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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [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: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Atallah J, Erickson CC, Cecchin F, Dubin AM, Law IH, Cohen MI, LaPage MJ, Cannon BC, Chun TU, Freedenberg V, Gierdalski M, Berul CI. Multi-Institutional Study of Implantable Defibrillator Lead Performance in Children and Young Adults. Circulation 2013; 127:2393-402. [DOI: 10.1161/circulationaha.112.001120] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease patients is hampered by poor long-term lead survival. Lead extraction is technically difficult and carries substantial morbidity. We sought to determine the outcomes of ICD leads in pediatric and congenital heart disease patients.
Methods and Results—
The Pediatric Lead Extractability and Survival Evaluation (PLEASE) is a 24-center international registry. Pediatric and congenital heart disease patients with ICD lead implantations from 2005 to 2010 were eligible. Study subjects comprised 878 ICD patients (44% congenital heart disease). Mean±SD age at implantation was 18.6±9.8 years. Of the 965 total leads, 54% were thin (≤7F), of which 57% were Fidelis, and 23% were coated with expanded polytetrafluoroethylene. There were 139 ICD lead failures (14%) in 132 patients (15%) at a mean lead age of 2.0±1.4 years, causing shocks in 53 patients (40%). Independent predictors of lead failure included younger implantation age and Fidelis leads. Actuarial analysis showed an incremental risk of lead failure with younger age at implantation: <8 years compared with >18 years (
P
=0.015). The actuarial yearly failure rate was 2.3% for non-Fidelis and 9.1% for Fidelis leads. Extraction was performed on 143 leads (80% thin, 7% expanded polytetrafluoroethylene coated), with lead age as the only independent predictor for advanced extraction techniques. There were 6 major extraction complications (4%) but no procedural mortality.
Conclusions—
This study demonstrates that ICD leads in children and congenital heart disease patients have an age-related suboptimal performance, further compounded by a high failure rate of Fidelis leads. Advanced extraction techniques were common and correlated with older lead age.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00335036.
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Affiliation(s)
- Joseph Atallah
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Christopher C. Erickson
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Frank Cecchin
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Anne M. Dubin
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Ian H. Law
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Mitchell I. Cohen
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Martin J. LaPage
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Bryan C. Cannon
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Terrence U.H. Chun
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Vicki Freedenberg
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Marcin Gierdalski
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Charles I. Berul
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
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