Isoprostane-8 and GDF-15 as novel markers of post-PE syndrome: Relation with prothrombotic factors.

BACKGROUND: Post-pulmonary embolism (PE) syndrome occurs in up to 50% of PE patients. The pathophysiology of this syndrome is obscure. OBJECTIVE: We investigated whether enhanced oxidative stress and prothrombotic state may be involved in post-PE syndrome. METHODS: We studied 101 normotensive noncancer PE patients (aged 56.5 ± 13.9 years) on admission, after 5-7 days and after a 3-month anticoagulation, mostly with rivaroxaban. A marker of oxidative stress, 8-isoprostane, endogenous thrombin potential, fibrinolysis proteins, clot lysis time (CLT) and fibrin clot permeability (Ks ), along with PE biomarkers, were determined. RESULTS: Patients who developed the post-PE syndrome (n = 31, 30.7%) had at baseline 77.6% higher N-terminal brain natriuretic propeptide and 46.8% higher growth differentiation factor 15, along with 14.1% longer CLT associated with 34.4% higher plasminogen activator inhibitor-1 as compared to subjects without post-PE syndrome (all P < .05). After 5-7 days, only hypofibrinolysis was noted in post-PE syndrome patients. When measured at 3 months, prolonged CLT and reduced Ks were observed in post-PE syndrome patients, accompanied by 23.8% higher growth differentiation factor 15 and 35.8% higher plasminogen activator inhibitor-1 (all P < .05). 8-isoprostane levels ≥108 pg/ml (odds ratio=4.36; 95% confidence interval 1.63-12.27) and growth differentiation factor 15 ≥ 1529 pg/ml (odds ratio=3.89; 95% confidence interval 1.29-12.16) measured at 3 months were associated with higher risk of developing post-PE syndrome. CONCLUSIONS: Enhanced oxidative stress and prothrombotic fibrin clot properties could be involved in the pathogenesis of the post-PE syndrome. Elevated growth differentiation factor 15 assessed at 3 months might be a new biomarker of this syndrome.

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study.

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome - a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and maintaining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up (ClinicalTrials.gov Identifier: NCT04718025; EudraCT number: 2020-005130-15).

Late to early velocity index as a predictor of iatrogenic femoral artery pseudoaneurysm recurrence in patients treated with ultrasound-guided thrombin injection.

INTRODUCTION: Ultrasound-guided thrombin injection (UGTI) is the preferred treatment of pseudoaneurysms (psA). The potential risk of complications increases with the number of UGTI treatments needed for complete psA obliteration. Identification of risk factors for recurrent psA is needed. MATERIAL AND METHODS: In total, 508 patients with femoral artery psA underwent UGTI, followed by ultrasound examination repeated twice, at 1-week intervals, to assess UGTI effectiveness. In cases of psA recurrence, the procedure was repeated. Clinical and ultrasound data were prospectively collected. RESULTS: The psA recurrence occurred in 76 (15%) patients. UGTI was repeated twice in 49 (64%), three times in 15 (20%) and more than three times in 12 (16%) patients. The median thrombin dose was 150 IU (80-250 IU), and was lower in initial procedures than repeated UGTI (p = 0.025). The median psA volume was 2.26 ml (0.86-5.47 ml). The median length of the communicating channel was 4 mm (0-12 mm). A time interval between vessel catheterization and UGTI greater than 7 days (p < 0.001), a late to early velocity index (LEVI) of < 0.2 identified during the outflow phase (p < 0.001), a psA volume > 5 ml (p = 0.032), and a short communicating channel between the psA and the artery (p = 0.037) predicted psA recurrence. Antiplatelet and anticoagulant agents did not increase the risk. CONCLUSIONS: The LEVI and time interval between artery cannulation and UGTI treatment are strong parameters identifying patients at risk of psA recurrence. The psA volume and communicating channel length are less substantial risks, but still significant. Concomitant antiplatelet and anticoagulant therapy do not affect the success rate of UGTI.

Right ventricular echocardiographic parameters associated with prothrombotic abnormalities in normotensive patients with acute pulmonary embolism.

