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Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States. Circulation 2015; 132:2363-71. [DOI: 10.1161/circulationaha.114.013801] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
Background—
Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications.
Methods and Results—
Using the Nationwide Inpatient Sample, we identified 91 890 TLR procedures. We investigated common complications including pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with TLR, defining them by the validated
International Classification of Diseases, Ninth Revision, Clinical Modification
diagnosis code. We specifically assessed in-hospital death (2.2%), hemorrhage requiring transfusion (2.6%), vascular complications (2.0%), pericardial complications (1.4%), open heart surgery (0.2%), and postoperative respiratory failure (2.4%). Independent predictors of complications were female sex and device infections. Hospital volume was not independently associated with higher complications. There was a significant rise in overall complication rates over the study period.
Conclusions—
The overall complication rate in patients undergoing TLR was higher than previously reported. Female sex and device infections are associated with higher complications. Hospital volume was not associated with higher complication rates. The number of adverse events in the literature likely underestimates the actual number of complications associated with TLR.
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102
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Brunner MP, Yu C, Hussein AA, Tarakji KG, Wazni OM, Kattan MW, Wilkoff BL. Nomogram for predicting 30-day all-cause mortality after transvenous pacemaker and defibrillator lead extraction. Heart Rhythm 2015; 12:2381-6. [DOI: 10.1016/j.hrthm.2015.07.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 10/23/2022]
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103
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Aytemir K, Yorgun H, Canpolat U, Şahiner ML, Kaya EB, Evranos B, Özer N. Initial experience with the TightRail™ Rotating Mechanical Dilator Sheath for transvenous lead extraction. Europace 2015; 18:1043-8. [PMID: 26467403 DOI: 10.1093/europace/euv245] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/17/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS In parallel with increasing implantation rates and patients' longer life expectancy, the need for transvenous lead extraction (TLE) as a specialized procedure has shown a significant growth over years. Herein, we aimed to present our initial experience in TLE by using a novel TightRail™ Rotating Mechanical Dilator Sheath. METHODS AND RESULTS Between October 2014 and March 2015, a total of 42 leads in 23 patients were removed at our tertiary referral centre. All of the extracted leads were >12 months old and indications for extraction were based on the recommendations of the Heart Rhythm Society. The leads were removed by using the TightRail™ Mechanical Dilator Sheath (Spectranetics Corporation) with the rotational cutting force only. Indications for lead removal included cardiac device infection in 12 (52.2%) cases, lead malfunction in the 10 (43.5%) cases, and upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) in the remaining 1 case (4.3%). The extracted devices were pacemaker in 10 (43.4%) cases, implantable cardioverter-defibrillator (ICD) in 7 (30.4%) cases, and CRT in the remaining 6 (26.0%) subjects. Among 42 leads, 10 (23.8%) were right ventricular, 14 (33.3%) were atrial, 13 (31.0%) were defibrilator, and 5 (11.9%) were coronary sinus electrodes. The median time from implantation was 72 (18-216) months. Complete procedural success with TightRail™ system alone was achieved in 22 (95.7%) patients (41/42 leads) and overall clinical success was 100%. One right ventricular lead was completely removed with the help of femoral snare. All the patients were discharged uneventfully without any complication. CONCLUSION Our preliminary data with small sample size show that TightRail™ Mechanical Dilator Sheath is a new useful tool for chronically implanted pacemaker (PM)/ICD leads. Continued investigation including large patient cohort is required to evaluate success and complication rates in comparison to other tools and techniques.
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Affiliation(s)
- Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - M Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Ergün Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Banu Evranos
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
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104
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Fu HX, Huang XM, Zhong LI, Osborn MJ, Asirvatham SJ, Espinosa RE, Brady PA, Lee HC, Greason KL, Baddour LM, Sohail RM, Acker NG, Hodge DO, Friedman PA, Cha YM. Outcomes and Complications of Lead Removal: Can We Establish a Risk Stratification Schema for a Collaborative and Effective Approach? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1439-47. [PMID: 26293652 DOI: 10.1111/pace.12736] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Removal of an entire cardiovascular implantable electronic device is associated with morbidity and mortality. We sought to establish a risk classification scheme according to the outcomes of transvenous lead removal in a single center, with the goal of using that scheme to guide electrophysiology lab versus operating room extraction. METHODS Consecutive patients undergoing transvenous lead removal from January 2001 to October 2012 at Mayo Clinic were retrospectively reviewed. RESULTS A total of 1,378 leads were removed from 652 (age 64 ± 17 years, M 68%) patients undergoing 702 procedures. Mean (standard deviation) lead age was 57.6 (58.8) months. Forty-four percent of leads required laser-assisted extraction. Lead duration (P < 0.001) and an implantable cardioverter defibrillator (ICD) lead (P < 0.001) were associated with the need for laser extraction and procedure failure (P < 0.0001 and P = 0.02). The major complication rate was 1.9% and was significantly associated with longer lead duration (odds ratio: 1.2, 95% confidence interval: 1.1-1.3; P < 0.001). High-risk patients (with a >10-year-old pacing or a >5-year-old ICD lead) had significantly higher major events than moderate-risk (with pacing lead 1-10 years old or ICD lead 1-5 years old) and low-risk (any lead ≤1-year-old) patients (5.3%, 1.2%, and 0%, respectively; P < 0.001). CONCLUSIONS Transvenous lead removal is highly successful, with few serious procedural complications. We propose a risk stratification scheme that may categorize patients as low, moderate, and high risk for lead extraction. Such a strategy may guide which extractions are best performed in the operating room.
