Is Venoplasty an Alternative to Lead Extraction for Patients With Venous Obstruction?

BACKGROUND: Indications for cardiovascular implantable electronic devices (CIEDs) have increased over time. Patients may require lead replacement or implantation due to lead failure or need for device upgrade. Venous obstruction is a common finding in these patients and often poses difficulties for operators. Venoplasty as an alternative to lead extraction emerges as an important intervention in the treatment of selected patients, particularly with a view to minimising procedural risk. METHODS: Nine (9) patients with CIED related venous occlusion were treated with venoplasty at our institution between April 2006 and October 2019. Six (6) of nine patients were initially referred to our institution for consideration of transvenous lead extraction in the setting of venous occlusion. These patients are the subjects of the case series. Patient demographics, indication for venoplasty and procedural outcomes were examined. RESULTS: We present a series of six patients in whom venoplasty has been performed at our centre as an alternative to lead extraction. Device and patient characteristics have been examined as well as radiation exposure and fluoroscopy time. The median age of our cohort was 64.5 years (range: 37-81 years) and 67% were female. Luminal calibre was improved in all patients allowing lead replacement, device upgrade or relief of symptoms. Procedural complications were not observed, and all patients remained free of symptoms related to venous occlusion at 3-month follow-up. CONCLUSIONS: We present venoplasty as a viable alternative to lead extraction in high risk patients or in those who favour a less invasive approach.

High-intensity interval training for patients with coronary artery disease: Finding the optimal balance.

BACKGROUND: The optimal characteristics of high-intensity interval training (HIIT) for patients with coronary artery disease (CAD) within cardiac rehabilitation (CR) are unclear. We assessed a HIIT protocol designed to balance patient safety, efficacy and enjoyment. METHODS: Twenty-nine patients with CAD completed 6-weeks (× 2 sessions per week) of HIIT within outpatient (phase 2) CR. HIIT comprised 15 repetitions × 30-seconds cycling at ∼85-90% maximum heart rate, interspersed with 30-seconds of active recovery. Key outcomes covered patient safety, efficacy (peak aerobic capacity, body composition, blood pressure and vascular function), and patient adherence and enjoyment. RESULTS: No cardiovascular-related adverse events were reported in relation to HIIT sessions. Patients showed significant improvement in peak aerobic capacity (mean +12%, p < 0.001, effect size d = 0.38), blood pressure (brachial systolic -7mmHg, p < 0.001, d = -0.59) and total body fat (-4%, p < 0.001, d = -0.49). Central adaptations were prominent (aortic systolic BP -5mmHg, p = 0.001, d = -0.50; visceral fat -10%, p = 0.001, d = -0.41). Patient enjoyment of training was high (5.5 out of 7 using the Exercise Enjoyment Scale) and measures of affective state improved following training (assorted p < 0.018). CONCLUSIONS: This HIIT protocol appears safe, effective and enjoyable for patients with CAD within CR. Improved aerobic fitness, blood pressure and body fat levels were observed indicating improved cardiovascular-risk. High patient enjoyment and improved mood suggest the HIIT could be sustainable for patients in the longer-term.

Valve-in-Ring Transcatheter Heart Valve for Severe Tricuspid Regurgitation.

We report the case of a man with recurrent decompensated right-sided heart failure secondary to severe tricuspid regurgitation after tricuspid annuloplasty. He was unfit for repeat surgical intervention and thus was considered for a valve-in-ring transcatheter heart valve. We detail the procedural complexities encountered and our approach to overcoming them. (Level of Difficulty: Advanced.).