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Bracke F, Rademakers LM. When pacing or defibrillator leads become redundant: Extract or abandon? Heart Rhythm 2024:S1547-5271(24)03089-3. [PMID: 39094726 DOI: 10.1016/j.hrthm.2024.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
The 2017 Heart Rhythm Society expert consensus paper on lead management and extraction did not express a preference for either extracting or abandoning pacing or defibrillator leads that are dysfunctional or superfluous after an upgrade (hereafter referred to as redundant leads). However, no randomized or even nonrandomized trials show a better patient outcome with extraction. Many experienced centers currently advise patients to have redundant leads removed to prevent more complicated procedures after years of abandonment. According to the literature, however, not all abandoned leads need to be extracted as >90% will have an uneventful follow-up. As immediate extraction of redundant leads has a small but significant risk, this will generate more adverse events at the population level than when extraction is limited to the patients with future lead complications, even considering a higher extraction risk at that time. Lead extraction is also limited to specialized centers and often necessitates expensive tools, in contrast to abandoning leads, which can be safely performed by any experienced device specialist without additional cost.
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Affiliation(s)
- Frank Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
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2
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Kwon S, Lee E, Choi EK, Lee SR, Oh S, Choi YS. Long-term outcomes of abandoned leads of cardiac implantable electronic devices. Heart Rhythm 2023; 20:1639-1646. [PMID: 37543304 DOI: 10.1016/j.hrthm.2023.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Evidence of the long-term outcomes of abandoned leads (ALs) in patients with cardiac implantable electronic devices (CIEDs) is scarce. OBJECTIVE This study aimed to investigate the long-term outcomes of ALs. METHODS This retrospective cohort study reviewed a single-center CIED registry of 2962 procedures performed from 1984-2018 and identified 130 patients with AL (AL group). We matched 2 controls without AL (by age, sex, device type, and device revision/removal date) to each patient with AL (n = 260) and compared CIED-related infection, venous thrombosis/stenosis, and all-cause mortality between groups using a Cox proportional hazard model analysis. RESULTS For a mean follow-up period of 11.2 ± 8.2 years, 14 (3.6%), 7 (1.8%), and 143 (36.7%) patients had a CIED-related infection, venous thrombosis/stenosis, or experienced all-cause mortality, respectively. The AL group had more comorbidities than the control group. Lead malfunction was the most common cause of abandonment (64.6%). After adjustment for covariates, no significant intergroup differences were noted in the risks of infection, venous thrombosis/stenosis, or all-cause mortality (adjusted hazard ratio [aHR] 2.52; 95% confidence interval [CI] 0.77-8.25; aHR 1.18; 95% CI 0.25-5.64; aHR 1.26; 95% CI 0.89-1.80, respectively). Patients with multiple ALs had increased risks of infection and all-cause mortality vs controls (aHR 8.61; 95% CI 2.13-34.84; aHR 2.42; 95% CI 1.17-5.00, respectively). CONCLUSION Patients with a single AL showed similar risks of CIED-related infections, venous thrombosis/stenosis, and all-cause mortality as those without ALs, whereas those with multiple ALs showed increased risks of infection and all-cause mortality.