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Affiliation(s)
- Hai-Xia Fu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Henan, People's Republic of China.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Xin-Miao Huang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - L I Zhong
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Michael J Osborn
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Raul E Espinosa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Peter A Brady
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Hon-Chi Lee
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rizwan M Sohail
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Nancy G Acker
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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105
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MERCHANT FAISALM, LEVY MATHEWR, KELLI HEVALM, HOSKINS MICHAELH, LLOYD MICHAELS, DELURGIO DAVIDB, LANGBERG JONATHANJ, LEON ANGELR, EL-CHAMI MIKHAELF. Predictors of Long-Term Survival Following Transvenous Extraction of Defibrillator Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1297-303. [DOI: 10.1111/pace.12733] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- FAISAL M. MERCHANT
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - MATHEW R. LEVY
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - HEVAL M. KELLI
- Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - MICHAEL H. HOSKINS
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - MICHAEL S. LLOYD
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - DAVID B. DELURGIO
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - JONATHAN J. LANGBERG
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - ANGEL R. LEON
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| | - MIKHAEL F. EL-CHAMI
- Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine; Emory University School of Medicine; Atlanta Georgia
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106
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Trucco E, Mont L. Extraction of sterile leads is the preferred approach rather than implanting a new lead: the con perspective. Card Electrophysiol Clin 2015; 7:427-431. [PMID: 26304522 DOI: 10.1016/j.ccep.2015.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.
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Affiliation(s)
- Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain.
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107
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3136] [Impact Index Per Article: 348.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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108
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Shepherd E, Stuart G, Martin R, Walsh MA. Extraction of SelectSecure leads compared to conventional pacing leads in patients with congenital heart disease and congenital atrioventricular block. Heart Rhythm 2015; 12:1227-32. [DOI: 10.1016/j.hrthm.2015.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Indexed: 11/16/2022]
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109
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Buiten MS, van der Heijden AC, Schalij MJ, van Erven L. How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods. Europace 2015; 17:689-700. [DOI: 10.1093/europace/euu378] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/02/2014] [Indexed: 12/30/2022] Open
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110
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Ahmed FZ, James J, Cunnington C, Motwani M, Fullwood C, Hooper J, Burns P, Qamruddin A, Al-Bahrani G, Armstrong I, Tout D, Clarke B, Sandoe JAT, Arumugam P, Mamas MA, Zaidi AM. Early diagnosis of cardiac implantable electronic device generator pocket infection using ¹⁸F-FDG-PET/CT. Eur Heart J Cardiovasc Imaging 2015; 16:521-30. [PMID: 25651856 PMCID: PMC4407104 DOI: 10.1093/ehjci/jeu295] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/25/2014] [Indexed: 01/07/2023] Open
Abstract
AIMS To examine the utility of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection. METHODS AND RESULTS A total of 86 patients with CIEDs were evaluated with (18)F-FDG PET/CT imaging: 46 with suspected generator pocket infection and 40 without any history of infection. (18)F-FDG activity in the region of the generator pocket was expressed as a semi-quantitative ratio (SQR)-defined as the maximum count rate around the CIED divided by the mean count rate between normal right and left lung parenchyma. All patients underwent standard clinical management, independent of the PET/CT result. Patients with suspected generator pocket infection that required CIED extraction (n = 32) had significantly higher (18)F-FDG activity compared with those that did not (n = 14), and compared with controls (n = 40) [SQR: 4.80 (3.18-7.05) vs. 1.40 (0.88-1.73) vs. 1.10 (0.98-1.40), respectively; P < 0.001]. On receiver operator characteristic analysis, SQR had a high diagnostic accuracy (area under curve = 0.98) for the early identification of patients with confirmed infection (i.e. those ultimately needing extraction)-with an optimal SQR cut-off value of >2.0 (sensitivity = 97%; specificity = 98%). CONCLUSION This study highlights the potential benefits of evaluating patients with suspected CIED generator pocket infection using (18)F-FDG PET/CT. In this study, (18)F-FDG PET/CT had a high diagnostic accuracy in the early diagnosis of CIED generator pocket infection, even where initial clinical signs were underwhelming.
