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O'Neill P, Osler B, Junarta J, Zivan T, Hoeltzel G, Ford R, Flomenberg P, Greenspon A, Mehrotra P. Combined transcatheter vegetectomy and leadless pacemaker implantation for endocarditis and complete heart block. Future Cardiol 2024; 20:359-363. [PMID: 39041543 PMCID: PMC11457670 DOI: 10.1080/14796678.2024.2357946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/17/2024] [Indexed: 07/24/2024] Open
Abstract
We describe a case of culture-negative right-sided endocarditis for which simultaneous transcatheter vegetectomy was performed with leadless pacemaker implantation and removal of a temporary externalized pacing system. The patient did not have a recurrence of endocarditis highlighting the safety and efficacy of same-procedure vegetation removal and pacemaker implantation. This report documents a novel approach for the treatment of cardiac implantable electronic device-associated endocarditis in poor surgical candidates who are pacemaker-dependent.
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Affiliation(s)
- Parker O'Neill
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA19107, USA
| | - Brian Osler
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA19107, USA
| | - Joey Junarta
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA19107, USA
| | - Tal Zivan
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA19107, USA
| | - Gerard Hoeltzel
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA19107, USA
| | - Robert Ford
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. Tenth Street, Suite 1087, Philadelphia, PA19107, USA
| | - Phyllis Flomenberg
- Division of Infectious Diseases, Thomas Jefferson University Hospital, 1015 Chestnut Street, Suite 1020, Philadelphia, PA19107, USA
| | - Arnold Greenspon
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA19107, USA
| | - Praveen Mehrotra
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA19107, USA
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Szatmári V, Thomas R. Pulmonary Thromboembolism and Myocarditis Resulting from a Large Pacing-Lead-Associated Right Ventricular Thrombus in a Dog with Chronic Cough as Presenting Sign. Vet Sci 2024; 11:237. [PMID: 38921984 PMCID: PMC11209049 DOI: 10.3390/vetsci11060237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
In the present case report, we describe the clinical course and postmortem findings of a 12-year-old Labrador retriever dog with a third-degree atrio-ventricular block that developed a chronic cough, and later dyspnea and weakness as a result of massive pulmonary thromboembolism 3 years after implantation of a transvenous permanent pacemaker. A large soft tissue mass was seen in the right ventricular chamber around the pacing lead with echocardiography. Initially, this was thought to be caused by mural bacterial endocarditis based on hyperthermia, severe leukocytosis and the appearance of runs of ventricular tachycardia, the latter suggesting myocardial damage. While blood culture results were pending, antibiotics were administered without a positive effect. Due to clinical deterioration, the owner elected for euthanasia and a post-mortem examination confirmed a right ventricular thrombus and surrounding myocarditis, without signs of bacterial infection, and a massive pulmonary thromboembolism. We conclude that pulmonary thromboembolism should be considered in dogs with a cough that have an endocardial pacing lead implanted. Serial screening for proteinuria before and after implantation of an endocardial pacing lead would allow timely initiation of prophylactic antiplatelet therapy. Local myocarditis can develop secondary to an intracavitary thrombus, which can subsequently lead to runs of ventricular tachycardia.
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Affiliation(s)
- Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Rachel Thomas
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
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3
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McGrath C, Dixon A, Hirst C, Bode EF, DeFrancesco T, Fries R, Gordon S, Hogan D, Martinez Pereira Y, Mederska E, Ostenkamp S, Sykes KT, Vitt J, Wesselowski S, Payne JR. Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study. J Vet Cardiol 2023; 49:9-28. [PMID: 37541127 DOI: 10.1016/j.jvc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Pacemaker implantation is the treatment of choice for clinically relevant bradyarrhythmias. Pacemaker-lead-associated thrombosis (PLAT) occurs in 23.0-45.0% of people with permanent transvenous pacemakers. Serious thromboembolic complications are reported in 0.6-3.5%. The incidence of PLAT in dogs is unknown. ANIMALS, MATERIALS AND METHODS multicenter retrospective study of seven centers with 606 client-owned dogs undergoing permanent pacemaker implantation between 2012 and 2019. 260 dogs with a transvenous pacemaker with echocardiographic follow-up, 268 dogs with a transvenous pacemaker without echocardiographic follow-up and 78 dogs with an epicardial pacemaker. RESULTS 10.4% (27/260) of dogs with transvenous pacemakers and echocardiographic follow-up had PLAT identified. The median time to diagnosis was 175 days (6-1853 days). Pacemaker-lead-associated thrombosis was an incidental finding in 15/27 (55.6%) dogs. Of dogs with a urine protein:creatinine ratio measured at pacemaker implantation, dogs with PLAT were more likely to have proteinuria at pacemaker implantation vs. dogs without PLAT (6/6 (100.0%) vs. 21/52 (40.4%), P=0.007). Urine protein:creatinine ratio was measured in 12/27 (44.4%) dogs at PLAT diagnosis, with proteinuria identified in 10/12 (83.3%) dogs. Anti-thrombotic drugs were used following the identification of PLAT in 22/27 (81.5%) dogs. The thrombus resolved in 9/15 (60.0%) dogs in which follow-up echocardiography was performed. Dogs with PLAT had shorter survival times from implantation compared to those without PLAT (677 days [9-1988 days] vs. 1105 days [1-2661 days], P=0.003). CONCLUSIONS Pacemaker-lead-associated thrombosis is identified in 10.4% (27/260) of dogs following transvenous pacing, is associated with proteinuria, can cause significant morbidity, and is associated with reduced survival times.