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Affiliation(s)
- Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Cardiovascular Medicine, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun-Shik Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Miguelena Hycka J, López Menéndez J, Martín García M, Muñoz Pérez R, Castro Pinto M, Torres Terreros CB, García Chumbiray PF, Rodriguez-Roda J. Electrodos no funcionantes ¿Extracción o abandono? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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4
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Russo V, Viani S, Migliore F, Nigro G, Biffi M, Tola G, Bisignani G, Dello Russo A, Sartori P, Rordorf R, Ottaviano L, Perego GB, Checchi L, Segreti L, Bertaglia E, Lovecchio M, Valsecchi S, Bongiorni MG. Lead Abandonment and Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) Implantation in a Cohort of Patients With ICD Lead Malfunction. Front Cardiovasc Med 2021; 8:692943. [PMID: 34395560 PMCID: PMC8356671 DOI: 10.3389/fcvm.2021.692943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background: When an implantable-cardioverter defibrillator (ICD) lead becomes non-functional, a recommendation currently exists for either lead abandonment or removal. Lead abandonment and subcutaneous ICD (S-ICD) implantation may represent an additional option for patients who do not require pacing. The aim of this study was to investigate the outcomes of a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction. Methods: We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and compared their outcomes with those of patients who underwent extraction and subsequent reimplantation of a single-chamber transvenous ICD (T-ICD). Results: Forty-three patients underwent S-ICD implantation after abandonment of malfunctioning leads, while 62 patients underwent extraction and subsequent reimplantation of a new T-ICD. The two groups were comparable. In the extraction group, no major complications occurred during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, 3 major complications or deaths occurred in the S-ICD group and 11 in the T-ICD group (HR 1.07; 95% CI 0.29–3.94; P = 0.912). Minor complications were 4 in the S-ICD group and 5 in the T-ICD group (HR 2.13; 95% CI 0.49–9.24; P = 0.238). Conclusions: In the event of ICD lead malfunction, extraction avoids the potential long-term risks of abandoned leads. Nonetheless the strategy of lead abandonment and S-ICD implantation was feasible and safe, with no significant increase in adverse outcomes, and may represent an option in selected clinical settings. Further studies are needed to fully understand the potential risks of lead abandonment. Clinical Trial Registration: URL: ClinicalTrials.gov Identifier: NCT02275637
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Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Sartori
- Cardiology Division, Hospital IRCCS San Martino, Genoa, Italy
| | - Roberto Rordorf
- Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luca Ottaviano
- Cardiology Division, Istituto Clinico S. Ambrogio, Milan, Italy
| | | | - Luca Checchi
- Cardiology Division, University of Florence, Florence, Italy
| | - Luca Segreti
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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Elgaard AF, Johansen JB, Nielsen JC, Gerdes C, Riahi S, Philbert BT, Haarbo J, Melchior TM, Larsen JM. Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study. Europace 2021; 22:1097-1102. [PMID: 32447372 DOI: 10.1093/europace/euaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. METHODS AND RESULTS All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. CONCLUSION More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
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Starck CT, Burger H, Osswald B, Hakmi S, Knaut M, Bimmel D, Bärsch V, Eitz T, Mierzwa M, Ghaffari N, Siebel A. HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Tabbah RN, Abi-Saleh B. Erosion of Cardiovascular Implantable Device: Conservative Therapy or Extraction? Cureus 2020; 12:e12032. [PMID: 33457133 PMCID: PMC7797431 DOI: 10.7759/cureus.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases. Despite the importance of lead extraction techniques, these techniques are complex and have some major risks. Success rates were high, but they are less favorable in patients with several comorbidities. An 80-year-old male presented for device erosion. The patient is known to have several cardiac comorbidities: a transcatheter aortic valve replacement (TAVR), mitral clips for severe aortic stenosis, mitral regurgitation, dual-chamber implantable cardioverter defibrillators (ICD) for secondary prevention. Several weeks ago, he noted tenderness and redness at the site of his device pocket, and his physician, after checking his wound, suggested a possible skin irritation with no systemic infection and started antibiotics treatment. Two weeks later, he noted thinning of the skin around the device with a hematoma and ecchymosis, and slight skin erosion. Strategies for assessment of the wound and pocket cleaning were taken. The strategy was to remove the left-sided device and keep the leads since the patient lately has no elevated inflammatory labs, negative cultures, no fever, nor signs of vegetation on transesophageal echocardiography (TEE) and refused any additional examination as positron emission tomography (PET) scan, and reimplant a new system on the contralateral side. The procedure was divided into two sequences: extracting the device and after one-week implantation of a right-sided new system. In this case, chronic antibiotics were discussable to decrease the recurrence rate, but they did increase the severity of the patient's thrombocytopenia. Despite extraction being the gold standard of treatment in most cases of devices with local and systemic infection, there are some frail patients with several comorbidities where extraction is unbearable due to its major risks and complex procedure. In these specific cases with local infection and device erosion with no signs of any systemic infection, conservative therapy could be a viable option.
