P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort

Background

Cardiac implantable electronic devices have been known to have lead and device malfunctions leading to advisories. Increased use of remote monitoring of devices has been suggested to allow the identification of abnormal device performance and allow early intervention. We sought to describe the outcomes of patients with and without remote monitoring of in devices in the Abbott Premature Battery Depletion advisory with data from a Canadian registry

Methods

Patients with an Abbott device subject to the Battery Performance Alert Advisory from nine ICD implanting centres in Canada were included in the registry. The use of remote monitoring was identified from baseline and followup data in the registry. The primary outcome was detection of premature battery depletion and all cause mortality.

Results

2679 patents were identified with a device subject to the advisory. Devices were implanted between 2010 and 2017. 1716 patients (64%) had remote monitoring at baseline with this increasing to 83.7% at followup at 12 months. Premature battery depletion occurred in 43 patients (1.6%). Discovery of premature battery depletion was detected by remote monitoring in 70% of patients. There were 492 deaths during the follow up. Mortality was higher in those without a remote monitor compared to those with a remote monitor at follow-up and remote monitor at baseline and follow-up (11.3%, 2.6% versus 6.1% respectively; p=0.0186). There were no deaths attributed to premature battery depletion

Conclusion

The use of remote monitoring in patients with ICD and CRT under advisory reliably detected device failure and was associated with a reduction in all-cause mortality.

P1872Canadian electrophysiology labs registry report update 2011–2018

Background

Interventional cardiac electrophysiology (EP) is rapidly evolving; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada.

Methods

The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically.

Results

All Canadian EP centres were identified (n=30); 50% and 45% of active centres participated in the last 2 instalments of the registry. Since 2011, data has been consistently obtained from 11 university-affiliated centres. Table 1 reports trends in procedural volumes and operators. Figure 1 depicts the ablations done per operator. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, 15.9 weeks for VT ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1–4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 38% of the respondents use circular ablation techniques.

Trends in procedural volumes + operators 2015–2016 2013–2014 2011–2012 Procedures per operator 117±70 120±68 113±42 Procedures per centre 498±299 477±245 446±237 Ratio of staff to trainees 2.0:1 1.6:1 1.5:1 Full time physicians per centre 4.1 (0–7) 4.1 (1–7) 3.5 (0–7) Nurses trained specifically for EP 4.6 (0–10) 4.4 (0–10) n/a Ablation procedures volume:   AV Reciprocal Tachycardia 12% 10% 11%   AV Nodal Re-entry Tachycardia 18% 19% 23%   Atrial Fibrillation/Atypical Flutter 33% 35% 30%   Typical Flutter 20% 14% 19%   Ventricular Tachycardia 8% 8% 10%   Total annual ablations in all respondent centres 5478 5243 4908 Mean ± standard deviation. Staff (full-time + part-time prorated to 0.5).

Annual ablation volumes per operator

Conclusion

This initiative provides contemporary data on invasive EP practices. The results show feasibility in data collection which will serve as a reference for decisions regarding resource planning.

[Hospital disinfection challenges due to multiresistant pathogens in surgery]

The number of antibiotic-resistant pathogens is increasing continuously while the development of new, effective antibiotics cannot be expected in the near future. Postoperative infections represent most of the nosocomial infections by now. Based on this, hygienic strategies regain importance, since a sustainable control of nosocomial infections will not succeed without the implementation of such strategies. In this article, the most important preventive strategies for prevention of infections with MRSA and 3- and 4-fold resistant gram-negative bacteria on the basis of current recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) are presented.

Krankenhaushygienische Herausforderungen durch multiresistente Erreger in der Chirurgie

Die Anzahl antibiotikaresistenter Erreger steigt kontinuierlich an, ohne dass in den nächsten Jahren mit der Entwicklung neuer, wirksamer Antibiotika zu rechnen sein wird. Postoperative Infektionen stellen mittlerweile mit die häufigsten nosokomialen Infektionen dar. Vor diesem Hintergrund erlangen Hygienestrategien wieder eine neue Bedeutung, ohne deren Umsetzung eine nachhaltige Kontrolle nosokomialer Infektionen nicht gelingen wird. In diesem Artikel werden die wichtigsten Präventionsstrategien zur Prävention einer Infektion mit MRSA sowie 3- und 4-fach resistenten gramnegativen Erregern auf der Grundlage der aktuellen Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) gegeben.

Auf die Präventionsstrategien zu den ebenso als nosokomiale Infektionserreger relevanten Vancomycin-resistenten Enterokokken (VRE) und Clostridium difficile soll in einem zukünftigen Beitrag eingegangen werden, da hierzu die Empfehlungen der KRINKO derzeit noch in Bearbeitung sind.

Combination biphasic waveform plus sequential pulse defibrillation improves defibrillation efficacy of a nonthoracotomy lead system

OBJECTIVES

We hypothesized that combining biphasic waveform and sequential pulse defibrillation techniques would lower the defibrillation threshold of a nonthoracotomy lead system in humans below that obtained with biphasic or sequential pulse defibrillation alone.

BACKGROUND

Previous studies have shown that sequential pulse monophasic shocks and biphasic waveform shocks are more effective than single monophasic shocks for ventricular defibrillation.

METHODS

Thirteen patients aged 48 to 71 years undergoing nonthoracotomy defibrillation lead testing participated in the study. Transvenous electrodes were positioned in the right ventricular apex, superior vena cava and coronary sinus. A cutaneous patch electrode was placed on the left chest wall. All electrodes were connected to an external defibrillator. In random order, defibrillation threshold measurements were made for biphasic defibrillation alone, sequential defibrillation alone and combined biphasic plus sequential defibrillation.

RESULTS

The mean defibrillation threshold-delivered energy was 18.0 +/- 11.9 J for biphasic defibrillation and 16.3 +/- 9.0 J for sequential defibrillation. Biphasic plus sequential defibrillation significantly reduced the threshold energy to 10.2 +/- 5.3 J (p < 0.001). Threshold peak voltage and current values showed corresponding reductions. The combined waveform resulted in a greater reduction in defibrillation threshold in patients with threshold energies > 18 J versus those with threshold values < or = 18 J for sequential (p = 0.001) or biphasic (p < 0.01) waveform alone. The nonthoracotomy lead implantation rate was improved from 62% with each of the single techniques (biphasic waveform or sequential pulse defibrillation) to 85% with the combined waveform.

CONCLUSIONS

Adding biphasic waveform to sequential pulse defibrillation significantly reduced the defibrillation threshold compared with either technique alone, and nonthoracotomy lead system implantation can be enhanced by this combined technique.