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Off-label combination of leadless pacemakers and subcutaneous defibrillators in bilateral venous occlusion: a new reimplantation strategy after lead extraction.

Session Device Therapy ePosters

Speaker Andrea Di Cori

Event : ESC Congress 2020

  • Topic : arrhythmias and device therapy
  • Sub-topic : Device Complications and Lead Extraction
  • Session type : ePosters

Authors : A Di Cori (Pisa,IT), S Viani (Pisa,IT), S Tolve (Pisa,IT), G Zucchelli (Pisa,IT), V Barletta (Pisa,IT), M Giannotti Santoro (Pisa,IT), M Parollo (Pisa,IT), T Cellamaro (Pisa,IT), G Branchitta (Pisa,IT), M Carluccio (Pisa,IT), L Segreti (Pisa,IT), L Paperini (Pisa,IT), R De Lucia (Pisa,IT), E Soldati (Pisa,IT), MG Bongiorni (Pisa,IT)

Authors:
A Di Cori1 , S Viani1 , S Tolve1 , G Zucchelli1 , V Barletta1 , M Giannotti Santoro1 , M Parollo1 , T Cellamaro1 , G Branchitta1 , M Carluccio1 , L Segreti1 , L Paperini1 , R De Lucia1 , E Soldati1 , MG Bongiorni1 , 1Santa Chiara Hospital, Department of Cardiovascular Diseases - Pisa - Italy ,

Topic(s):
Device Complications and Lead Extraction

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemakers (LPM) provide an alternative to transvenous implantable devices. Sometimes, after transvenous (TV) lead extraction, patients show a bilateral venous occlusion, resulting not eligible for TV reimplantation.

Purpose: This analysis was designed to provide preliminary data on feasibility and short-term outcome of an hybrid combination (Hyb) of s-ICD plus LPM  after TV-ICD explantation, in patients without anatomical transvenous reimplantation options.

Methods: Among 2684 consecutive extracted patients, 31 (1.1%) were reimplanted with a LPM, 66 (2.4%) with a s-ICD and 6 (0.2%) patients with an Hyb combination. Hyb strategy was considered in patients with a pacing plus defibrillating indication, and an anatomical barrier, as bilateral superior venous occlusion or massive bilateral skin erosion.

Results: Hyb patients were old (72 ±10 years), with a prevalent ischemic disease (4/6) and a reduced ejection fraction (43±16%). Extraction indication was infection in 4 and severe venous occlusion in 2, and included 2 single chamber, 2 dual chamber and 2 biventricular ICD. After extraction, reimplantation timing was 7±6 days, LPM was implanted before and sICD the day after.

LPM reimplantation indication was sinus node dysfunction in 2 and AV block in 4. Implantation duration was 68±23 and fluoroscopy time 9.4±2.3 min. ICD reimplantation indication was primary prevention in 4 and secondary prevention in 2. Implantation duration was 118±10 min. No complications were observed. At 1 year, no complications were observed, including device related cross-talks.

Conclusions: The Hyb strategy is a potential option after TV-ICD explantation in pacemaker dependent patients, when transvenous implantation is not available.

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