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Affiliation(s)
- Randa N Tabbah
- Cardiology, Centre Hospitalier Universitaire Notre Dame de Secours, Beirut, LBN
| | - Bernard Abi-Saleh
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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Shoda M, Kusano K, Goya M, Nishii N, Imai K, Okamoto Y, Takegami M, Nakao YM, Miyamoto Y, Nogami A. Study Design of the Nationwide Japanese Lead Extraction (J-LEX) Registry: Protocol for a Prospective, Multicenter, Open Registry. J Arrhythm 2020; 36:849-853. [PMID: 33024462 PMCID: PMC7532273 DOI: 10.1002/joa3.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transvenous lead extractions (TLEs) in Japan have grown to become the standard therapy since the approval of the laser extraction system in 2008. However, little is known about the current indications, methods, success rate, and acute complications in the real-world setting. METHODS The Japanese Lead EXtraction (J-LEX) registry is a nationwide, multicenter, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. This study is a nationwide registry ordered by the JHRS and its data are collected prospectively using the Research Electronic Data Capture (REDCap) system. The acute success rate at discharge and complications associated with TLEs will be collected in all cases. Based on the provided information, the annual incidence and predictive factors for the outcomes will be investigated by the Event Assessment Committee (EAC). This registry started in July 2018 and the number of participating medical institutions will be more than 50 hospitals and the target number of procedures will be 500-1000 per year. We will also compare the results with other registries in foreign countries. RESULT The results of this study are currently under investigation. CONCLUSION The J-LEX registry will provide real-world data regarding the results and complications of TLEs for the various types of indications, methods, and performing hospitals in Japan.
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Affiliation(s)
- Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Department of Cardiovascular Medicine Shinshu University School of Medicine Matsumoto Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine Heart Rhythm Center Tokyo Medical and Dental University Tokyo Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery Kure Medical Center & Chugoku Cancer Center National Hospital Organization Kure Japan
| | - Yoji Okamoto
- Department of Cardiology Kawasaki Medical School General Medical Center Okayama Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Suita Japan
| | - Yoko M Nakao
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center National Cerebral and Cardiovascular Center Suita Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center National Cerebral and Cardiovascular Center Suita Japan
| | - Akihiko Nogami
- Department of Cardiology Faculty of Medicine University of Tsukuba Tsukuba Japan
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Higuchi S, Shoda M, Saito S, Kanai M, Kataoka S, Yazaki K, Yagishita D, Ejima K, Hagiwara N. Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience. Pacing Clin Electrophysiol 2019; 42:1517-1523. [DOI: 10.1111/pace.13806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Satoshi Higuchi
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Satoshi Saito
- Department of Cardiovascular SurgeryTokyo Women's Medical University Tokyo Japan
| | - Miwa Kanai
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Kyoichiro Yazaki
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
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Alqarawi W, Coppens J, Aldawood W, Ramirez FD, Redpath CJ, Nair GM, Nery PB, Davis DR, Abu Shama R, Aydin A, Klein A, Golian M, Schaller RD, Green MS, Birnie DH, Sadek MM. A Strategy of Lead Abandonment in a Large Cohort of Patients With Sprint Fidelis Leads. JACC Clin Electrophysiol 2019; 5:1059-1067. [DOI: 10.1016/j.jacep.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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Sidhu BS, Gould J, Sieniewicz B, Porter B, Rinaldi CA. The role of transvenous lead extraction in the management of redundant or malfunctioning pacemaker and defibrillator leads post ELECTRa. Europace 2019; 20:1733-1740. [PMID: 29452360 DOI: 10.1093/europace/euy018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
Cardiac implantable electronic devices implantation rates have increased over the past decade due to broader indications and an ageing population. Similarly, device and lead complications have also risen. The management of pacemaker/defibrillator leads that are no longer required (redundant) or malfunctioning, can be contentious. There is a need to balance the risk of transvenous lead extraction (TLE) against those of lead abandonment. The recently published European Lead Extraction ConTRolled Registry (ELECTRa) study provides contemporary outcomes for TLE across Europe with important implications for the management of redundant and/or malfunctioning leads. This review article discusses the potential complications for each interventional approach when managing redundant or malfunctioning pacemaker leads.
