS motion group (IAS motion < 4.2, n＝47) than in the high IAS motion group (IAS motion ≥ 4.2, n＝52) (log-rank test, p＝0.001). A negative correlation was observed between IAS motion and left atrial volume (LAV), and conversely, a positive correlation was found between IAS motion and left atrial appendage flow velocity. The low IAS motion group had a higher left atrial pressure (LAP) than the high IAS motion group. Conclusions : PsAF recurrence after CA was associated with reduced IAS motion. Decreased IAS motion could be an important finding suggestive of left atrial remodeling as well as LAV enlargement and increasing LAP.
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