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Akcay M, Yuksel S. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads-A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1360. [PMID: 39202640 PMCID: PMC11356401 DOI: 10.3390/medicina60081360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: The number of cardiac pacemakers being used has increased in recent decades, and this increase has led to a rise in device-related complications, requiring percutaneous device extraction. Our aim was to present our single-center clinical experience in percutaneous lead extractions. Materials and Methods: We analyzed an observational retrospective cohort study of 93 patients for the transvenous removal of a total of 163 endocardial leads. We evaluated the device details, indications, lead characteristics, extraction methods, complications, reimplantation procedure, follow-up data, effectiveness, and safety. Results: Patients' mean age was 68.6 ± 11.6 years. Lead extraction indications were pocket infection in 33 (35.5%), lead dysfunction in 33 (35.5%), and system upgrade in 21 (23%) cases, and lead endocarditis in 6 (6%) cases. The duration from implantation to extraction time was a detected median of 43 (24-87) months. The most common retracted lead type was the RV defibrillator lead (62%), and the lead fixation type was active for one hundred (61%) patients. A new device was inserted in 74 (80%) patients, and the device type was most commonly a CRT-D (61%). Patients were followed up at a median of 17 (8-36) months, and 18 patients (19%) died at follow-up. Complete procedural success was obtained in 78 (84%) patients, and clinical procedural success was obtained in 83 (89%) patients. Procedural failure was detected in 15 (16%) patients. Major and minor complications were detected in 10 (11%) and 6 (6.5%) patients, respectively. The most common minor complication was pocket hematoma. Conclusions: Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications. The simple manual traction method has a high rate of procedural success, despite a high dwell time of the lead.
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Affiliation(s)
- Murat Akcay
- Department of Cardiology, Ondokuz Mayıs University School of Medicine, Samsun 55139, Turkey;
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2
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Khalil C, Lazar S, Megaly M, Mekritthikrai R, Vipparthy SC, Doukky R, Mortada ME, Huang HD, Sharma PS. Trends and outcomes of inpatient cardiac implantable electronic device transvenous lead extractions: a nationwide analysis. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01891-y. [PMID: 39105957 DOI: 10.1007/s10840-024-01891-y] [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: 03/17/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Higher rates of CIED implantations have been associated with an increased rate of lead failures and complications resulting in higher rates of transvenous lead extractions (TLE). OBJECTIVE To assess the trends TLE admissions and evaluate the patient related predictors of safety outcomes. METHODS National Readmission Database was queried to identify patients who underwent TLE from January 2016 to December 2019. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality in patients undergoing TLE. Additionally, we compared trends and outcomes of TLE among patients with prior sternotomy versus those without prior sternotomy and analyzed sex-based differences among patients undergoing TLE. RESULTS We identified 30,128 hospitalizations for TLE. The index admission in-hospital mortality rate was 3.21% with cardiac tamponade happening in 1.46% of the admissions. Age, infective endocarditis, CKD, congestive heart failure and anemia were associated with higher in-hospital mortality rates. There was a lower rate of in-hospital mortality in patients with history of prior sternotomy versus patients without (OR 0.72, CI: 0.59-0.87, p-value < 0.001). There was no difference in in-hospital mortality rate between males and females. Females had a shorter length and a higher cost of stay when compared to male gender. CONCLUSION TLE admissions continue to increase. Overall rates of mortality and complications are relatively low. Patients with prior sternotomy had better outcomes and less complications when compared to those without prior sternotomy. Female gender is associated with higher rates of cardiac tamponade, yet shorter length of stay with lower cost.
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Affiliation(s)
- Charl Khalil
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy/suite 317 Kellogg, Chicago, IL, 60612, USA.
- Division of Cardiology, Department of Medicine, Aurora St. Luke's Medical Center, Wisconsin, USA.
| | - Sorin Lazar
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Michael Megaly
- Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Raktham Mekritthikrai
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Sharath C Vipparthy
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy/suite 317 Kellogg, Chicago, IL, 60612, USA
| | - Rami Doukky
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Mohammad E Mortada
- Division of Cardiology, Department of Medicine, Aurora St. Luke's Medical Center, Wisconsin, USA
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy/suite 317 Kellogg, Chicago, IL, 60612, USA
| | - Parikshit S Sharma
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy/suite 317 Kellogg, Chicago, IL, 60612, USA
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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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Arabia G, Aboelhassan M, Calvi E, Cerini M, Bellicini MG, Bontempi L, Giacopelli D, Nawar A, Raweh A, Abbas MMM, Curnis A. Sex differences in long-term outcomes following transvenous lead extraction. J Cardiovasc Electrophysiol 2024. [PMID: 39075799 DOI: 10.1111/jce.16379] [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: 02/28/2024] [Revised: 07/05/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is generally considered a safe procedure, albeit not without risks. While gender-based disparities have been noted in short-term outcomes following TLE, a notable gap exists in understanding the long-term consequences of this procedure. The objective of this analysis was to investigate sex differences in both acute and long-term outcomes among patients who underwent TLE at a tertiary referral center. METHODS In this retrospective cohort study, consecutive patients who underwent TLE between January 2014 and January 2016 were enrolled. The primary outcome comprised a composite of all-cause mortality and need for repeated TLE procedures. Secondary outcomes included fluoroscopy time, lead extraction techniques, success rates, and major and minor complications. Results were compared between female and male cohorts. RESULTS The study population comprised 191 patients (median age, 70 years), 29 (15.2%) being women and 162 men (84.8%). Study groups had similar baseline characteristics. Complete procedural success was achieved in 189 out of 191 patients (99.0%), with no significant difference observed between the two groups (p = .17). No major complications were reported in the total cohort. However, there was a significantly higher incidence of minor complications in women compared to men (17.2% vs. 2.5%, p < .01). Following a median follow-up of 6.5 years, the incidence of the primary composite outcome occurred similarly between the study groups (log-rank p = .68). CONCLUSION Women who underwent TLE exhibited a significantly higher incidence of minor acute intra- and peri-procedural complications than men. However, no differences in long-term outcomes between genders were observed.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Mohamed Aboelhassan
