Strategies and outcomes of patients with severely reduced ejection fraction (≤15%) undergoing transvenous lead extraction: A single-center experience.

BACKGROUND: Patients with severely reduced ejection fraction (SREF ≤15%) are deferred from transvenous lead extraction (TLE) owing to fear of intraoperative hemodynamic collapse. When these patients require lead extraction, their management options are limited, and they suffer from high morbidity and mortality. Left ventricular (LV) assist devices provide intraoperative hemodynamic support and facilitate TLE, enabling lifesaving interventions. OBJECTIVE: We present our experience of performing TLE in 245 patients with SREF. Additionally, we report outcomes of 8 patients who received LV support during TLE. METHODS: Between January 2008 and January 2022, we performed TLE in 245 patients with stage D heart failure, SREF, and class I or II indications for extraction. Primary (clinical success and in-hospital mortality) and secondary (length of stay and procedure-associated complications) outcomes were compared between patients with SREF and patients in our registry undergoing extraction with EF < 15%. A subgroup analysis was performed in the SREF group to evaluate outcomes of 8 patients who underwent extraction with LV assist devices. RESULTS: In patients with SREF, clinical success was high (97.6%) and mortality was low (5.3%). There were no statistically significant differences in primary outcomes between groups. Similarly, there were no significant differences in procedural complications between groups. In the SREF group, there were no significant differences in outcomes between the 8 patients undergoing TLE with LV assist devices and patients that did use LV assist devices. CONCLUSION: Lead extraction in patients with SREF can be performed safely and effectively. Adopting a few simple steps, including the early initiation of LV support, can overcome myocardial impairment in patients who decompensate.

Social Media in Physician Education.

Background Social media has fundamentally changed the practice of medicine. It has taken the medical community by storm, benefited patient care, and has become a leading source for distributing medical information. Social media platforms are a low-cost, low-barrier entry means for health systems to highlight their competitive advantage to patients and providers alike. This study aimed to assess the role of social media in the education of physicians. Methods To evaluate the utility of social media in engaging physicians, four vignettes were utilized to highlight Class 1 indications for transvenous lead extraction (TLE), an electrophysiology procedure aimed at removing infected or damaged cardiac device leads. Individuals, via Twitter, were presented with cases and multiple-choice response options to determine the next best step in management. Results The clinical vignettes were seen by more than 18,000 individuals worldwide. Survey results indicated that 83% of individuals who participated had correctly identified class 1 indications for this life-saving procedure. Sixteen percent to 21% of physicians incorrectly identified the next step in the management of Class 1 indications for lead extraction, representing a need for education and an opportunity to inform and educate. Conclusion Social media may be a useful tool in physician education. However, guidelines and further research are needed to continue to understand the role of social media within the medical field.

A Unique Case of Elizabethkingia Associated Cardiac Device Infection.

Elizabethkingia is a ubiquitous gram-negative aerobic bacillus that has gained attention in recent years as an emerging nosocomial infection in critically ill patients. We describe a case of bacteremia that developed in a patient who underwent complicated surgery with an extended intensive care unit (ICU) stay. The patient underwent pacemaker extraction with laser lead extraction and treatment with intravenous antibiotics. This case illustrates the importance of lead management strategies in septic patients with cardiac implantable electronic devices (CIED).