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Affiliation(s)
- Fozia Zahir Ahmed
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jacqueline James
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Colin Cunnington
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Manish Motwani
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK Department of Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jacquelyn Hooper
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Phillipa Burns
- Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ahmed Qamruddin
- Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ghada Al-Bahrani
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ian Armstrong
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Deborah Tout
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Bernard Clarke
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Mamas A Mamas
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Amir M Zaidi
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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111
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Strategies to reduce infections during the cardiac implantable electronic device implant: a time to name and shame. Europace 2015; 17:511-3. [DOI: 10.1093/europace/euu370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/27/2014] [Indexed: 11/12/2022] Open
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112
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Sanghera R, Sanders R, Husby M, Bentsen JG. Development of the subcutaneous implantable cardioverter-defibrillator for reducing sudden cardiac death. Ann N Y Acad Sci 2014; 1329:1-17. [DOI: 10.1111/nyas.12550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rick Sanghera
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Richard Sanders
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Michael Husby
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - James G. Bentsen
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
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113
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Di Monaco A, Pelargonio G, Narducci ML, Manzoli L, Boccia S, Flacco ME, Capasso L, Barone L, Perna F, Bencardino G, Rio T, Leo M, Di Biase L, Santangeli P, Natale A, Rebuzzi AG, Crea F. Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis. Europace 2014; 16:1496-507. [PMID: 24965015 DOI: 10.1093/europace/euu137] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. AIM Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. METHODS Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. RESULTS When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. CONCLUSIONS In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Stefania Boccia
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lucy Barone
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Teresa Rio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Milena Leo
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | - Pasquale Santangeli
- Department of Cardiology, University of Foggia, Foggia, Italy Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Antonio Giuseppe Rebuzzi
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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114
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Brinker J. Extraction of chronically implanted cardiovascular electronic device leads. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:325. [PMID: 24916463 DOI: 10.1007/s11936-014-0325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT Cardiovascular implantable electronic devices (CIED) are a remarkable success story. These systems are widely used to prevent symptomatic bradycardia, treat malignant tachyarrhythmia, and to restore a more physiologic contraction to a failing left ventricle. Implantation of a CIED usually involves a lifelong commitment to this therapy, which, unfortunately, is not free from complication requiring removal and/or replacement of all or part of the system. The major obstacle to removal of a CIED is the fibrous attachments that develop between a lead and co-existent leads, veins, and the heart. This process increases over time such that, by one year, removal by traction alone may be problematic and, if aggressive, result in complication. Physicians, surgeons, and engineers have refined techniques of percutaneous lead extraction and developed tools, which have facilitated the process, increased success, and lowered the incidence of complication. Extraction may be performed for a variety of indications some of which are unanimously agreed upon while others remain controversial. Proponents of a broadened application of extraction have proffered the concept of 'lead management,' which includes the removal of all leads that are not clinically relevant to the patient. The benefit of this approach would be to limit the risk of future complication, such as venous occlusion or thromboembolism, and to obviate the increase in difficulty of extraction (due to longer implant duration) that might accompany removal should that be required in the future. Intuitively appealing as this approach might be, there is little evidence supporting it, and the extraordinarily large number of patients currently implanted with recalled ICD leads is indicative of the potential impact this practice may have. This review will discuss extraction, its indications, and outcomes.