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Emiliano Calvi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Luca Bontempi
- Unit of Cardiology, Cardiac Electrophysiology and Electrostimulation Laboratory, "Bolognini" Hospital of Seriate, ASST Bergamo Est, Bergamo, Italy
| | | | - Amr Nawar
- Critical Care Department, Cairo University, Giza, Egypt
| | - Abdallah Raweh
- Cardiology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Mohamed Magdy M Abbas
- Cardiology Department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
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Patel K, Toomu S, Lee E, Darden D, Jacobs K, Pollema T, Ho G, Birgersdotter-Green U. Computed tomography predictors of increased transvenous lead extraction difficulty. Pacing Clin Electrophysiol 2024. [PMID: 38967391 DOI: 10.1111/pace.15034] [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: 10/29/2023] [Revised: 05/19/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The ability of computed tomography (CT) characteristics to predict the difficulty of transvenous lead extraction (TLE) is an evolving subject. OBJECTIVE To identify CT characteristics associated with increased TLE difficulty. METHODS All consecutive patients undergoing TLE at the University of California San Diego from January 2018 to February 2022 were analyzed, utilizing the UC San Diego Lead Extraction Registry. Patients underwent cardiac-gated chest CT scans with intravenous contrast; all scans were reviewed by a single radiologist. Lead extraction was performed per standard institutional protocol with the initial use of a laser sheath and crossover to a mechanical sheath as needed. Multivariable linear and logistic regression analyses were performed to identify predictors of individual lead-removal fluoroscopy time and mechanical sheath use, as markers of extraction difficulty. RESULTS A total of 343 patients were analyzed. The mean age of the study population was 63.8 ± 15.4 years; 71% were male. The mean lead dwell-in duration was 8.6 ± 5.7 years. In multivariable linear regression analysis, venous occlusion detected on CT was independently associated with higher individual lead-removal fluoroscopy time (p = 0.004), when adjusting for clinical characteristics such as lead dwell time. In multivariable logistic regression analysis, calcification and venous occlusion were independently associated with a higher need for mechanical sheath use during TLE (odds ratio:5.08, p < 0.001, 95% CI: 2.54-10.46) and (odds ratio:3.72, p < 0.001, 95% CI: 1.89-7.35), respectively. CONCLUSION In patients undergoing TLE, venous occlusion identified by chest CT is associated with increased fluoroscopy time. Patients with lead-associated calcification or venous occlusion detected by chest CT are each five and three times more likely to require crossover from laser to a mechanical sheath.
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Affiliation(s)
- Kavisha Patel
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Sandeep Toomu
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Euyhyun Lee
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Douglas Darden
- Department of Cardiology, Kansas City Heart Rhythm Institute, Kansas City, Kansas, USA
| | - Kathleen Jacobs
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Travis Pollema
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Gordon Ho
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
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Hayashi K, Callahan T, Rickard J, Baranowski B, Martin DO, Nakhla S, Tabaja C, Paul A, Wilkoff BL. Comparison of outcomes and required tools between transvenous extraction of pacemaker and implantable cardioverter defibrillator leads: Insight from single high-volume center experience. J Cardiovasc Electrophysiol 2024; 35:1382-1392. [PMID: 38725252 DOI: 10.1111/jce.16294] [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: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Reports of comparison with procedural outcomes for implantable cardioverter defibrillator (ICD) and pacemaker (PM) transvenous lead extraction (TLE) are old and limited. We sought to compare the safety, efficacy, and procedural properties of ICD and PM TLE and assess the impact of lead age. METHODS The study cohort included all consecutive patients with ICD and PM TLE in the Cleveland Clinic Prospective TLE Registry between 2013 and 2022. Extraction success, complications, and failure employed the definitions described in the HRS 2017 TLE guidelines. RESULTS A total of 885 ICD leads, a median implant duration of 8 (5-11) years in 810 patients, and 1352 PM leads of 7 (3-13) years in 807 patients were included. Procedural success rates in ICD patients were superior to those of PM in >20 years leads but similar in ≤20 years leads. In the PM group, the complete success rate of TLE decreased significantly according to the increase of lead age, but not in the ICD group. ICD TLE required more extraction tools compared with PM TLE but cases with older leads required non-laser sheath extraction tools in both groups. The most common injury site in major complication cases differed between ICD and PM TLE, although major complication rates showed no difference in both groups (2.7% vs. 1.6%, p = .12). CONCLUSION The procedural success rate by TLE is greater for ICD patients than PM patients with leads >20 years old but requires more extraction tools. Common vascular complication sites and the impact of lead age on procedural outcomes and required tools differed between ICD and PM TLE.
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Affiliation(s)
- Katsuhide Hayashi
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Callahan
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - David O Martin
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aritra Paul
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA
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Igbinomwanhia E, Jiwani S, Karim S, Pimentel R. Case Series and Review of Literature for Superior Vena Cava Injury During Laser Lead Extraction. Card Electrophysiol Clin 2024; 16:117-124. [PMID: 38749629 DOI: 10.1016/j.ccep.2023.10.011] [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] [Indexed: 05/26/2024]
Abstract
Transvenous laser lead extraction poses a risk of major complications (0.19%-1.8%), notably injury to the superior vena cava (SVC) in 0.19% to 0.96% of cases. Various factors contribute to SVC injury, which can be categorized as patient-related (such as female gender, low body mass index, diabetes, renal problems, anemia, and reduced ejection fraction), device-related (including the number, dwell time, and type of leads), or procedural-related (such as reason for extraction, venous obstructions, and bilateral lead placements).
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Affiliation(s)
- Efehi Igbinomwanhia
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
| | - Sania Jiwani
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
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Poposka L, Risteski D, Cvetkovski D, Pocesta B, Janusevski F, Zimbakov Z, Trajkov I, Stefanovski D, Logar M, Ksela J. Stepwise transvenous lead extraction due to pacemaker pocket infection following lactational mastitis complicated with breast abscess. Int Breastfeed J 2024; 19:27. [PMID: 38641819 PMCID: PMC11027399 DOI: 10.1186/s13006-024-00633-0] [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: 01/01/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. CASE PRESENTATION A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. CONCLUSION Although patients' decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs.