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Affiliation(s)
- C McGrath
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - A Dixon
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - C Hirst
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - T DeFrancesco
- College of Veterinary Medicine, North Carolina State Veterinary Hospital, 1052 William Moore Dr., Raleigh, NC, 27607, USA
| | - R Fries
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Gordon
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - D Hogan
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - Y Martinez Pereira
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, United Kingdom
| | - E Mederska
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - S Ostenkamp
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - K T Sykes
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J Vitt
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Wesselowski
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom.
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Fakhry MA, Siddique S. A Shocking Discovery: Apical Thrombus Formation Post–Cardiac Resynchronization Therapy Placement. CASE 2020; 4:500-503. [PMID: 33376842 PMCID: PMC7756184 DOI: 10.1016/j.case.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CRT-D is beneficial for patients in systolic heart failure with dyssynchrony. Complications after CRT-D placement can arise due to changes post–myocardial infarction. Apical thrombus can develop in a predisposed area in the left ventricle. CRT-D placement can worsen aneurysmal areas of the left ventricle.
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Panagiotis MN, Nikolaos MP, St. Georgia G, Athanasios KI. Case report: recurrent thrombosis of an old lead of a DDDR pacemaker mimicking lead infection. Eur Heart J Case Rep 2018; 2:yty063. [PMID: 31020141 PMCID: PMC6176961 DOI: 10.1093/ehjcr/yty063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/05/2018] [Indexed: 11/12/2022]
Abstract
Introduction Thrombosis of the intracardiac part of a permanent pacemaker lead, which is usually detected during a routine transthoracic echocardiographic examination, can be totally asymptomatic. The differential diagnosis between intracardiac lead thrombosis and vegetation is crucial, especially in febrile patients, as these two situations are totally different regarding prognosis and treatment. Case presentation We describe the case of an 85-year-old patient with a dual chamber pacemaker (DDDR) due to complete heart block, who was admitted twice, within 2 years, with vegetation-like masses attached to the ventricular lead of the pacemaker. Infective endocarditis was not documented (diagnostic criteria were not fulfilled), although clinical suspicion was high during both hospitalizations. Masses resolved under applied treatment (anticoagulation) in both cases. Discussion Differential diagnosis between lead thrombosis and vegetation was ambiguous in both hospitalizations. Τhe 18F-fluorodeoxyglucose positron emission tomography/computed tomography during the 2nd hospitalization excluded a possible inflammatory origin of the masses.