BACKGROUND: In acute pulmonary embolism (PE) right ventricular (RV) pressure overload negatively affects prognosis. Recently we have shown that RV dilatation is associated with a prothrombotic state in PE. We investigated which RV echocardiographic parameters best indicate prothrombotic alterations in acute PE. METHODS: In 121 normotensive, noncancer PE patients, markers of RV dilatation and dysfunction were evaluated on admission using transthoracic echocardiography, along with prothrombotic state markers, i.e. increased endogenous thrombin generation (ETP), low fibrin clot permeability (Ks, a measure of clot density), and prolonged clot lysis time (CLT). RESULTS: RV parasternal long axis (RVOT PLAX) >30 mm was associated with ETP (OR 3.86; 95% CI 1.55-9.62; p = 0.004) and CLT (OR 4.08; 95% CI 1.58-10.54; p = 0.004) in the top quartiles, but not with Ks. RV short parasternal axis (RVOT PSAX) >27 mm showed similar associations with higher ETP (OR 3.54; 95% CI 1.50-8.37; p = 0.004) and prolonged CLT (OR 2.78; 95% CI 1.17-6.62; p = 0.021). RV basal diameter >41 mm solely predicted prolonged CLT (OR 2.93; 95% CI 1.23-6.99; p = 0.016). The right atrium area, pulmonary trunk diameter, and tricuspid regurgitation maximum velocity were not related to prothrombotic markers, except for tricuspid annular plane systolic excursion weakly associated with ETP. Multivariable analysis showed that RVOT PSAX is independently associated with prolonged CLT (OR 1.16; 95% CI 1.04-1.30; p = 0.007), low Ks (OR 1.21; 95% CI 1.02-1.44; p = 0.029), and higher ETP (OR 1.14; 95% CI 1.03-1.26; p = 0.009). CONCLUSIONS: Among RV echocardiographic parameters, the RVOT dilatation measured in PSAX best predicts prothrombotic alterations in PE patients.

ROS-Mediated Apoptosis and Autophagy in Ovarian Cancer Cells Treated with Peanut-Shaped Gold Nanoparticles.

BACKGROUND: Even with considerable improvement in treatment of epithelial ovarian cancer achieved in recent years, an increasing chemotherapy resistance and disease 5-year relapse is recorded for a majority part of patients that encourages the search for better therapeutic options. Gold nanoparticles (Au NPs) due to plethora of unique physiochemical features are thoroughly tested as drug delivery, radiosensitizers, as well as photothermal and photodynamic therapy agents. Importantly, due to highly controlled synthesis, it is possible to obtain nanomaterials with directed size and shape. METHODS: In this work, we developed novel elongated-type gold nanoparticles in the shape of nanopeanuts (AuP NPs) and investigated their cytotoxic potential against ovarian cancer cells SKOV-3 using colorimetric and fluorimetric methods, Western blot, flow cytometry, and fluorescence microscopy. RESULTS: Peanut-shaped gold nanoparticles showed high anti-cancer activity in vitro against SKOV-3 cells at doses of 1-5 ng/mL upon 72 hours treatment. We demonstrate that AuP NPs decrease the viability and proliferation capability of ovarian cancer cells by triggering cell apoptosis and autophagy, as evidenced by flow cytometry and Western blot analyses. The overproduction of reactive oxygen species (ROS) was noted to be a critical mediator of AuP NPs-mediated cell death. CONCLUSION: These data indicate that gold nanopeanuts might be developed as nanotherapeutics against ovarian cancer.

Loose Fibrin Clot Structure and Increased Susceptibility to Lysis Characterize Patients with Central Acute Pulmonary Embolism: The Impact of Isolated Embolism.

BACKGROUND: Prothrombotic fibrin clot properties are associated with higher early mortality risk in acute pulmonary embolism (PE) patients. It is unknown whether different types of PE are associated with particular clot characteristics. METHODS: We assessed 126 normotensive, noncancer acute PE patients (median age: 59 [48-70] years; 52.4% males), who were categorized into central versus peripheral PE with or without concomitant deep vein thrombosis (DVT). Plasma fibrin clot permeability (K s), clot lysis time (CLT), thrombin generation, platelet-derived markers, and fibrinolytic parameters were measured on admission. Plasma fibrin clot morphology was assessed by scanning electron microscopy (SEM). RESULTS: Patients with central PE (n = 76; 60.3%) compared with peripheral PE (n = 50; 39.7%) had 17.8% higher K s and 14.3% shortened CLT (both p < 0.01 after adjustment for potential confounders including fibrinogen), with no differences between segmental and subsegmental PE. SEM analysis demonstrated larger fibrin fiber diameter and pore size in central PE compared with peripheral PE (both p < 0.01). For isolated PE, there was 23.3% higher K s in central PE than in peripheral PE (n = 24; 19%) with no differences in other variables. Central PE combined with DVT (n = 45; 35.7%), as compared with central isolated PE (n = 31; 24.6%), was associated with shortened CLT (all p < 0.05). CONCLUSION: Our findings suggest that looser fibrin networks composed of thicker fibers with increased susceptibility to lysis characterize patients with central PE, suggesting that fibrin clot phenotype affects the size of thrombi occluding the pulmonary arteries, highlighting the role of fibrin structures in thrombus formation and stability.

Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes.

BACKGROUND: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. METHODS: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). RESULTS: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94-0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24-0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64-12.99; p = 0.0038) as predictors of 12-month mortality in this group. CONCLUSIONS: Invasive MI treatment may be beneficial for selected very old patients.

Prothrombotic fibrin clot properties associated with NETs formation characterize acute pulmonary embolism patients with higher mortality risk.

Venous thromboembolism is associated with formation of denser fibrin clots resistant to lysis. We investigated whether prothrombotic plasma clot properties are associated with the severity of acute pulmonary embolism (PE). We enrolled 126 normotensive acute PE patients (aged 58 ± 14 years) and 25 age- and sex-matched healthy controls. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were evaluated on admission. PE patients compared to controls had 370% higher citH3 levels, 41% higher ETP, 16.5% reduced Ks, and 25.6% prolonged CLT. Patients with intermediate-high (n = 29) and intermediate-low (n = 77) PE mortality risk had reduced Ks and prolonged CLT, increased PAI-1 and ETP as compared to low-risk PE (n = 20) patients. Prolonged CLT was predicted by PAI-1 and citH3, while low Ks by C-reactive protein. During a 12-month follow-up 9 (7.1%) patients who had 24% higher ETP, 45% higher citH3 levels, and 18% prolonged CLT at baseline died. High ETP combined with elevated citH3 levels and prolonged CLT was associated with eightfold increased risk of PE-related death. Prothrombotic fibrin clot properties and enhanced neutrophil extracellular traps formation are associated with higher early mortality risk in acute PE patients, which suggests a prognostic role of these biomarkers.

Associations of changes in patient characteristics and management with decrease in mortality rates of men and women with ST-elevation myocardial infarction - a propensity score-matched analysis.

INTRODUCTION: The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women. MATERIAL AND METHODS: This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores. RESULTS: There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men. CONCLUSIONS: The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.

Elevated Lactate Levels in Acute Pulmonary Embolism Are Associated with Prothrombotic Fibrin Clot Properties: Contribution of NETs Formation.

BACKGROUND: Elevated plasma lactate levels correlate with high mortality rate in acute pulmonary embolism (PE) patients. We hypothesized that elevated lactate levels correlate with prothrombotic fibrin clot properties and enhanced neutrophil extracellular trap (NET) formation in acute PE. METHODS: As many as 126 normotensive acute PE patients (aged 58 ± 14 years) were enrolled. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), citrullinated histone H3 (citH3), and plasminogen activator inhibitor-1 antigen (PAI-1), together with plasma L-lactate levels were evaluated on admission. RESULTS: Lactate levels ≥2 mM were found in 70 (55.6%) patients in whom we observed 29% higher neutrophil count and 45% elevated plasma citH3 levels. Elevated lactate levels were associated with more prothrombotic fibrin properties as reflected by 11% reduced Ks, 13% longer CLT, along with 11% increased ETP. Lactate levels were positively associated with plasma citH3 concentrations, ETP, CLT, and PAI-1 (p < 0.05). An increase of lactate levels by 1 mM leading to the prolongation of CLT by 8.82 minutes was shown in the linear regression. CONCLUSIONS: Our findings suggest a new mechanism contributing to a negative impact of elevated lactate levels on prognosis in acute PE patients, in particular hypofibrinolysis, associated with enhanced NET formation.

Nanoantibiotics containing membrane-active human cathelicidin LL-37 or synthetic ceragenins attached to the surface of magnetic nanoparticles as novel and innovative therapeutic tools: current status and potential future applications.

Nanotechnology-based therapeutic approaches have attracted attention of scientists, in particular due to the special features of nanomaterials, such as adequate biocompatibility, ability to improve therapeutic efficiency of incorporated drugs and to limit their adverse effects. Among a variety of reported nanomaterials for biomedical applications, metal and metal oxide-based nanoparticles offer unique physicochemical properties allowing their use in combination with conventional antimicrobials and as magnetic field-controlled drug delivery nanocarriers. An ever-growing number of studies demonstrate that by combining magnetic nanoparticles with membrane-active, natural human cathelicidin-derived LL-37 peptide, and its synthetic mimics such as ceragenins, innovative nanoagents might be developed. Between others, they demonstrate high clinical potential as antimicrobial, anti-cancer, immunomodulatory and regenerative agents. Due to continuous research, knowledge on pleiotropic character of natural antibacterial peptides and their mimics is growing, and it is justifying to stay that the therapeutic potential of nanosystems containing membrane active compounds has not been exhausted yet.

