Suneet Mittal1, Bruce L Wilkoff2, Jeanne E Poole3, Charles Kennergren4, David J Wright5, Brett J Berman6, David Riggio7, Darius P Sholevar8, Joaquin Martinez-Arraras9, Jean B Moubarak10, Robert D Schaller11, John C Love12, Robert A Pickett13, Francois Philippon14, Zayd Eldadah15, Jeffrey D Lande16, Daniel R Lexcen16, Reece Holbrook16, Khaldoun G Tarakji2. 1. Valley Health System, Ridgewood, New Jersey. Electronic address: MITTSU@Valleyhealth.com. 2. Cleveland Clinic, Cleveland Ohio. 3. University of Washington School of Medicine, Seattle, Washington. 4. Sahlgrenska University Hospital, Göteborg, Sweden. 5. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 6. Chula Vista Cardiac Center, Chula Vista, California. 7. Arizona Arrhythmia Consultants, Scottsdale, Arizona. 8. Virtua Health System, Camden, New Jersey. 9. Amarrillo Heart Group, Amarillo, Texas. 10. Hamot Medical Center, Erie, Pennsylvania. 11. University of Pennsylvania, Philadelphia, Pennsylvania. 12. Maine Medical Center, Portland, Maine. 13. Saint Thomas Research Institute, LLC Thomas, Nashville, Tennessee. 14. Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canada. 15. MedStar Heart and Vascular Institute, Washington, DC. 16. Medtronic, Mounds View, Minnesota.
Abstract
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.
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.
Authors: Caleb Chiang; Sharath Vipparthy; Muhammad Talha Ayub; Richard G Trohman; Timothy R Larsen; Henry D Huang; Kousik Krishnan; Erica D Engelstein; Janet M Haw; Parikshit S Sharma; Jeremiah Wasserlauf Journal: J Interv Card Electrophysiol Date: 2022-06-06 Impact factor: 1.759