Low-temperature electrocautery improves outcomes in secondary cardiac device procedures
Compared with standard electrocautery, low-temperature electrocautery reduced adverse events in patients with a cardiac implantable electronic device requiring revision, upgrade or replacement, according to new data from WRAP-IT.
As Healio previously reported, in WRAP-IT trial, wrapping cardiac implantable electronic devices (CIEDs) in an antibiotic-eluting envelope (Tyrx, Medtronic) reduced major device-related infections.
In the present analysis, Suneet Mittal, MD, director of electrophysiology and medical director of the Snyder Center for Comprehensive Atrial Fibrillation at Valley Hospital in Ridgewood, New Jersey, and colleagues analyzed whether low-temperature electrocautery (PlasmaBlade, Medtronic) influenced the development of an adverse event. According to the study background, the low-temperature electrocautery instrument operates at a temperature range of 40°C to 170°C, whereas standard versions operate between 200°C and 350°C.
Reduction across multiple event types
The study included 5,641 patients who underwent device revision, upgrade or replacement; an independent physician committee adjudicated all adverse events.
Overall, 92.3% of patients (mean age, 72 years; 29% women) received electrocautery and 35.9% received low-temperature electrocautery.
Results revealed that low-temperature electrocautery reduced the incidence of procedure- or lead-related adverse events at 3 years compared with standard electrocautery (HR = 0.77; 95% CI, 0.65-0.91; P = .002).
Additionally, in an analysis that controlled for the number of active leads, degree of capsulectomy, degree of lead dissection and renal dysfunction, low-temperature electrocautery yielded a decrease in lead-related adverse events (HR = 0.68; 95% CI, 0.52-0.89; P = .004). Researchers found that the effects stayed consistent across a spectrum of lead-related adverse event types.
Mittal and colleagues wrote that the significantly fewer lead-related events observed with low-temperature electrocautery may be attributed to the focused energy along the very thin edge of the blade. “This concentrated energy enables lower operating temperatures that are below lead insulation melting points,” they wrote.
The researchers added that the improved outcomes were driven by a lower risk for device stimulation issues, device pacing issues, device lead damage and lead dislodgment. “For at least the first three reasons, one can implicate a lower likelihood of mechanical and thermal damage at time of generator revision/upgrade/replacement procedure,” they wrote.
Mitigation of complications needed
In an accompanying editorial, Muhammad Bilal Munir, MD, and Ulrika Birgersdotter-Green, MD, both from the University of California, San Diego, wrote that secondary CIED implantations will be performed more frequently as the number of de novo CIED implantations continue to increase exponentially.
“The associated complications occurring after secondary CIED implantations not only overburden physicians but also increase health care costs,” they wrote. “Therefore, effective strategies that can mitigate the risk of such complications would be a useful clinical adjunct. To that end, the study by Mittal et al is a useful addition to the CIED literature. However, there is a clinical necessity for further high-powered studies designed to specifically assess comparative outcomes between low-temperature and standard electrocautery practices before any changes in clinical practice can be recommended.”