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BACKGROUND: Cryoballoon ablation for treatment of atrial fibrillation (AF) reduces procedure times, but limited data is available about its impact on electrophysiology (EP) lab efficiency in Central and Eastern Europe (CEE). Using CEE-specific procedure data, the present study modeled cryoballoon ablation procedures on EP lab resource consumption to improve efficiency. METHODS: A discrete event simulation model was developed to assess EP efficiency with cryoballoon ablation. Model inputs were taken from CEE sites within the Cryo Global Registry, namely Czech Republic, Hungary, Poland, Serbia, and Slovakia. The main endpoints were percentage of days that resulted in overtime and percentage of days with time for one extra simple EP procedure. Use of the 'figure of 8' (Fo8) closure technique to reduce procedure time was also examined. RESULTS: The mean lab occupancy time across all CEE sites was 133 ± 47 minutes (min: 104 minutes, max:181 minutes). Cryoballoon ablation in the base-case scenario resulted in 14.6% of days with overtime and 64.8% of days with time for an extra simple EP procedure. Use of the Fo8 closure technique enhanced these values to 5.5% and 85.3%, respectively. Model endpoints were most sensitive to changes in lab occupancy times and overtime start time. CONCLUSIONS: In this CEE-specific analysis of EP lab efficiency it was found that 3 cryoballoon ablation procedures could be performed in 1 lab day, leaving time for a 4th simple EP procedure on most days. As such, use cryoballoon ablation for PVI is an effective way to improve EP lab efficiency.
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INTRODUCTION: Cardiac implantable electronic devices (CIED) are a recognized form of therapy in cardiology. Apart from the benefits, the use of CIEDs is also associated with the risk of complications, and the most important ones influencing treatment results and prognosis are infectious complications. AIM: This study aimed to calculate the cost of treatment of CIED-related infections, including transvenous lead extraction and device reimplantation, from the perspective of a Polish hospital. METHODS: A retrospective analysis of hospitalization costs of patients referred to transvenous lead extraction (TLE) for CIED infection was performed. The study covers cases from three Polish reference centers specializing in the comprehensive treatment of cardiac electrotherapy complications. RESULTS: It was shown that the average cost of treating a CIED infection is 34 000 PLN (8010 EUR) and is the highest in the cardiac resynchronization therapy with defibrillator function (CRT-D) group, where it amounts to almost 50 000 PLN (11 440 EUR). Thus, treatment of CIED infections is associated with an average loss of 3000 PLN for the healthcare provider and the length of hospitalization has a major influence on final outcomes. CONCLUSIONS: The hospital cost of treatment of CIED-related infections was high and related mainly to the type of device and length of hospitalization. Despite the low utilization of costly extraction tools, the hospitalization was still likely to be unprofitable.
Assuntos
Desfibriladores Implantáveis , Cardiopatias , Marca-Passo Artificial , Infecções Relacionadas à Prótese , Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Eletrônica , Cardiopatias/terapia , Hospitais , Humanos , Marca-Passo Artificial/efeitos adversos , Polônia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/terapia , Estudos RetrospectivosAssuntos
COVID-19 , Procedimentos Cirúrgicos Cardíacos , Cardiologia , Humanos , SARS-CoV-2 , Resultado do TratamentoAssuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Aspirina/efeitos adversos , Carbidopa , Combinação de Medicamentos , Humanos , Levodopa/análogos & derivados , Inibidores da Agregação Plaquetária/efeitos adversos , Ticagrelor , Resultado do TratamentoRESUMO
The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p < 0.05 each). Young age (75.9% vs. 50%, p < 0.05) and no vascular access (7.3% vs. 0%, p < 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p < 0.05). In the European population, S-ICD was more frequently chosen because of patients' active lifestyle and patients' preference (both 10.3% vs. 0%, p < 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient.
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Desfibriladores Implantáveis , Europa (Continente) , Humanos , New York , Polônia/epidemiologia , Sistema de Registros , Resultado do TratamentoAssuntos
Desfibriladores Implantáveis , Cardioversão Elétrica , Eletrocardiografia , Humanos , PolôniaRESUMO
BACKGROUND: Patients with chronic cardiorenal syndrome type 2 (T2-CRS) who qualify for resynchronization therapy (CRT) are exposed perioperatively to potentially nephrotoxic factors including contrast agents and blood loss. METHODS: The objective of this prospective interventional study was to assess the effects of CRT on renal function in patients with T2-CRS within the first 48 hours following implantation. Initially, 76 patients (15% female; aged 69 ± 9.56 years) with heart failure (New York Heart Association classes II-IV), ejection fraction ≤ 35%, and QRS > 130 ms were included in the study. During CRT implantation, a nonionic contrast agent (72.2 ± 44.9 mL) was administered. Prior to and 48 hours following implantation, renal function was evaluated using the following serum biomarkers: creatinine (sCr), estimated glomerular filtration rate (using the Chronic Kidney Disease Epidemiology Collaboration equation [eGFRCKD-EPI]), and the electrolyte and urine biomarkers albumin (uAlb), albumin/creatinine ratio (UACR), and neutrophil gelatinase-associated lipocalin (uNGAL). RESULTS: Before CRT, patients classified as NYHA class III or IV had higher uNGAL levels in comparison to uNGAL levels after CRT (43.63 ± 60.02 versus 16.63 ± 18.19; p=0.041). After CRT implantation, uAlb, UACR, and potassium levels were reduced (p < 0.05), and uNGAL, sCr, and eGFRCKD-EPI were unchanged. The contrast medium volume did not correlate with the test biomarkers (p > 0.05). CONCLUSIONS: In patients with T2-CRS, uNGAL is a biomarker of kidney injury that correlates with the NYHA classes. A stable uNGAL value before and after CRT implantation confirms the lack of risk of contrast-induced nephropathy. Reduced albuminuria and blood potassium are biomarkers of improving T2-CRS in the early post-CRT period.
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A 35-year-old female, mother of 4 children was admitted to the hospital for coronary angiography before scheduled surgical correction of severe mitral insufficiency. During angiography anomalous ostium of left main artery from pulmonary trunk was found. The patient underwent mitral ring correction, implantation of LIMA-LAD graft and ligation of left coronary artery during open heart surgery.