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Affiliation(s)
- Lidija Poposka
- University Clinic for Cardiology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Dejan Risteski
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Bekim Pocesta
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Zhan Zimbakov
- University Clinic for Cardiology, Skopje, North Macedonia
| | - Ivan Trajkov
- Clinical hospital "Acibadem Sistina" Skopje, Skopje, North Macedonia
| | - Dime Stefanovski
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Logar
- Clinic of Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Kutarski A, Jacheć W, Czajkowski M, Stefańczyk P, Kosior J, Tułecki Ł, Nowosielecka D. Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures. J Clin Med 2024; 13:2349. [PMID: 38673622 PMCID: PMC11051408 DOI: 10.3390/jcm13082349] [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: 03/10/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
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Tan MC, Ang QX, Yeo YH, Thong JY, Tolat A, Scott LR, Lee JZ. Effect of age on in-hospital outcomes of transvenous lead extraction for infected cardiac implantable electronic device. Pacing Clin Electrophysiol 2024; 47:577-582. [PMID: 38319639 DOI: 10.1111/pace.14939] [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: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The real-world data on the safety profile of transvenous lead extraction (TLE) for infected cardiac implantable electronic devices (CIED) among elderly patients is not well-established. This study aimed to evaluate the hospital outcomes between patients of different age groups who underwent TLE for infected CIED. METHOD Using the Nationwide Readmissions Database, our study included patients aged ≥18 years who underwent TLE for infected CIED between 2017 and 2020. We divided the patients into four groups: Group A. Young (<50 years), Group B. Young intermediate (50-69 years old), Group C. Older intermediate (70-79 years old), and Group D. Octogenarian (≥80 years old). We then analyzed the in-hospital outcome and 30-day readmission between these age groups. RESULTS A total of 10,928 patients who were admitted for TLE of infected CIED were included in this study: 982 (9.0%) patients in group A, 4,234 (38.7%) patients in group B, 3,204 (29.3%) patients in group C and 2,508 (23.0%) of patients in group D. Our study demonstrated that the risk of early mortality increased with older age (Group B vs. Group A: OR: 1.92, 95% CI: 1.19-3.09, p < .01; Group C vs. Group A: OR: 2.47, 95% CI: 1.51-4.04, p < .01; Group D vs. Group A: OR: 2.82, 95% CI: 1.69-4.72, p < .01). The risk of non-home discharge also increased in elderly groups (Group B vs. Group A: OR: 1.89; 95% CI: 1.52-2.36; p < .01; Group C vs. Group A: OR: 2.82; 95% CI 2.24-3.56; p < .01; Group D vs. Group A: OR: 4.16; 95% CI: 3.28-5.28; p < .01). There was no significant difference in hospitalization length and 30-day readmission between different age groups. Apart from a higher rate of open heart surgery in group A, the procedural complications were comparable between these age groups. CONCLUSION Elderly patients had worse in-hospital outcomes in early mortality and non-home discharge following the TLE for infected CIED. There was no significant difference between elderly and non-elderly groups in prolonged hospital stay and 30-day readmission. Elderly patients did not have a higher risk of procedural complications.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Qi Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, Michigan, USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, Michigan, USA
| | - Jia Yean Thong
- Fudan University Shanghai Medical College, Shanghai, China
| | - Aneesh Tolat
- Department of Cardiovascular Medicine, Hartford Healthcare/University of Connecticut, Hartford, Connecticut, USA
| | - Luis R Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Gładysz-Wańha S, Joniec M, Wańha W, Piłat E, Drzewiecka A, Gardas R, Biernat J, Węglarzy A, Gołba KS. Transvenous lead extraction safety and efficacy in infected and noninfected patients using mechanical-only tools: Prospective registry from a high-volume center. Heart Rhythm 2024; 21:427-435. [PMID: 38157921 DOI: 10.1016/j.hrthm.2023.12.015] [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: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a well-established treatment option for patients with cardiac implantable electronic devices (CIED) complications. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of TLE in CIED infection and non-CIED infection patients. METHODS Consecutive patients who underwent TLE between 2016 and 2022 entered the EXTRACT Registry. Models of prediction were constructed for periprocedural clinical and procedural success and the incidence of major complications, including death in 30 days. RESULTS The registry enrolled 504 patients (mean age 66.6 ± 12.8 years; 65.7% male). Complete procedural success was achieved in 474 patients (94.0%) and clinical success in 492 patients (97.6%). The total number of major and minor complications was 16 (3.2%) and 51 (10%), respectively. Three patients (0.6%) died during the procedure. New York Heart Association functional class IV and C-reactive protein levels defined before the procedure were independent predictors of any major complication, including death in 30 days in CIED infection patients. The time since the last preceding procedure and platelet count before the procedure were independent predictors of any major complication, including death in 30 days in non-CIED infection patients. CONCLUSIONS TLE is safe and successfully performed in most patients, with a low major complication rate. CIED infection patients demonstrate better periprocedural clinical success and complete procedural success. However, CIED infection predicts higher 30-day mortality compared with non-CIED infection patients. Predictors of any major complication, including death in 30 days, differ between CIED infection and non-CIED infection patients.
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Affiliation(s)
- Sylwia Gładysz-Wańha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland.
| | - Michał Joniec
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Eugeniusz Piłat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Anna Drzewiecka
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Andrzej Węglarzy
- Department of Anaesthesiology and Intensive Care with Cardiac Supervision, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
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12
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Kutarski A, Jacheć W, Stefańczyk P, Brzozowski W, Głowniak A, Nowosielecka D. Analysis of 1051 ICD Leads Extractions in Search of Factors Affecting Procedure Difficulty and Complications: Number of Coils, Tip Fixation and Position-Does It Matter? J Clin Med 2024; 13:1261. [PMID: 38592112 PMCID: PMC10931966 DOI: 10.3390/jcm13051261] [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: 01/06/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Implantable cardioverter-defibrillator (ICD) leads are considered a risk factor for major complications (MC) during transvenous lead extraction (TLE). Methods: We analyzed 3878 TLE procedures (including 1051 ICD lead extractions). Results: In patients with ICD lead removal, implant duration was almost half as long (69.69 vs. 114.0 months; p < 0.001), procedure complexity (duration of dilatation of all extracted leads, use of more advanced tools or additional venous access) (15.13% vs. 20.78%; p < 0.001) and MC (0.67% vs. 2.62%; p < 0.001) were significantly lower as compared to patients with pacing lead extraction. The procedural success rate was higher in these patients (98.29% vs. 94.04%; p < 0.001). Extraction of two or more ICD leads or additional superior vena cava (SVC) coil significantly prolonged procedure time, increased procedure complexity and use of auxiliary or advanced tools but did not influence the rate of MC. The type of ICD lead fixation and tip position did not affect TLE complexity, complications and clinical success although passive fixation reduces the likelihood of procedural success (OR = 0.297; p = 0.011). Multivariable regression analysis showed that ICD lead implant duration ≥120 months (OR = 2.956; p < 0.001) and the number of coils in targeted ICD lead(s) (OR = 2.123; p = 0.003) but not passive-fixation ICD leads (1.361; p = 0.149) or single coil ICD leads (OR = 1.540; p = 0.177) were predictors of higher procedure complexity, but had no influence on MC or clinical and procedural success. ICD lead implant duration was of crucial importance, similar to the number of leads. Lead dwell time >10 years is associated with a high level of procedure difficulty and complexity but not with MC and procedure-related deaths. Conclusions: The main factors affecting the transvenous removal of ICD leads are implant duration and the number of targeted ICD leads. Dual coil and passive fixation ICD leads are a bit more difficult to extract whereas fixation mechanism and tip position play a much less dominant role.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (A.K.)