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Affiliation(s)
- Margos N Panagiotis
- 1st Cardiology Department, General Hospital of Nikea Ag. Panteleimon, Mantouvalou 3, Nikea Attitkis, Greece
| | - Margos P Nikolaos
- 1st Cardiology Department, General Hospital of Nikea Ag. Panteleimon, Mantouvalou 3, Nikea Attitkis, Greece
| | - Goranitou St. Georgia
- 1st Cardiology Department, General Hospital of Nikea Ag. Panteleimon, Mantouvalou 3, Nikea Attitkis, Greece
| | - Kranidis I Athanasios
- 1st Cardiology Department, General Hospital of Nikea Ag. Panteleimon, Mantouvalou 3, Nikea Attitkis, Greece
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6
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Lin KF, Wu FZ. Large right atrial pacemaker lead thrombus diagnosed by chest CT angiography. Postgrad Med J 2017; 93:109-110. [DOI: 10.1136/postgradmedj-2016-134414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/04/2022]
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7
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Rapid Detection of Intracardiac Thrombus with Bedside Echocardiography. J Emerg Med 2016; 50:501-3. [DOI: 10.1016/j.jemermed.2015.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022]
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8
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Lenz CJ, DeSimone CV, Ponamgi SP, Sugrue A, Sinak LJ, Chandrasekaran K, Packer DL, Asirvatham SJ. Cardiac implantable electronic device lead-based masses and atrial fibrillation ablation: a case-based illustration of periprocedural anticoagulation management strategies. J Interv Card Electrophysiol 2016; 46:237-43. [PMID: 26898212 DOI: 10.1007/s10840-016-0110-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/27/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) leads frequently develop echogenic masses. However, the nature of these masses is not well understood. In patients in whom atrial fibrillation (AF) catheter ablation is planned, there is concern that transseptal puncture may result in cerebrovascular embolism of these masses. The optimal therapeutic strategy in this setting remains undefined. METHODS We describe six patients identified over a 6-year period (2008-2014) with device lead-based masses prior to or at the time of AF ablation. We examined the anticoagulation strategy and periprocedural management based on mass identification. RESULTS In all six patients (age 39-73; four males), the device lead mass was found in the right atrium. The average mass size was 11 ± 1.3 mm. The majority of patients were already on anticoagulation (5/6; 83 %), and an intensified anticoagulation regimen was initiated (INR goal 3.0). In all six patients, the size of the device lead mass decreased on repeat imaging. In two sixths (33 %) patients, the lead-based mass completely resolved within 2 months. The remaining four patients had persistent lead-based masses (average follow-up of 10.9 ± 9.6 months). DISCUSSION We describe a series of patients with CIED lead-based masses found at the time of ablation. These cases illustrate that lead-based masses can disappear while patients are on high-intensity anticoagulation, most compatible with a thrombotic origin. These early data will need to be assessed in larger cohorts for further validation and evaluation of safety.
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Affiliation(s)
- Charles J Lenz
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Christopher V DeSimone
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Shiva P Ponamgi
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Alan Sugrue
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lawrence J Sinak
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Krishnaswamy Chandrasekaran
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Douglas L Packer
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA. .,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. .,Division of Cardiovascular Diseases and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Complex Perioperative Decision-Making: Liver Resection in a Patient with Extensive Superior Vena Cava/Right Atrial Thrombus and Superior Vena Cava Syndrome. Case Rep Anesthesiol 2016; 2016:2106242. [PMID: 26904303 PMCID: PMC4745874 DOI: 10.1155/2016/2106242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC syndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting in pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid application via the upper extremities. We present our perioperative approach in management of a patient scheduled for right hepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome.
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10
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Buttigieg J, Asciak R, Azzopardi CM. Pacemaker lead-associated thrombosis in cardiac resynchronisation therapy. BMJ Case Rep 2015; 2015:bcr-2015-210314. [PMID: 26153289 DOI: 10.1136/bcr-2015-210314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pacemaker lead-associated thrombosis is a possible complication of any cardiac implantable electronic device. We present a case of a middle-aged woman with a history of ischaemic left ventricular failure, who presented with fever and other non-specific symptoms 4 months after cardiac resynchronisation therapy. A transoesophageal echocardiogram confirmed a vegetation-like structure originating from the pacemaker lead in the right atrium. The patient was treated with intravenous antibiotics followed by open heart surgery in order to remove this mass as well as the pacing device, including all three pacing leads. Histology and culture of the retrieved mass confirmed a sterile thrombus with no features to suggest an infected mass (vegetation). The patient made an uncomplicated recovery and there were no long-term sequelae on follow-up during the 2 years after the event.
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Affiliation(s)
| | | | - Charles Mallia Azzopardi
- Department of Internal Medicine and Infectious Diseases Medicine, Mater Dei Hospital, Msida, Malta
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11
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Noheria A, Ponamgi SP, Desimone CV, Vaidya VR, Aakre CA, Ebrille E, Hu T, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace 2015; 18:246-52. [PMID: 25767086 DOI: 10.1093/europace/euv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
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Affiliation(s)
- Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Christopher V Desimone
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Chung MY, Chae SM, Kim CJ. Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report. Korean J Anesthesiol 2015; 68:74-7. [PMID: 25664159 PMCID: PMC4318869 DOI: 10.4097/kjae.2015.68.1.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022] Open
Abstract
Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.