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Affiliation(s)
- Jeffrey Brinker
- Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, 7125Q, Baltimore, MD, 21287, USA,
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Clinical predictors of adverse patient outcomes in an experience of more than 5000 chronic endovascular pacemaker and defibrillator lead extractions. Heart Rhythm 2014; 11:799-805. [DOI: 10.1016/j.hrthm.2014.01.016] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Indexed: 11/20/2022]
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116
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Hilberath JN, Burrage PS, Shernan SK, Varelmann DJ, Wilusz K, Fox JA, Eltzschig HK, Epstein LM, Nowak-Machen M. Rescue transoesophageal echocardiography for refractory haemodynamic instability during transvenous lead extraction. Eur Heart J Cardiovasc Imaging 2014; 15:926-32. [PMID: 24686256 DOI: 10.1093/ehjci/jeu043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The rising number of cardiovascular implantable electronic devices has led to a steep increase in transvenous lead extractions (TLEs). Procedure-related, haemodynamically significant adverse events are uncommon during TLE yet remain an inevitable risk. While the use of transoesophageal echocardiography (TEE) as a guide to clinical decision-making during refractory circulatory instability has been well established, the specific utility of rescue TEE during TLE has not been comprehensively studied. METHODS AND RESULTS Twenty-six patients who required emergent TEE to determine the aetiology of intractable haemodynamic instability during TLE were evaluated. Pericardial effusion requiring urgent pericardiocentesis and/or cardiac surgical intervention was diagnosed by TEE in 10 patients, and progressed to cardiac arrest in 4 patients. Haemorrhagic shock developed in two patients suffering from femoral vein laceration and right haemothorax, respectively. One additional patient developed acute respiratory compromise and right ventricular dysfunction diagnosed by TEE, which necessitated prolonged post-operative intubation and inotropic therapy. In 14 patients, TEE excluded life-threatening cardiovascular injuries and enabled the pursuit of continued medical management. Two patients with reassuring TEE findings underwent intra-operative placement of chest tubes for pneumothorax. All the 26 patients were discharged from the hospital. CONCLUSION While TLE is a relatively safe procedure, life-threatening cardiovascular injuries remain a rare risk. In this study, the use of rescue TEE ruled out significant cardiovascular injuries in the majority of patients. Furthermore, rescue TEE had a substantial impact on the efficiency of determining the aetiology of refractory haemodynamic instability during TLE and thereby facilitated the timely initiation of definitive intervention.
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Affiliation(s)
- Jan N Hilberath
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Peter S Burrage
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Dirk J Varelmann
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Kerry Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - John A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Holger K Eltzschig
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Laurence M Epstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Martina Nowak-Machen
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
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117
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KONERU JAYANTHIN, ELLENBOGEN KENNETHA. High-Risk Lead Extraction Using a Hybrid Approach: The Blade and the Lightsaber. J Cardiovasc Electrophysiol 2014; 25:622-3. [DOI: 10.1111/jce.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- JAYANTHI N. KONERU
- Division of Cardiology; Department of Medicine; Medical College of Virginia/VCU School of Medicine; Richmond Virginia USA
| | - KENNETH A. ELLENBOGEN
- Division of Cardiology; Department of Medicine; Medical College of Virginia/VCU School of Medicine; Richmond Virginia USA
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118
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Deckx S, Marynissen T, Rega F, Ector J, Nuyens D, Heidbuchel H, Willems R. Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience. Europace 2014; 16:1218-25. [DOI: 10.1093/europace/eut410] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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119
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Gomes S, Cranney G, Bennett M, Li A, Giles R. Twenty-year experience of transvenous lead extraction at a single centre. Europace 2014; 16:1350-5. [DOI: 10.1093/europace/eut424] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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120
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Burri H, Combescure C. Management of recalled implantable cardioverter-defibrillator leads at generator replacement: a decision analysis model for Fidelis leads. ACTA ACUST UNITED AC 2014; 16:1210-7. [DOI: 10.1093/europace/eut425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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121
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Rickard J, Tarakji K, Cheng A, Spragg D, Cantillon DJ, Martin DO, Baranowski B, Gordon SM, Tang WHW, Kanj M, Wazni O, Wilkoff BL. Survival of patients with biventricular devices after device infection, extraction, and reimplantation. JACC-HEART FAILURE 2013; 1:508-13. [PMID: 24622003 DOI: 10.1016/j.jchf.2013.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare outcomes in patients with biventricular device infections who undergo successful treatment including extraction and reimplantation to patients with biventricular devices never known to become infected. BACKGROUND Infection of a cardiac implantable electronic device (CIED) is associated with substantial morbidity and mortality. Survival in patients with cardiac resynchronization therapy (CRT) device infections undergoing full system extraction is unknown. METHODS We extracted data on all patients undergoing extraction of a biventricular pacing device for an infectious indication at the Cleveland Clinic between February 16, 2000, and June 30, 2011. Survival of patients who presented with a CRT device infection, extraction, and successful reimplantation was compared to that of a large cohort of consecutive patients undergoing initial CRT implantation without a known history of subsequent device-related infection. In addition, long-term outcomes were compared between patients who were extracted and deemed to be cured with and without successful biventricular device reimplantation. RESULTS In all, 151 patients underwent biventricular device extraction for infection, of whom 81 were successfully reimplanted. The noninfected cohort consisted of 879 patients. In a multivariate Cox regression model controlling for sex, a history of ischemic cardiomyopathy, creatinine, hemoglobin, beta-blocker use, angiotensin-converting enzyme inhibitor use, and diuretic use, no significant association between subsequent infection with reimplantation and all-cause mortality was noted (p = 0.21). There was a trend toward worse outcomes for patients extracted, deemed cured, and not reimplanted compared to patients with successful CRT reimplantation. CONCLUSIONS Patients with a biventricular device infection who are successfully extracted, treated with antibiotics, and reimplanted with a biventricular device have outcomes similar to those of patients with biventricular devices not known to have become infected.