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland
| | - Wojciech Brzozowski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (A.K.)
| | - Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (A.K.)
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland
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13
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Jacheć W, Nowosielecka D, Ziaja B, Polewczyk A, Kutarski A. LECOM (Lead Extraction COMplexity): A New Scoring System for Predicting a Difficult Procedure. J Clin Med 2023; 12:7568. [PMID: 38137637 PMCID: PMC10743865 DOI: 10.3390/jcm12247568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis of 3741 TLE procedures with and without complicating factors (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a five-point Complex Indicator of Difficulty of (TLE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicate a higher level of procedure complexity. (3) Results: Patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous procedures, passive fixation and multiple leads to be extracted, and a ratio of dwell time of oldest lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrates that a point total (being the sum of the odds ratios of the above variables) of >9.697 indicates a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, a logistic function was calculated, and we constructed a simple equation for lead extraction complexity that can predict the probability of a difficult procedure. The risk of complex extraction (as a percentage) is calculated as [1/(1 + 55.34 · 0.754X)] · 100 (p < 0.001). (4) Conclusion: The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management.
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Affiliation(s)
- Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Bettina Ziaja
- Department of Cardiology, Specialist Hospital, 41-800 Zabrze, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
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14
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Hayashi K, Callahan T, Rickard J, Younis A, Baranowski B, Martin D, Nakhla S, Tabaja C, Wilkoff BL. Extraction outcomes of implantable cardioverter-defibrillator leads vary by manufacturer and model family. Europace 2023; 25:euad345. [PMID: 38000893 PMCID: PMC10751850 DOI: 10.1093/europace/euad345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads is considered challenging. The structure of each ICD leads is variable between manufacturer and model families. The net impact of lead family on the safety and effectiveness of TLE is poorly characterized. We assessed the safety and efficacy of ICD TLE and the impact of manufacturer ICD model family on the outcomes. METHODS AND RESULTS The study cohort included all consecutive patients with ICD who underwent TLE between 2013 and 2022 and are enrolled in the Cleveland Clinic Prospective TLE Registry. A total of 885 ICD leads (median implant duration 8 years) in 810 patients were included. Complete ICD TLE success was achieved in 97.2% of the leads (n = 860) and in 98.0% of the patients (n = 794). Major complications occurred in 22 patients (2.7%). Complete procedural success rate varied by manufacturer and lead family; Medtronic 98.9%, Abbott 95.9%, Boston Scientific 95.0%, Biotronik 91.2%, P = 0.03, and Linox family leads had the lowest, 89.7% P = 0.02. Multivariable predictors of incomplete ICD lead removal included ICD lead age > 10 years and Linox family lead. Multivariable predictors of major complications included ICD lead age > 15 years and longer lead extraction time, and predictors of all-cause mortality within 30 days included lead extraction for infection, end-stage renal disease, and higher New York Heart Association functional class. CONCLUSION Complete and safe ICD lead removal rate by TLE is extremely high but varied by manufacturer and lead family. Linox family lead and >10 years lead age were independent predictors of incomplete lead removal.
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Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - David Martin
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Chadi Tabaja
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
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15
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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16
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Heck R, Peters B, Lanmüller P, Photiadis J, Berger F, Falk V, Starck C, Kramer P. Transvenous lead extraction in children with bidirectional rotational dissection sheaths. Front Cardiovasc Med 2023; 10:1256752. [PMID: 37745106 PMCID: PMC10515391 DOI: 10.3389/fcvm.2023.1256752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited. Methods We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements. Results Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017). Conclusions TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
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Affiliation(s)
- Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Peters
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Photiadis
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Felix Berger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Steinbeis Hochschule, Steinbeis-Transfer-Institut Kardiotechnik, Berlin, Germany
| | - Peter Kramer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
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17
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Bracke FA, Rademakers LM, van Veghel D. Extraction of non-infected redundant pacing and defibrillator leads does not result in better patient outcomes. Neth Heart J 2023; 31:327-329. [PMID: 37010738 PMCID: PMC10444728 DOI: 10.1007/s12471-023-01770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 04/04/2023] Open
Abstract
The introduction of dedicated tools for pacing and defibrillator lead extraction has resulted in relatively high success and low complication rates. The confidence this elicits has broadened the indications from device infections to non-functional or redundant leads and the latter make up an increasing share of extraction procedures. Proponents of extracting these leads point to the higher complication burden of lead extraction in patients with longstanding abandoned leads when compared one-to-one with extraction when these leads become redundant. However, this does not translate into better patient outcomes on a population level: complications are rare with properly abandoned leads and thus most patients will never be subjected to an extraction procedure and the ensuing complications. Therefore, not extracting redundant leads minimises the risk for the patients and avoids many expensive procedures.
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Affiliation(s)
- Frank A Bracke
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | - Leonard M Rademakers
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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18
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Khalil M, Maqsood MH, Maraey A, Elzanaty A, Saeyeldin A, Ong K, Barbhaiya CR, Chinitz LA, Bernstein S, Shokr M. Sex differences in outcomes of transvenous lead extraction: insights from National Readmission Database. J Interv Card Electrophysiol 2023; 66:1375-1382. [PMID: 36445605 DOI: 10.1007/s10840-022-01438-z] [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: 06/10/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. OBJECTIVE The present study aims at evaluating the impact of sex on outcomes of lead extraction. METHODS We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07-1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02-1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14-3.1), P = 0.014; OR 3.4, 95% CI (1.8-6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18-1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3-2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02-1.17), P < 0.01). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87-1.14), P = 0.95). CONCLUSION In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.
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Affiliation(s)
- Mahmoud Khalil
- Internal Medicine Department, Lincoln Medical and Mental Health Center, New York, NY, USA.