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Affiliation(s)
- Mee Young Chung
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Min Chae
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Risk of Cerebrovascular Events in Patients With Patent Foramen Ovale and Intracardiac Devices. JACC Cardiovasc Interv 2014; 7:1221-6. [DOI: 10.1016/j.jcin.2014.04.025] [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] [Received: 10/15/2013] [Revised: 03/31/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
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14
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Yunfei L, Dongxu L, Shuhua L, Yabo W, San D, Changping G, Ke L, Qi A. A case report: mixed thrombus formation in a previously sutured right atrium. Heart Surg Forum 2014; 17:E234-6. [PMID: 25179981 DOI: 10.1532/hsf98.2013287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe the case of a 19-year-old Chinese woman who nine months prior underwent repair of an atrial septal defect and came to our hospital with a right atrial mass attached to the anterior wall of the right atrium on transthoracic echocardiography. Pathologic examination revealed the mass was a mixed-type thrombosis with some unusual organization, which previously was not described in literature.
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Affiliation(s)
- Ling Yunfei
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Li Dongxu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Luo Shuhua
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wang Yabo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Deep San
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Gan Changping
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lin Ke
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - An Qi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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15
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Stroke or Transient Ischemic Attack in Patients With Transvenous Pacemaker or Defibrillator and Echocardiographically Detected Patent Foramen Ovale. Circulation 2013. [DOI: 10.1161/circulationaha.113.003540] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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D'Aloia A, Bonadei I, Vizzardi E, Curnis A. Right giant atrial thrombosis and pulmonary embolism complicating pacemaker leads. BMJ Case Rep 2013; 2013:bcr-2012-008017. [PMID: 23997072 DOI: 10.1136/bcr-2012-008017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of a patient with bilateral pulmonary embolism because of a giant intracardiac thrombus anchored on a right atrial pacemaker lead treated with unfractionated heparin and the consecutively complete thrombus resolution after 5-6 days.
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Affiliation(s)
- Antonio D'Aloia
- Department of Cardiology, University of Brescia, Brescia, Italy
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Rahbar AS, Azadani PN, Thatipelli S, Fleischmann KE, Nguyen N, Lee BK. Risk factors and prognosis for clot formation on cardiac device leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1294-300. [PMID: 23844971 DOI: 10.1111/pace.12210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/14/2012] [Accepted: 05/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clot formation on cardiac device leads is poorly understood. We sought to determine how often clot is seen on device leads by transthoracic echo (TTE), identify risk factors, and to describe the natural history of this phenomenon. METHODS We reviewed 71,888 echocardiographic studies performed at the University of California, San Francisco from 2005 to 2011. We searched for cases where clot was found adhered to a device lead with no diagnosis of endocarditis. For every case, three age-matched controls with a device but no clot were selected from the echo database. RESULTS We found 15 cases with clot adhered to a device lead among 1,086 patients with devices who had TTE (1.4%). In univariate analysis, females had more than four times greater odds of having a clot on their device lead and patients with a history of atrial fibrillation (AF) had an eight times greater odds. Percentage mode switch was also associated with clot formation. Only AF was still associated with clot formation after multivariate analysis. Follow-up data were available for nine of 15 patients. All nine patients had intensification of their anticoagulant/antiplatelet regimen following clot discovery. Complete resolution or shrinkage of clot was observed in eight of nine patients. The one case with no change was a patient who continued taking only aspirin (higher dose) after clot discovery. None of the nine patients had embolic phenomenon. CONCLUSION Patients with AF are at higher risk for clot formation on device leads. After clot detection, treatment with anticoagulants usually results in resolution of the clot without embolic phenomenon.
