RESUMEN
INTRODUCTION: Despite the overall safety, transvenous lead extraction (TLE) remains a challenging procedure with inherent risks, where surgery can still be required in elective cases. In this study, we report our experience with a minimally invasive "hybrid" approach, defined as a procedure performed by an electrophysiologist with the support of a cardiac surgeon in the same operative session. METHODS AND RESULTS: We reported 12 cases of planned hybrid lead extraction; minithoracotomy and thoracoscopy were performed on 10 (83%) and 2 (17%) patients, respectively. A total of 25 leads out of 27 (median lead age 19 years) were successfully extracted with laser, mechanical or combined transvenous sheath. In 3 patients, the direct monitoring of vascular and myocardial integrity allowed for prompt treatment of potential vascular injury during the lead extraction maneuvers. Mean in-hospital stay was 4 ± 2 days. There were no major intraoperative complications and no deaths occurred after 30 days' follow-up. CONCLUSION: The hybrid approach, with minithoracotomy or thoracoscopy, is feasible and it might increase the safety in the most challenging TLE procedures: the minimally invasive surgical intervention allows for continuous monitoring of the critical cardiac structures and prompt treatment of potential complications.
Asunto(s)
Dispositivos de Terapia de Resincronización Cardíaca , Desfibriladores Implantables , Remoción de Dispositivos/métodos , Marcapaso Artificial , Toracoscopía , Toracotomía , Adulto , Anciano , Anciano de 80 o más Años , Cardiólogos , Remoción de Dispositivos/efectos adversos , Técnicas Electrofisiológicas Cardíacas , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Grupo de Atención al Paciente , Diseño de Prótesis , Falla de Prótesis , Factores de Riesgo , Cirujanos , Toracoscopía/efectos adversos , Toracotomía/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Coronary artery spasm can cause both brady- and tachyarrhythmia, through induction of AV block (usually linked to coronary spasm of the right coronary artery) or ventricular tachycardia/fibrillation linked to extensive myocardial ischemia. The electrocardiographic aspect of coronary artery spasm is an ST segment elevation. We describe the case of patient implanted with an implantable cardioverter defibrillator (ICD) for unexplained syncope which, during coronary artery spasm, received an inappropriate device firing due to ST segment elevation, leading to a double count of the QRS by the ICD.