- Cardiovascular Medicine Department, Tanta University, Tanta, Egypt.
| | | | - Ahmed Maraey
- Department of Internal Medicine, CHI St. Alexius Health/University of North Dakota, Bismarck, ND, USA
| | - Ahmed Elzanaty
- Cardiovascular Medicine Department, University of Toledo, Toledo, OH, USA
| | - Ayman Saeyeldin
- Department of Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Kenneth Ong
- Cardiovascular Department, Lincoln Medical and Mental Health Center, New York, NY, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
- Northern Light Cardiology, EMMC Heart Care, Eastern Maine Medical Center, Bangor, ME, USA
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19
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Talaei F, Tan MC, Trongtorsak A, Lee JZ, Rattanawong P. Heart failure is associated with increased risk of all-cause mortality after transvenous lead extraction: A systematic review and meta-analysis. J Arrhythm 2023; 39:596-606. [PMID: 37560268 PMCID: PMC10407184 DOI: 10.1002/joa3.12880] [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] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is increasingly considered in cardiac implantable electronic device management. Heart failure (HF) might be associated with mortality risks after the TLE procedure. This study aims to assess mortality risk in HF patients undergoing TLE. METHOD We searched MEDLINE and Embase databases from inception to June 2022 to identify articles that included patients with and without HF who underwent TLE, which reported mortality in both groups. The pooled effect size was calculated with a random-effects model and 95% CI to compare post-TLE mortality between the two groups. RESULTS Eleven studies were included in the analysis. Each left ventricular ejection fraction (LVEF) increased by 1% was associated with reduced mortality by 2% (HR = 0.98, 95% CI: 0.97-0.99, I 2 = 74.9%, p < .01). The presence of HF compared to those without HF was associated with higher mortality rates (OR: 3.04, 95% CI: 2.56-3.61, I 2 = 0.0%, p < .531). There was a significant increase in the mortality rates in patients with New York Heart Association (NYHA) function class III (OR: 2.29, 95% CI: 1.29-4.06, I 2 = 0.0%, p = .498) and NYHA IV (OR: 8.5, 95% CI: 2.98-24.3, I 2 = 0.0%, p = .997). CONCLUSIONS Our study found that post-TLE mortality decreases by 2% as LVEF increases by 1%, also mortality is higher in patients with NYHA III and IV.
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Affiliation(s)
- Fahimeh Talaei
- Department of Internal MedicineMcLaren Flint HospitalFlintMichiganUSA
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
| | - Min C. Tan
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Justin Z. Lee
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac ArrhythmiasMassachusetts General Hospital Harvard Medical SchoolBostonMassachusettsUSA
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20
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [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: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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21
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Schenker N, Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Safety and Efficacy of Excimer Laser Powered Lead Extractions in Obese Patients: A GALLERY Subgroup Analysis. J Clin Med 2023; 12:4096. [PMID: 37373789 DOI: 10.3390/jcm12124096] [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: 05/19/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood. METHODS AND RESULTS All patients (n = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5-24.9; 25-29.9; 30-34.9; ≥35 kg/m2). Patients with a BMI ≥ 35.0 kg/m2 had the highest prevalence of arterial hypertension (84.2%, p < 0.001), chronic kidney disease (36.8%, p = 0.020) and diabetes mellitus (51.1%, p < 0.001). The rates for procedural minor (p = 0.684) and major complications (p = 0.498), as well as procedural success (p = 0.437), procedure-related (p = 0.533) and all-cause mortality (p = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m2), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06-8.45; p = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31-8.10; p = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03-9.22; p = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08-0.93; p = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03-77.49; p < 0.001). CONCLUSIONS LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients.
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Affiliation(s)
- Niklas Schenker
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, 61231 Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, 47228 Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, 57072 Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, 22457 Hamburg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, 16321 Bernau, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
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22
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Domain G, Strubé C, Jacques F, Marzouk M, Dumont É, Villeneuve J, Plourde B, Albert G, Sarrazin JF, Steinberg C, Philippon F. Superior vena cava tear during transvenous lead extraction: Medical management in hemodynamically stable patients. Pacing Clin Electrophysiol 2023. [PMID: 37196145 DOI: 10.1111/pace.14718] [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: 10/24/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Superior vena cava (SVC) tear is the most lethal complication during transvenous lead extraction (TLE) with a mortality rate as high as 50%. Treatment involves aggressive attempts to maintain cardiac output and immediate sternotomy to localize and repair the vascular tear. Occlusion balloons have been developed to provisionally occlude the lacerated SVC and to provide hemodynamic stability allowing time for surgery. In case of mediastinal hematoma without hemodynamic instability, the strategy remains unclear. METHODS AND RESULTS We describe two cases of SVC tear during TLE. The first case was a 60-year-old man who presented with a right ventricular single-chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28-year-old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual-chamber defibrillator (ICD). CONCLUSION Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.
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Affiliation(s)
- Guillaume Domain
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Camille Strubé
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Frédéric Jacques
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Mohamed Marzouk
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Éric Dumont
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Jacques Villeneuve
- Anesthesiology Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Benoît Plourde
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Gabriella Albert
- Radiology Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Jean-François Sarrazin
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Christian Steinberg
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - François Philippon
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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23
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Arabia G, Mitacchione G, Cersosimo A, Calvi E, Salghetti F, Bontempi L, Giacopelli D, Cerini M, Curnis A. Long-term outcomes following transvenous lead extraction: Data from a tertiary referral center. Int J Cardiol 2023; 378:32-38. [PMID: 36841289 DOI: 10.1016/j.ijcard.2023.02.040] [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: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) has shown a safe and efficacy profile in the intraoperative and short-term setting; however, data on long-term outcomes are limited. OBJECTIVE The purpose of this study was to assess long-term outcomes and prognostic factors in patients who underwent TLE. METHODS Consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were retrospectively studied. The primary outcome was the composite endpoint of death and repeated TLE stratified by infective/non-infective indication. Individual components of the primary outcome were also evaluated. RESULTS One hundred ninety-one patients were included in the analysis, 50% extracted for CIED-related infection. Complete procedural success was achieved in 189 patients (99%) with no major acute complications. After a median of 6.5 years, infection indication was associated with significantly lower event-free survival (67% vs. 83% non-infection group, adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02-3.81, p = 0.04). All-cause mortality rate was higher in the TLE infection group (30% vs. 10%, p < 0.01). The rate of repeated TLE did not differ between groups (4% vs. 7%, p = 0.62). Among patients who had TLE for infection, the presence of vegetation (aHR 2.56; 95%CI 1.17-5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04-6.70, p = 0.04) were independently associated with the primary outcome. CONCLUSION Patients who underwent TLE for CIED-related infection exhibit a high mortality risk during long-term follow-up. Vegetation and positive blood cultures in patients with CIED-related infection are associated with a worse prognosis regardless of successful and uncomplicated TLE.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy.
| | | | - Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Emiliano Calvi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Francesca Salghetti
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Luca Bontempi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Cologno Monzese (MI), Italy; Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
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24
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Hayashi K, Younis A, Callahan T, Baranowski B, Martin DO, Nakhla S, Wilkoff BL. Clinical Predictors of Incomplete CS Lead Removal during Transvenous Lead Extraction in the Patients with Cardiac Resynchronization Therapy. Heart Rhythm 2023; 20:872-878. [PMID: 36933853 DOI: 10.1016/j.hrthm.2023.03.015] [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: 01/16/2023] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Reports of coronary sinus (CS) lead removal include small studies with short implant durations. Procedural outcomes for mature CS leads removed with long duration implantation are unavailable. OBJECTIVE To examine the safety, efficacy, and clinical predictors for incomplete CS lead removal by Transvenous Lead Extraction (TLE) in a large, long implant duration cardiac resynchronization therapy (CRT) patient cohort. METHODS Consecutive patients with CRT devices in the Cleveland Clinic Prospective TLE Registry who had TLE between 2013 and 2022. RESULTS CS leads, n=231, implant duration = 6.1±4.0 years, removed from 226 patients were included, employing powered sheaths for 137 leads (59.3%). Complete CS lead success was achieved in 95.2% of leads (n=220) and in 95.6% of patients (n=216). Major complications occurred in 5 patients (2.2%). Patients who had the CS lead extracted 1st had significantly higher incomplete removal rates than when the other leads were 1st removed. Multivariable analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent predictors of incomplete CS lead removal. CONCLUSION Complete and safe lead removal rate of long implant duration CS leads by TLE was 95%. However, CS lead age and the order that leads were extracted were the independent predictors of incomplete CS lead removal. Therefore, before the CS lead is extracted, physicians should first extract the leads from the other chambers and employ powered sheaths.
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Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - David O Martin
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
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25
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Villegas EG, Juárez Del Río JI, Carmona JCR, Valdíris UR, Peinado ÁA, Peinado RP. Efficacy and safety of the extraction of cardiostimulation leads using a mechanical dissection tool. A single center experience. Pacing Clin Electrophysiol 2023; 46:217-225. [PMID: 36401870 DOI: 10.1111/pace.14625] [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: 07/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). METHODS A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X-ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. RESULTS A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). CONCLUSION In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.
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26
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Migliore F, Pittorru R, Dall'Aglio PB, De Lazzari M, Rovaris G, Piazzi E, Dentico A, Ferrieri A, D'Angelo G, Marzi A, Sawaf BE, Bertaglia E, Iliceto S, Gerosa G, Tarzia V, Carretta D, Mazzone P. Outcomes of transvenous lead extraction of very old leads using bidirectional rotational mechanical sheaths: Results of a multicentre study. J Cardiovasc Electrophysiol 2023; 34:728-737. [PMID: 36477909 DOI: 10.1111/jce.15767] [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: 10/07/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lead dwell time >10 years is a recognized predictor for transvenous lead extraction (TLE) failure and complications. Data on the efficacy and safety of TLE using the bidirectional rotational mechanical sheaths in patients with very old leads are lacking. In this multicenter study, we reported the outcomes of transvenous rotational mechanical lead extraction in patients with leads implanted for ≥10 years. METHODS A total of 441 leads (median: 159 months [135-197]; range: 120-487) in 189 consecutive patients were removed with the Evolution RL sheaths (Cook Medical, Bloomingtom, IN, USA) and mechanical ancillary tools supporting the procedures. RESULTS The main indication for TLE was infection in 74% of cases. Complete procedural success rate, clinical success rate, per lead were 94.8% and 98.2%, respectively. Failure of lead extraction was seen in 1.8% of leads. The additional use of a snare via the femoral approach was required in 9% of patients. Lead dwell time was the only predictor of incomplete led removal (odds ratio: 1.009; 95% confidence interval [CI]: 1.003-1.014; p = .002). Four major complication (2%) were encountered. During a mean time follow-up of 31 ± 27 months, 21 patients (11%) died. No procedure-related mortality occurred. Predictors of mortality included severe left ventricular systolic dysfunction (hazard ratio [HR]: 8.06; 95% CI: 2.99-21.73; p = .001), TLE for infection (HR: 8.0; 95% CI: 1.04-62.5; p = .045), diabetes (HR: 3.7; 95% CI: 1.48-9.5; p = .005), and previous systemic infection (HR: 3.1; 95% CI: 1.17-8.24; p = .022). Incomplete lead removal or failure lead extraction did not impact on survival during follow-up. CONCLUSION Our findings demonstrated that the use of bidirectional rotational TLE mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in patients with very old leads at experienced specialized centers.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Elena Piazzi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Alessia Dentico
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Alessandra Ferrieri
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Giuseppe D'Angelo
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Alessandra Marzi
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Basma El Sawaf
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Carretta
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Patrizio Mazzone
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
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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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28
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Ząbek A, Boczar K, Ulman M, Holcman K, Kostkiewicz M, Pfitzner R, Dębski M, Musiał R, Lelakowski J, Małecka B. Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre. Europace 2023; 25:1100-1109. [PMID: 36660771 PMCID: PMC10062326 DOI: 10.1093/europace/euac272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/15/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems. METHODS AND RESULTS Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B. CONCLUSION The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.