Safety of dental extractions in patients on dual antiplatelet therapy - a meta-analysis.

INTRODUCTION: Safety of dental extractions in patients on chronic antiplatelet therapy either with only acetylsalicylic acid (ASA) or clopidogrel or with both combined has been a matter of debate, with no clearly conclusive studies published. AIM: To perform a meta-analysis of published observational studies in order to study the effect of single and double antiplatelet therapy in comparison to controls on the occurrence of immediate local bleeding complications during dental extractions. MATERIAL AND METHODS: PubMed/Scopus/Embase database search revealed 22 papers (13 original and 9 review), 3 of which were finally included in the meta-analysis. Phrases searched: dual[All Fields] AND antiplatelet[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("tooth extraction"[MeSH Terms] OR ("tooth"[All Fields] AND "extraction"[All Fields]) OR "tooth extraction"[All Fields]). RESULTS: The overall event incidence (bleeding complication after extraction) in the entire population was 1.59% (42 events in 2637 patients). As compared to the control group, the use of double antiplatelet therapy DAPT was associated with on odd ratio OR of 40.23 (95% CI: 4.37-370.36) increase in risk of bleeding events occurrence (p = 0.0011). Significant heterogeneity was observed (p < 0.001; I 2 of 76.7%). CONCLUSIONS: Dental extractions following strict procedural protocols in patients on double antiplatelet therapy with clopidogrel and ASA are associated with an additional risk of immediate local bleeding complications.

Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention: a 2-year follow-up.

BACKGROUND: The failure of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) is more frequent than considered previously. AIM: To evaluate sex-related differences in long-term outcomes in patients with STEMI and incomplete infarct-related artery reperfusion after a primary percutaneous coronary intervention. PATIENTS AND METHODS: Of consecutive 42 752 patients with STEMI hospitalized between 2009 and 2011 in Poland, we analyzed a group of 766 (35%) women and 1453 (65%) men with less than thrombolysis in myocardial infarction (TIMI) flow grade 3 following a primary percutaneous coronary intervention. RESULTS: In the 2-year follow-up, the mortality rate among women was significantly higher compared with men: 39.8 versus 30.9% (P=0.0009) in the TIMI 0 or 1 group, and 31.6 versus 20% (P<0.0001) in the TIMI 2 group. In women, the risk of rehospitalization because of heart failure was significantly higher irrespective of the final TIMI flow grade. In the multivariate analysis, female sex did not influence both in-hospital (odds ratio: 1.09; 95% confidence interval: 0.82-1.44; P=0.54) and long-term (hazard ratio: 1.14; 95% confidence interval: 0.97-1.34; P=0.11) mortality. Peripheral artery disease, anterior myocardial infarction, and previous stroke were associated with increased mortality only in men. Postprocedural TIMI flow grade 2 (vs. TIMI grade 0 or 1) was the strongest factor impacting mortality irrespective of sex. CONCLUSION: Women with STEMI and postprocedural suboptimal epicardial blood flow have higher mortality than men and are at high risk of developing heart failure, with frequent in-patient visits. However, these differences may be attributed to the advanced age and worse clinical presentation of women compared with men.

Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions.

BACKGROUND: Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. METHODS: Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. RESULTS: Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. CONCLUSIONS: There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.

Left atrial longitudinal strain in dilated cardiomyopathy patients: is there a discrimination threshold for atrial fibrillation?