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Affiliation(s)
- Baldeep S Sidhu
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Justin Gould
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Benjamin Sieniewicz
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Bradley Porter
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Christopher A Rinaldi
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol 2019; 42:1006-1017. [DOI: 10.1111/pace.13715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Jacheć
- 2nd Department of CardiologyMedical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze Zabrze Poland
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences KielceThe Jan Kochanowski University Kielce Poland
- Swietokrzyskie Cardiology Center Kielce Poland
| | - Luca Segreti
- Department of CardiologyUniversity Hospital of Pisa Pisa Italy
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Merchant FM, Tejada T, Patel A, El-Khalil J, Desai Y, Keeling B, Lattouf OM, Leon AR, El-Chami MF. Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads. Heart Rhythm 2018; 15:855-859. [DOI: 10.1016/j.hrthm.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 10/18/2022]
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15
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Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, Zeitler EP, Al-Khatib SM, Hegland DD, Piccini JP. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation 2017; 136:1387-1395. [DOI: 10.1161/circulationaha.117.027636] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Abstract
Background:
Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.
Methods:
Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.
Results:
Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years;
P
<0.0001), were less likely to be male (65% versus 68%;
P
=0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years;
P
<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7–14.4) and 54.3% (95% CI, 52.8–55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62–0.97;
P
=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.
Conclusions:
Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.
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Affiliation(s)
- Sean D. Pokorney
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Xiaojuan Mi
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Robert K. Lewis
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Melissa Greiner
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Laurence M. Epstein
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Roger G. Carrillo
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Emily P. Zeitler
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Sana M. Al-Khatib
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Donald D. Hegland
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Jonathan P. Piccini
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
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16
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 736] [Impact Index Per Article: 105.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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17
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Zeitler EP, Wang Y, Dharmarajan K, Anstrom KJ, Peterson ED, Daubert JP, Curtis JP, Al-Khatib SM. Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.003953. [PMID: 27406605 DOI: 10.1161/circep.116.003953] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with an unused or malfunctioning implantable cardioverter-defibrillator (ICD) lead may have the lead either abandoned or explanted; yet there are limited data on the comparative acute and longer-term safety of these 2 approaches. METHODS AND RESULTS We examined in-hospital events among 24 908 subject encounters using propensity score 1:1 matching for ICD lead abandonment or explantation in the National Cardiovascular Data Registry (NCDR) ICD Registry (April 2010 to June 2014). Relative to patients undergoing lead abandonment, patients undergoing lead explantation had more in-hospital procedure-related complications: 2.19% (n=273) versus 3.77% (n=469; P<0.001), respectively. Similarly, patients undergoing lead explantation had slightly higher rates of in-hospital death: 0.21% (n=26) versus 0.64% (n=80; P<0.001), respectively. At 1 year in a Medicare subset for survival, there was a trend of increased mortality in the explantation group (11% versus 8%; P=0.06). In the Medicare subset analyzed for postprocedure complications, there was no difference with respect to 6-month bleeding (4.80% in both the groups), tamponade (0.38% versus 0.58%), infection (1.34% versus 3.07%), upper extremity thrombosis (0.77% versus 0.96%), pulmonary embolism (0.38% versus 0.96%), or urgent surgery (1.15% for both the groups; P>0.05 for all). CONCLUSIONS After matching, patients undergoing removal of an unused or malfunctioning ICD lead had slightly higher in-hospital complications and deaths than those with a lead abandonment strategy. Although the 1-year mortality risk was slightly higher in the lead explantation group, this difference was not statistically significant and may be explained by chance.