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Affiliation(s)
- Andrzej Ząbek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, 12 Świętej Anny Street, 31-008, Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland
| | - Mateusz Ulman
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, The John Paul II Hospital, 80 Prdnicka Street, 31-202, Krakow, Poland
| | - Magdalena Kostkiewicz
- Institute of Cardiology, Jagiellonian University Medical College, 12 Świętej Anny Street, 31-008, Krakow, Poland.,Department of Cardiac and Vascular Diseases, The John Paul II Hospital, 80 Prdnicka Street, 31-202, Krakow, Poland
| | - Roman Pfitzner
- Institute of Cardiology, Jagiellonian University Medical College, 12 Świętej Anny Street, 31-008, Krakow, Poland.,Department of Cardiac and Vascular Surgery, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland
| | - Maciej Dębski
- Department of Cardiology, Norfolk and Norwich University Hospital, University of East Anglia, Norwich NR4 7TJ, UK
| | - Robert Musiał
- Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Krakow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, 12 Świętej Anny Street, 31-008, Krakow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka Street, 31-202, Krakow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, 12 Świętej Anny Street, 31-008, Krakow, Poland
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Xiao Z, He J, Du A, Yang D, An Y, Li X. Predictors for adverse events during cardiac lead extraction - Experience from a large single centre. Int J Cardiol 2023; 371:167-174. [PMID: 36272572 DOI: 10.1016/j.ijcard.2022.10.008] [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: 07/14/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND As the use of cardiac implantable electronic devices (CIED) has increased in recent years, the need for transvenous lead extraction (TLE) has also steadily increased. However, the TLE procedure could lead to serious complications and even death. Clinical decision-making tools are necessary for predicting these adverse events, but the appropriate tools have not yet been developed. OBJECTIVE To explore the possible predictors and develop a clinical model to predict TLE related adverse events. METHODS All the patients who were admitted to our cardiac center for TLE from January 2014 to January 2021 were included in this study. The patient information, device baseline characteristics, procedure-related information, complications and outcomes were recorded. Independent predictors of TLE related adverse events were identified by univariate, LASSO and multivariate analysis. A nomogram for predicting these adverse events was developed based on these independent predictors. Calibration and decision curve analysis were conducted to evaluate the nomogram. RESULTS One thousand and one hundred patients were included in this study, 778 (70.7%) were male and the median age was 68 years old. A total of 2,208 leads were extracted and 2.01±0.74 leads were extracted per procedure. Fifty-five patients (5%) developed adverse events including minor complications (2.4%), major complications (2.3%) and death (0.27%). Seven independent predictors for TLE related adverse events were identified and selected to establish the nomogram including BMI, female gender, hypoalbuminemia, number of extracted leads>3, longest dwell time of the extracted leads and manual traction. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.774. Calibration curve and decision curve analysis showed that the nomogram had good prediction performance. CONCLUSION TLE related adverse events are some of the key issues that concern clinicians. We have identified seven independent factors and established a predictive model that may help clinicians identify at-risk patients and create better plans for lead extraction.
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Affiliation(s)
- Zengli Xiao
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Jinshan He
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Anqi Du
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Dandan Yang
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Youzhong An
- Intensive care unit, Peking University People's Hospital, Beijing, China.
| | - Xuebin Li
- Cardiovascular department, Peking University People's Hospital, Beijing, China.
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Tan MC, Talaei F, Trongtorsak A, Lee JZ, Rattanawong P. Chronic kidney disease is associated with increased all-cause mortality in transvenous lead extraction: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2023; 46:66-72. [PMID: 36441922 DOI: 10.1111/pace.14631] [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: 08/12/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well-established. We performed a systematic review and meta-analysis to explore the association between CKD and all-cause mortality in TLE. METHODS We searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random-effects model. RESULTS Eight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all-cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65-2.77, I2 = 51.1%, p < .001). The risk of overall all-cause mortality increased with the severity of CKD for nonspecific CKD (HR = 2.01, 95% CI: 1.49-2.69, I2 = 53.4, p < .001) and ESRD (HR = 2.79, 95% CI: 1.85-4.23, I2 = 0%, p < .001). The risk of all-cause mortality in CKD is double at follow-up ≤1 year (HR = 1.99, 95% CI: 1.29-3.09, I2 = 50.9%, p = .002) and higher at follow-up >1 year (HR = 2.36, 95% CI: 1.63-3.42, I2 = 59.7%, p < .001). CONCLUSIONS Our meta-analysis demonstrates a significantly increased risk of overall all-cause mortality in patients with CKD who underwent TLE compared to controls.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, McLaren Flint Hospital, Flint, Michigan, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Mizuno T, Goya M, Fujiwara T, Oishi K, Takeshita M, Yashima M, Nagaoka E, Oi K, Sasano T. Surgical extraction of cardiac implantable electronic device leads based on a heart team approach. J Cardiol 2023; 81:111-116. [PMID: 36229301 DOI: 10.1016/j.jjcc.2022.08.013] [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: 05/23/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND As cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy. This study aimed to investigate the validity of this heart team decision-making. METHODS From 2013 to 2021, 384 consecutive patients underwent lead extraction at our institution. RESULTS SLE was proposed as the primary intervention for 21 patients who had high risk of bleeding, difficult TVLE conditions, large vegetations, and other concomitant cardiac diseases. Of the 363 TVLE patients, 10 patients required surgical intervention; 5 had TVLE difficulty followed by SLE and 5 had excessive bleeding. SLE was performed in 26 patients, 19 of whom required valve surgery, and 8 required plication of the great veins. In 4 of the 17 hybrid procedures with SLE and TVLE, excessive bleeding occurred due to laceration of the superior vena cava and innominate vein. Operative mortality was not observed in SLE patients but was observed in 1 of the 4 TVLE patients who required emergent open-chest hemostasis. CONCLUSIONS The heart team discussion was essential to provide optimal treatment and maintain medical safety policies for each patient. SLE should be selected for patients with high risk of TVLE or other cardiac complications such as tricuspid valve incompetence.
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Affiliation(s)
- Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan; Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Masahiko Goya
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Takeshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Transvenous lead extractions in a single high-volume center over 24 years: High success rate and low complication rate. Heart Rhythm O2 2023; 4:232-240. [PMID: 37124554 PMCID: PMC10134393 DOI: 10.1016/j.hroo.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Transvenous lead extraction (TLE) procedures can be complicated and are associated with a small but significant risk of cardiovascular complications. However, methods and tools vary among centers. Objective The purpose of this study was to the present the methods and results of pacemaker and implantable cardioverter-defibrillator TLE procedures in our center over a 24-year period. Methods From April 1997 through 2020, we attempted to extract 2964 leads in 1780 procedures and 1642 patients. We mainly utilized single sheath technique using snaring or mechanical rotational sheaths and steel sheaths when necessary. Difficult procedures were performed by an experienced cardiologist, and close supervision was emphasized. Most of the extractions were performed using local anesthesia with sedation. Results Median age of patients was 65.0 [interquartile range 20.00] years, and median dwelling time of leads was 5.0 [7.0] years. Clinical success was achieved in 1739 procedures (97.7%) and complete technical success in 2841 leads (95.8%). Clinical success (leaving <4 cm of the lead in the body and achieving the clinical goal for the patient) was achieved for 79 leads (2.7%). TLE failed in 44 leads (1.1%) and 41 procedures (2.3%) among 36 patients (2.2%). There were 23 cases (1.3%) of major complications, with only 1 death directly related to the procedure (<0.1%). In addition, 2 patients with sepsis died within the first 24 hours after the procedure. No caval tears occurred. Conclusion Single sheath lead extractions utilizing snaring or mechanical rotational sheaths were effective and safe in our high-volume center as performed by experienced operators.