To determine the left atrial longitudinal strain discrimination threshold of atrial fibrillation (AF) in patients with dilated cardiomyopathy (DCM). A total of 100 DCM patients and LVEF < 25% were included. Of them, 50 had sinus rhythm (SR), and 50 had AF. Patients with significant valvular disease, cardiac pacemakers and prosthetic valves were excluded. Speckle tracking echocardiography was performed to visualize the inferior and lateral walls of the left atrium as well as the interatrial septum. The Q-Analysis software was used to assess left atrial contractile strain (εCT) during the atrial systole and left atrial conduit strain (εCD) during the atrial filling. In SR patients analysis was P-wave timed. In AF patients the reference point was at 200 ms before the QRS complex on the surface ECG. The εCD was significantly higher in SR patients than in those with AF (9.68% vs. 4.7%; p = 0.0003). ROC analysis demonstrated that εCD less than 5.43% (AUC 0.95; 95% CI 0.905-0.995; p < 0.0001) together with εCT below - 1.97% (AUC = 0.97; 95% CI 0.46-1.00; p < 0.0001) identified patients with AF. In patients with LVEF < 25% and AF left atrial contractile strain analysis is feasible. In these patients both contractile and conduit strain values are significantly lower than in patients with preserved SR, and εCD below 5.43% and εCT less than - 1.97% distinguish SR from AF patients with LVEF < 25%.

Ten-year study of late electrotherapy complications. Single-centre analysis of indications and safety of transvenous leads extraction.

BACKGROUND: An increase in the number of cardiac implantable electronic device (CIED) implantations is associated with a higher frequency of electrotherapy complications. AIM: The aim of the study was to determine the risk factors for late electrotherapy complications and to evaluate the effectiveness of transvenous lead extraction (TLE) and survival after TLE. METHODS: We analysed the clinical data of 225 patients with electrotherapy complications referred for TLE in a single centre in the years 2006 to 2015. Indications for TLE, risk factors for infectious complications, effectiveness of TLE, and survival after the procedure were assessed. RESULTS: In the study group, non-infectious indications for TLE predominated (78.2%). Analysis of risk for infectious complications demonstrated the important role of chronic renal failure (hazard ratio [HR] 1.842, p = 0.034) and a greater number of CIED-related procedures (HR 4.768, p < 0.001). High effectiveness of TLE and significantly higher long-term mortality of patients with infectious complications compared with the remainder (50% vs. 20%, p < 0.05) were documented. CONCLUSIONS: The study demonstrated a high rate of patients with non-infectious complications referred for TLE and very high effectiveness of the procedure. The worse long-term survival of patients with infectious complications, as well as increased risk for such complications due to the greater number of prior procedures, should prompt the consideration of early referral for TLE in the case of lead dysfunctions.

Complications of electrotherapy - the dark side of treatment with cardiac implantable electronic devices.

In the past years we have been observing the dynamic development of electrotherapy, as evidenced by the steadily rising number of implanted pacemakers (PM), as well as devices used in the treatment of dangerous arrhythmia and heart failure, such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT-P/D). This is a consequence of the ageing of the populations of the majority of developed countries and also the gradually widening indications for the use of such devices. Along with the observed rise in the number of new implantations, the number of complications of electrotherapy is rising as well. In view of the increase in the incidence of complications, it is necessary to systematize the knowledge on this subject, because there is still no official classification of this type of complication and guidelines for dealing with such cases do not appear to cover the scale of the problem. In addition, late complications of electrotherapy play the most important role, in which case the removal of the entire pacing system, transvenous lead extraction (TLE), is a challenge due to the older age of leads strongly attached to the venous walls and endocardium of the heart cavity. The present paper presents a modern classification of electrotherapy complications and discusses the types of complications according to the most recent literature reports. Moreover, the diagnosis and management of particular types of complications with the assessment of indications for TLE are discussed.

Risk Factors Predicting Complications of Transvenous Lead Extraction.

OBJECTIVE: Transvenous lead extraction (TLE) is the gold standard in the management of patients with cardiac implantable electronic devices (CIED)-related complications. Knowledge of TLE risk factors is very important. METHODS: Clinical data from 1915 patients undergoing TLE at the Reference Center between 2006 and 2015 were analyzed. The effects of clinical and procedure-related factors on the development of major (MJC) and minor (MIC) complications and survival after TLE were evaluated. RESULTS: MJC were caused mainly by lead implant duration, presence of abandoned leads, multiple procedures preceding TLE, and any technical problem during TLE. Of clinical factors female gender and anemia increased the risk of MJC. MIC were reported in patients with the first implantation of CIED under the age of 30 and after sternotomy analysis of 30-day survival after procedure demonstrated a significant effect of clinical factors and lead dwell times, previous unsuccessful TLE, and MIC. CONCLUSIONS: Efficacy and safety of TLE depend mainly on procedure-related factors. This knowledge is essential for preventing MJC and MIC. Mortality at 30 days following TLE is mainly associated with the clinical factors; however, there was also a significant effect of lead dwell time and periprocedural complications on the short-term prognosis of patients undergoing TLE.