Same-day discharge after transvenous lead extraction: feasibility and outcomes.

AIMS: Same-day discharge (SDD) is safe for patients undergoing electrophysiology procedures. There is no existing data regarding SDD for patients undergoing transvenous lead extraction (TLE). We report our experience with SDD for patients undergoing TLE. METHODS AND RESULTS: The study group included patients undergoing TLE between February 2020 and July 2021 without an infectious indication. A modified SDD protocol for device implants/ablations was applied to TLE patients. Patient characteristics, extraction details, outcomes, and complications were reviewed. Of 239 patients undergoing TLE, 210 were excluded (94 infections and 116 did not meet SDD criteria). Of the remaining 29 patients, seven stayed due to patient preference and 22 were discharged home the same day. The SDD group had an average age of 65.9 ± 12 (47-84), 41% female, and LVEF of 52.2 ± 18% (10-80). The indication for TLE was malfunction (20), upgrade (4), advisory lead (2), and magnetic resonance imaging compatibility (1). Extractions included four implantable cardioverter-defibrillators (ICDs), 17 pacemakers (PPM), and one cardiac resynchronization therapy (CRT)-P system. The leads were 9.6 years (1.5-21.7) old, and 1.8 leads were removed per patient (1-3); the lead extraction difficulty (LED) score was 11.6 ± 7. Twenty underwent cardiovascular implantable electronic device (CIED) re-implantation (2 ICD, 3 CRT-D, 13 PPM, and 2 CRT-P). For CIED re-implants, patients sent a remote transmission the next day, and all patients received a next-day call. There were no procedure or device-related issues, morbidities, or mortalities in the 30 days after discharge. CONCLUSION: Same-day discharge after TLE for non-infectious aetiologies is safe and feasible in a select group of patients with early procedure completion who meet strict SDD criteria.

Flecainide-induced AV dyssynchrony and atrial latency progression in a patient with a dual-chamber pacemaker.

INTRODUCTION: Flecainide is a class 1C antiarrhythmic primarily usedfor the management of supraventricular arrhythmias. Adverse effects in patientswith pacemakers are poorly described in the current literature. We report acase of worsening intracardiac conduction in a patient with baseline atriallatency. CASE: A patient with paroxysmalatrial fibrillation and recently implanted dual chamber pacemaker withresultant atrial latency underwent flecainide treatment resulting in worseningatrial latency, progressive dyspnea, and pacemaker syndrome physiology. The patientexperienced symptomatic improvement with pacemaker reprogramming to AAI andreduced flecainide dosages. CONCLUSION: Prudence should be exercised when initiating flecainide therapy, particularly in pacemaker-dependentpatients, who may be at risk for increasedthresholds, inconsistent capture, and latency. In the setting of apparentcapture latency, changing to AAI mode may both confirm the diagnosis andprovide a symptomatic benefit.

The Persistence of Specialty Disrespect: Student Perspectives.

PURPOSE: One aspect of the hidden curriculum of medicine is specialty disrespect (SD)-an expressed lack of respect among medical specialties that occurs at all levels of training and across geographic, demographic, and professional boundaries, with quantifiable impacts on student well-being and career decision making. This study sought to identify medical students' perceptions of and responses to SD in the learning environment. METHODS: We conducted quantitative and content analysis of an annual survey collected between 2008 and 2012 from 702 third- and fourth-year students at the University of Washington School of Medicine. We describe the frequency of reported SD, its self-rated impact on student specialty choice, and major descriptive categories. RESULTS: Nearly 80% of respondents reported experiencing SD in the previous year. A moderate or strong impact on specialty choice was reported by 25.9% of respondents. In our sample, students matching into family medicine, obstetrics/gynecology, and emergency medicine were most likely to report exposure. Content analysis identified two new concepts not previously reported. Internecine strife describes students distancing themselves from both disrespecting and disrespected specialties, while legitimacy questions the validity of the targeted specialty. CONCLUSIONS: SD is a consistent and ubiquitous part of clinical training that pushes students away from both disrespecting and disrespected specialties. These results emphasize the need for solutions aimed at minimizing disrespect and mitigating its effects upon students.