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1.
Pacing Clin Electrophysiol ; 34(10): 1209-16, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21671952

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction is required due to the occurrence of system infection, malfunction, or upgrade. Published series of CS lead extraction are limited by small sample sizes. We present a 10-year experience of CRT device and CS lead extraction. METHODS: All lead extractions between 2000 and 2010 were entered into a computer database. From these, a cohort of 71 cases involving a CRT device or CS lead was analyzed for procedural method, success, and complications. RESULTS: Sixty coronary sinus leads were extracted in 71 cases (median age 71 years; 90% male) by manual traction/locking stylets (n = 54) or using a laser sheath (n = 6). Procedural success was achieved in 98% of CS leads. A total of 143 non-CS leads were extracted, with laser required in 46% of cases. The mean duration of lead implantation was 35.8 months (range 1-116 months) and 2.86 ± 1.07 leads were extracted per case. CRT extraction case load increased significantly over time. Minor complications occurred in four (5.6%) cases and major complications in one (1.4%) case. There were no intraprocedural deaths, but two deaths occurred within 30 days of extraction. CONCLUSIONS: Our 10-year experience confirms that percutaneous removal of CS leads can be achieved with high procedural success. Our recorded complication rates are no higher than those of non-CS lead extraction series, and should be taken in the context of the frail nature of CRT patients. Ongoing audit of procedure success and complications will be required to further guide best practice in CS lead extraction.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Seio Coronário , Remoção de Dispositivo/métodos , Eletrodos Implantados , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Remoção de Dispositivo/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Phys Med Biol ; 54(16): 5039-55, 2009 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-19652288

RESUMO

We present a robust method to register three-dimensional echocardiography (echo) images to magnetic resonance images (MRI) based on anatomical features, which is designed to be used in the registration pipeline for overlaying MRI-derived roadmaps onto two-dimensional live x-ray images during cardiac catheterization procedures. The features used in image registration are the endocardial surface of the left ventricle and the centre line of the descending aorta. The MR-derived left ventricle surface is generated using a fully automated algorithm, and the echo-derived left ventricle surface is produced using a semi-automatic segmentation method provided by the QLab software (Philips Healthcare) that it is routinely used in clinical practice. We test our method on data from six volunteers and four patients. We validated registration accuracy using two methods: the first calculated a root mean square distance error using expert identified anatomical landmarks, and the second method used catheters as landmarks in two clinical electrophysiology procedures. Results show a mean error of 4.1 mm, which is acceptable for our clinical application, and no failed registrations were observed. In addition, our algorithm works on clinical data, is fast and only requires a small amount of manual input, and so it is applicable for use during cardiac catheterization procedures.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional/métodos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Cirurgia Assistida por Computador/métodos , Algoritmos , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Estudos de Casos e Controles , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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