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Affiliation(s)
- Ata Soleimani Rahbar
- Cardiac Electrophysiology Section, Division of Cardiology, University of California, San Francisco, School of Medicine, San Francisco, California
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Dimitrakakis G, Dimitrakaki IA. eComment. Surgical complications of permanent cardiac pacemaker insertion. Interact Cardiovasc Thorac Surg 2012; 15:1087. [PMID: 23166222 DOI: 10.1093/icvts/ivs484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs 2012; 16:23-33. [PMID: 23104398 DOI: 10.1007/s10047-012-0668-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
The number of pediatric pacemakers implanted is still relatively small. Children requiring pacing therapy have characteristics that are distinct from those of adults, including physical size, somatic growth, and cardiac anomalies. Considering these features, long-term follow-up of pediatric pacemaker implantation is necessary. Selection of appropriate generators, pacing modes, pacing sites, and leads is important. Generally, epicardial leads are commonly used in small infants. On the other hand, the use of endocardial leads in children is increasing worldwide because of their benefits over epicardial leads, such as minimal invasiveness, lower pacing threshold, and longer generator longevity. Endocardial leads are not suitable for patients with intracardiac shunts because of the high risk of systemic thrombosis. Venous occlusion is another significant problem with endocardial leads. With the increase in the number of pacing device implantations, the incidence of infection from such devices is also increasing. Complete device removal is sometimes recommended to treat device infection, but experience in the removal of endocardial leads in children is still scarce. This article gives an overview of pacing therapy in the pediatric population, including discussions on new pacing systems, such as remote monitoring systems, magnetic imaging compliant pacemaker systems, and leadless pacing devices.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Implantable cardiac devices with patent foramen ovale—a risk factor for cardioembolic stroke? J Interv Card Electrophysiol 2012; 35:159-62. [DOI: 10.1007/s10840-012-9712-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/02/2012] [Indexed: 11/26/2022]
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Feuchter AC, Katz KD. Right atrial thrombus secondary to pacemaker wires. J Emerg Med 2010; 43:e185-7. [PMID: 20656436 DOI: 10.1016/j.jemermed.2010.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/19/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pacemaker-induced right atrial thrombus is a rare condition that has not been described in the Emergency Medicine literature. This is a potentially fatal condition that is diagnosed with an echocardiogram and treated with surgical removal, thrombolytics, or long-term anticoagulation. OBJECTIVES This case report is designed to increase awareness among emergency physicians of this potentially fatal condition. CASE REPORT We describe the case of a patient with a massive right atrial thrombus secondary to pacemaker wire who presented to the Emergency Department with syncope, bradycardia, and rapid hemodynamic deterioration. CONCLUSION Emergency physicians should be aware of this life-threatening entity. Emergency bedside cardiac ultrasound or echocardiogram may be of value in its early identification.
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Affiliation(s)
- Alexander C Feuchter
- University of Pittsburgh Affiliated Residency in Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Hildebrandt N, Stertmann W, Wehner M, Schneider I, Neu H, Schneider M. Dual Chamber Pacemaker Implantation in Dogs with Atrioventricular Block. J Vet Intern Med 2009; 23:31-8. [DOI: 10.1111/j.1939-1676.2008.0233.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Paino AM, Maffè S, Pardo NF, Perucca A, Dellavesa P, Lanzillo G, Bielli M, Signorotti F, Paffoni P, Zenone F, Parravicini U, Carola F, Zanetta M. Biventricular pacemaker lead thrombosis: a rare case treated with surgical thrombectomy. J Cardiovasc Med (Hagerstown) 2008; 9:1130-3. [PMID: 18852586 DOI: 10.2459/jcm.0b013e328308b66b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right cardiac thrombosis is an infrequent complication after pacemaker implant. We report a patient who received a biventricular implantable cardioverter defibrillator, with a large mobile thrombus, adherent to the left ventricular lead. This catheter was partially dislocated, with a large, mobile loop through the right atrium and right ventricle; so the lead thrombus could alternately obstruct the pulmonary valve and the tricuspid valve. We believe that this is the first case of left ventricular lead thrombosis, in which the surgical treatment included thrombectomy with conservation of the catheter that was anchored to the internal right atrial wall in order to limit its great motility, maintaining the contribution to the cardiac resynchronization.
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Singh AV, Walsh JT, Birdi IS. Right atrial thrombus masquerading as intracardiac cyst: a case report. Asian Cardiovasc Thorac Ann 2008; 16:e35-6. [PMID: 18670013 DOI: 10.1177/021849230801600424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intracardiac cystic lesions are rare. Hydatid disease, blood cysts and bronchogenic cysts in various chambers of the heart have been reported. Right atrial thrombus presenting as a cystic lesion on echocardiogram has not been reported. We describe a patient with mitral regurgitation in atrial fibrillation with a right atrial cyst, which was found to be a cavitating thrombus.
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Affiliation(s)
- Arvind V Singh
- Department of Cardiothoracic Surgery, Trent Cardiac Center, Nottingham City Hospital, Hucknall Road, Nottingham, United Kingdom.
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Cardioverter-defibrillator lead-related thrombus treated with prolonged anticoagulation in patient with prothrombotic disorder. Blood Coagul Fibrinolysis 2008; 19:319-21. [DOI: 10.1097/mbc.0b013e3282fe73c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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