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Affiliation(s)
- John Rickard
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | | | - Alan Cheng
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - David Spragg
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David O Martin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Steven M Gordon
- Division of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammed Kanj
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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122
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Hanninen M, Wright G, Manlucu J, Peck D, Yee R. Arteriovenous fistula formation after lead extraction. Can J Cardiol 2013; 29:1742.e5-7. [PMID: 24140075 DOI: 10.1016/j.cjca.2013.07.681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 06/27/2013] [Accepted: 07/22/2013] [Indexed: 11/26/2022] Open
Abstract
The junction between the left brachiocephalic vein and the superior vena cava is a high-risk region during lead extraction. Venous laceration with hemodynamic collapse is the most feared complication arising in this region, but arteriovenous fistula formation after excimer laser extraction also has been reported. A case of arteriovenous fistula presenting 3 days after extraction with acute pulmonary edema is described. A continuous murmur was heard near the extraction site and invasive angiography demonstrated a left internal mammary artery to the brachiocephalic vein fistula, which was coiled. A new continuous murmur after lead extraction is the hallmark of this rare complication.
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Affiliation(s)
- Mikael Hanninen
- Arrhythmia Service, University of Western Ontario, London, Ontario, Canada.
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123
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Abstract
Ventricular arrhythmias may be benign, requiring only evaluation for associated risks and then reassurance, or associated with a risk of sudden death or significant morbidity. Therapies for these arrhythmias have evolved considerably over the past 20 years. For some, a definitive, curative therapy is available in the form of catheter ablation. Others are best managed with an implantable cardioverter-defibrillator that provides effective arrhythmia termination and protection from sudden death, with antiarrhythmic drugs or ablation to control recurrent arrhythmias. Although progress has been substantial, many challenges remain.
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124
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COFFEY JAMESO, SAGER SOLOMONJ, GANGIREDDY SANDEEP, LEVINE AVI, VILES-GONZALEZ JUANF, FISCHER AVI. The Impact of Transvenous Lead Extraction on Tricuspid Valve Function. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:19-24. [DOI: 10.1111/pace.12236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/11/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- JAMES O. COFFEY
- Cardiac Electrophysiology; University of Miami School of Medicine; Miami Florida
| | - SOLOMON J. SAGER
- Cardiac Electrophysiology; University of Miami School of Medicine; Miami Florida
| | | | - AVI LEVINE
- Internal Medicine; Mount Sinai School of Medicine; New York
| | | | - AVI FISCHER
- Cardiac Electrophysiology; Mount Sinai School of Medicine; New York
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125
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Abstract
Managing patients with cardiac implantable electrophysiological devices (CIED) infections can be challenging. The first step should be prevention, which involves patient selection, timing of implantation, and the procedure itself. After implantation, a high degree of suspicion should be applied in order to correctly diagnose patients with infected implanted devices. It is necessary to recognize that patients can present with a wide variety of signs and symptoms. Once diagnosed, the next step is determining if it is a local pocket infection or system infection. In almost every patient, in addition to antibiotics, complete removal of ALL hardware is required. Transvenous lead extraction is now safe and effective, but should only be performed at experienced centres with a practiced extraction team, all possible needed equipment, and cardiothoracic surgical backup. After extraction, the indication for CIED therapy should be re-evaluated to determine re-implantation is warranted. Timing of re-implantation depends on a variety of factors such as type of infection or valvular involvement and should be made in concordance with an infectious disease specialist. This review is aimed at introducing the steps needed to manage patients with infected cardiac devices.
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Affiliation(s)
- Eyal Nof
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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126
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Pelargonio G, Narducci ML. Transvenous lead extractions in CRT patients: the end is only the beginning. J Cardiovasc Electrophysiol 2012; 23:1217-8. [PMID: 23148987 DOI: 10.1111/j.1540-8167.2012.02404.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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