Comparison of acute and chronic term lead stabilization efficiencies of two suturing methods used in pectoral muscle fixation of cardiac implantable electronic devices

Project no. 23677 · Status: Kapanmış · 2022

Summary

Purpose             Cardiac implantable electronic devices (CIED) are frequently used in treatment of arrhythmias. Stable lead position is important for proper work of the CIEDs. There are two suturing techniques that commonly used to fix the leads to pectoral muscle (simple knot and anchor knot techniques). While there is one in-vitro study comparing lead stabilising efficacy of these two techniques, there is no in-vivo study in  the literature. In this in-vivo study, lead stabilisation efficacy of these two techniques on pectoral muscle was compared . Methods Twenty rabbits were included in this study and they were divided into two equal groups. The anchor knot technique was used in one group while the simple knot technique was used in other group. The rabbits was followed up two weeks (acute term) and four weeks (chronic term). At the end of the acute term, the leads were evaluated for spontaneous dislocation and resistance of the leads to at least 10 N of traction force. Whether the leads remained stabilised in sleeve was confirmed by measurement. At the end of four weeks, in addition to these criteria, necrosis was evaluated on pectoral muscle biopsy specimens that including the area where suture was taken. The two suturing techniques were also compared for procedural time on the last two rabbits of the each group.             Results             Seven and nine rabbits were evaluated for outcomes in two-week and four-week follow-up groups, respectively. Four rabbits died which two of them died by anesthetical complications. No lead- or suture-related complications were observed at postmortem examinations of dead rabbits. In acute and chronic terms all leads fixed by anchor knot technique remained in sleeve and were resistant to at least 10 N of traction force. The leads fixed by simple knot (three rabbits) remained their position in the acute term while only one of them were found to be resistant to at least 10 N of traction force. 0,5 cm dislocation was observed between that lead and its sleeve. Only two of the leads fixed by simple knot in chronic term (four rabbits) remained their position. In one of them lead and sleeve dislocated together while the other lead is found seperately dislocated from its sleeve. One of the two other leads was resistant to at least 10 N of traction force and that lead was in stable position in sleeve. However 0,8 cm dislocation was observed in the lead which was dislocated from pectoral muscle with sleeve. Eight rabbits’ specimens were evaluated for necrosis. Two of the 3 simple knot group had necrosis however any of the 5 rabbits that included in anchor knot technique group had necrosis. In the last two rabbits of each suturing technique group, the time required for complete stabilisation process were 215 s and 313,5 s for simple knot and anchor knot techniques, respectively.  Conclusion The anchor knot technique provided more effective mechanical stabilisation compared to simple knot technique in acute and chronic terms. Simple knot technique increased necrosis risk in chronic term. Applying the simple knot technique was faster than anchoring knot technique by only 98,5 s. However this time difference is not long enough for considering importance of lead stabilization efficiency of anchor knot technique.

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