Low-temperature electrocautery reduces adverse effects from secondary cardiac implantable electronic device procedures: Insights from the WRAP-IT trial.

Autor:	Mittal S; Valley Health System, Ridgewood, New Jersey. Electronic address: MITTSU@Valleyhealth.com., Wilkoff BL; Cleveland Clinic, Cleveland Ohio., Poole JE; University of Washington School of Medicine, Seattle, Washington., Kennergren C; Sahlgrenska University Hospital, Göteborg, Sweden., Wright DJ; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Berman BJ; Chula Vista Cardiac Center, Chula Vista, California., Riggio D; Arizona Arrhythmia Consultants, Scottsdale, Arizona., Sholevar DP; Virtua Health System, Camden, New Jersey., Martinez-Arraras J; Amarrillo Heart Group, Amarillo, Texas., Moubarak JB; Hamot Medical Center, Erie, Pennsylvania., Schaller RD; University of Pennsylvania, Philadelphia, Pennsylvania., Love JC; Maine Medical Center, Portland, Maine., Pickett RA; Saint Thomas Research Institute, LLC Thomas, Nashville, Tennessee., Philippon F; Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canada., Eldadah Z; MedStar Heart and Vascular Institute, Washington, DC., Lande JD; Medtronic, Mounds View, Minnesota., Lexcen DR; Medtronic, Mounds View, Minnesota., Holbrook R; Medtronic, Mounds View, Minnesota., Tarakji KG; Cleveland Clinic, Cleveland Ohio.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2021 Jul; Vol. 18 (7), pp. 1142-1150. Date of Electronic Publication: 2021 Mar 27.
DOI:	10.1016/j.hrthm.2021.03.033
Abstrakt:	Background: Cardiac device procedures require tissue dissection to free existing device lead(s). Common techniques include blunt dissection, standard electrocautery, and low-temperature electrocautery (PlasmaBlade, Medtronic); however, data on the type of electrosurgical tool used and the development of procedure- or lead-related adverse events are limited. Objective: The purpose of this study was to determine whether standard or low-temperature electrocautery impacts the development of an adverse event. Methods: We evaluated patients enrolled in WRAP-IT (Worldwide Randomized Antibiotic EnveloPe Infection PrevenTion Trial) undergoing cardiac implantable electronic device (CIED) revision, upgrade, or replacement. All adverse events were adjudicated by an independent physician committee. Data were analyzed using Cox proportional hazard regression modeling. Results: In total, 5641 patients underwent device revision/upgrade/replacement. Electrocautery was used in 5205 patients (92.3%) (mean age 70.6 ± 12.7 years; 28.8% female), and low-temperature electrocautery was used in 1866 patients (35.9%). Compared to standard electrocautery, low-temperature electrocautery was associated with a 23% reduction in the incidence of a procedure- or lead-related adverse event through 3 years of follow up (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.65-0.91; P = .002). After controlling for the number of active leads, degree of capsulectomy, degree of lead dissection, and renal dysfunction, low-temperature electrocautery was associated with a 32% lower risk of lead-related adverse events (HR 0.68; 95% CI 0.52-0.89; P = .004). These effects were consistent across a spectrum of lead-related adverse event types. Conclusion: This study represents one of the largest assessments of electrocautery use in patients undergoing CIED revision, upgrade, or replacement procedures. Compared to standard electrocautery, low-temperature electrocautery significantly reduces adverse effects from these procedures. (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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