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Affiliation(s)
- Emily P Zeitler
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Yongfei Wang
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Kumar Dharmarajan
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Kevin J Anstrom
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Eric D Peterson
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - James P Daubert
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Jeptha P Curtis
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.)
| | - Sana M Al-Khatib
- From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
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18
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Kim J, Hwang J, Choi JH, Choi HI, Kim MS, Jung SH, Nam GB, Choi KJ, Lee JW, Kim YH, Kim JJ. Frequency and clinical impact of retained implantable cardioverter defibrillator lead materials in heart transplant recipients. PLoS One 2017; 12:e0176925. [PMID: 28464008 PMCID: PMC5413001 DOI: 10.1371/journal.pone.0176925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/08/2017] [Indexed: 12/31/2022] Open
Abstract
End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.
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Affiliation(s)
- Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jongmin Hwang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-In Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Huang XM, Fu H, Osborn MJ, Asirvatham SJ, McLeod CJ, Glickson M, Acker NG, Friedman PA, Cha YM. Extraction of superfluous device leads: A comparison with removal of infected leads. Heart Rhythm 2015; 12:1177-82. [DOI: 10.1016/j.hrthm.2015.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Indexed: 10/24/2022]
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20
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Segreti L, Di Cori A, Zucchelli G, Soldati E, Coluccia G, Viani S, Paperini L, Bongiorni MG. A Questionable Indication For ICD Extraction After Successful VT Ablation. J Atr Fibrillation 2015; 7:1172. [PMID: 27957158 DOI: 10.4022/jafib.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD). In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. To date, no control data have been published on transvenous lead extraction in the setting of VT ablation. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.
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Affiliation(s)
- Luca Segreti
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Coluccia
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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21
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Abstract
Defibrillator lead advisories stir a lot of emotions, both with patients and physicians, and this may influence lead management. We reviewed the literature for a more evidence-based approach to this issue. From the complications of two of the current advisory leads, the Medtronic Sprint Fidelis and St. Jude Riata leads, and the consequences of possible interventions, we can conclude that a restrained approach to premature replacement is appropriate. It may be opportune to replace the leads during a scheduled generator replacement in case of a higher electrical failure rate, in order to prevent future premature interventions. We found no support to extract non-functional advisory leads. In contrast, extraction is often more demanding than anticipated, and the risk substantially exceeds that of simply abandoning the leads.
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22
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Grazia Bongiorni M, Dagres N, Estner H, Pison L, Todd D, Blomstrom-Lundqvist C. Management of malfunctioning and recalled pacemaker and defibrillator leads: results of the European Heart Rhythm Association survey. Europace 2014; 16:1674-8. [DOI: 10.1093/europace/euu302] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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23
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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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24
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Diemberger I, Mazzotti A, Giulia MB, Biffi M, Cristian M, Massaro G, Matteo M, Martignani C, Letizia ZM, Ziacchi M, Reggiani B, Reggiani ML, Battistini P, Boriani G. From lead management to implanted patient management: systematic review and meta-analysis of the last 15 years of experience in lead extraction. Expert Rev Med Devices 2014; 10:551-73. [PMID: 23895081 DOI: 10.1586/17434440.2013.811837] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous lead extraction is considered a safe and effective procedure, although published results derive primarily from cohort studies. The authors performed a systematic review and meta-analysis of the last 15 years' experience in this field, to give an objective evaluation of the efficacy and safety of this procedure. Moreover, the subsequent metaregression analysis enabled the identification of the main factors influencing these results: patient age, presence of leads in situ for more than 1 year, presence of device infection and use of laser sheath. These findings are significant in order to improve our extraction approach, data reporting and future research.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
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