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Tułecki Ł, Jacheć W, Polewczyk A, Czajkowski M, Targońska S, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. Assessment of the impact of organisational model of transvenous lead extraction on the effectiveness and safety of procedure: an observational study. BMJ Open 2022; 12:e062952. [PMID: 36581437 PMCID: PMC9806044 DOI: 10.1136/bmjopen-2022-062952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the impact of the organisational model of transvenous lead extraction (TLE) on effectiveness and safety of procedures. DESIGN Post hoc analysis of patient data entered prospectively into a computer database. SETTING Data of all patients undergoing TLE in three centres in Poland between 2006 and 2021 were analysed. PARTICIPANTS 3462 patients including: 985 patients undergoing TLE in a hybrid room (HR), with cardiac surgeon (CS) as co-operator, under general anaesthesia (GA), with arterial line (AL) and with transoesophageal echocardiography (TEE) monitoring (group 1), 68 patients-TLE in HR with CS, under GA, without TEE (group 2), 406 patients-TLE in operating theatre (OT) using 'arm-C' X-ray machine with CS under GA and with TEE (group 3), 154 patients-TLE in OT with CS under GA, without TEE (group 4), 113 patients-TLE in OT with anaesthesia team, using the 'arm-C' X-ray machine, without CS (group 5), 122 patients-TLE in electrophysiology lab (EPL), with CS under intravenous analgesia without TEE and AL (group 6), 1614 patients-TLE in EPL, without CS, under intravenous analgesia without TEE and AL (group 7). KEY OUTCOME MEASURE Effectiveness and safety of TLE depending on organisational model. RESULTS The rate of major complications (MC) was higher in OT/HR than in EPL (2.66% vs 1.38%), but all MCs were treated successfully and there was no MC-related death. The use of TEE during TLE increased probability of complete procedural succemss achieving about 1.5 times (OR=1.482; p<0.034) and were connected with reduction of minor complications occurrence (OR=0.751; p=0.046). CONCLUSIONS The most important condition to avoid death due to MC is close co-operation with cardiac surgery team, which permits for urgent rescue cardiac surgery. Continuous TEE monitoring plays predominant role in immediate decision on rescue sternotomy and improves the effectiveness of procedure.
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Affiliation(s)
- Łukasz Tułecki
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Wojciech Jacheć
- Cardiology, Faculty of Medical Science, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Physiology, Patophysiology and Clinical Immunology, Jan Kochanowski University of Kielce Collegium Medicum, Kielce, Poland
- Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | | | | | - Konrad Tomków
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Kamil Karpeta
- Cardiac Surgery, Masovian Specialistic Hospital, Radom, Poland
| | - Dorota Nowosielecka
- Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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Atteya G, Alston M, Sweat A, Saleh M, Beldner S, Mitra R, Willner J, John RM, Epstein LM. Same-day discharge after transvenous lead extraction: feasibility and outcomes. Europace 2022; 25:586-590. [PMID: 36575941 PMCID: PMC9934987 DOI: 10.1093/europace/euac185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/31/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS Same-day discharge (SDD) is safe for patients undergoing electrophysiology procedures. There is no existing data regarding SDD for patients undergoing transvenous lead extraction (TLE). We report our experience with SDD for patients undergoing TLE. METHODS AND RESULTS The study group included patients undergoing TLE between February 2020 and July 2021 without an infectious indication. A modified SDD protocol for device implants/ablations was applied to TLE patients. Patient characteristics, extraction details, outcomes, and complications were reviewed. Of 239 patients undergoing TLE, 210 were excluded (94 infections and 116 did not meet SDD criteria). Of the remaining 29 patients, seven stayed due to patient preference and 22 were discharged home the same day. The SDD group had an average age of 65.9 ± 12 (47-84), 41% female, and LVEF of 52.2 ± 18% (10-80). The indication for TLE was malfunction (20), upgrade (4), advisory lead (2), and magnetic resonance imaging compatibility (1). Extractions included four implantable cardioverter-defibrillators (ICDs), 17 pacemakers (PPM), and one cardiac resynchronization therapy (CRT)-P system. The leads were 9.6 years (1.5-21.7) old, and 1.8 leads were removed per patient (1-3); the lead extraction difficulty (LED) score was 11.6 ± 7. Twenty underwent cardiovascular implantable electronic device (CIED) re-implantation (2 ICD, 3 CRT-D, 13 PPM, and 2 CRT-P). For CIED re-implants, patients sent a remote transmission the next day, and all patients received a next-day call. There were no procedure or device-related issues, morbidities, or mortalities in the 30 days after discharge. CONCLUSION Same-day discharge after TLE for non-infectious aetiologies is safe and feasible in a select group of patients with early procedure completion who meet strict SDD criteria.
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Affiliation(s)
- Gourg Atteya
- Corresponding author. Tel: 516 562-1430, Fax: 516 562-3978, E-mail address:
| | - Michael Alston
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Austin Sweat
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Moussa Saleh
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Stuart Beldner
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Raman Mitra
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Jonathan Willner
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Roy M John
- Stanford School of Medicine Cardiology, 300 Pasteur Drive, 2nd Floor, Palo Alto, CA 94305, USA
| | - Laurence M Epstein
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
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Lee JZ, Tan MC, Karikalan S, Deshmukh AJ, Sorajja D, Valverde A, Srivathsan K, Scott L, Kusumoto FM, Friedman PA, Asirvatham SJ, Mulpuru SK, Cha YM. Causes of Early Mortality After Transvenous Lead Removal. JACC Clin Electrophysiol 2022; 8:1566-1575. [PMID: 36543507 DOI: 10.1016/j.jacep.2022.08.006] [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: 04/26/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. OBJECTIVES This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. METHODS A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. RESULTS A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. CONCLUSIONS The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Fred M Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Kutarski A, Jacheć W, Nowosielecka D, Czajkowski M, Tułecki Ł, Polewczyk A. Repeat Transvenous Lead Extraction-Predictors, Effectiveness, Complications and Long-Term Prognostic Significance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15602. [PMID: 36497674 PMCID: PMC9740863 DOI: 10.3390/ijerph192315602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. METHODS Retrospective analysis of a large single-center database of 3654 TLEs. RESULTS Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. CONCLUSIONS Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University, 20-059 Lublin, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
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Chung DU, Pecha S, Burger H, Anwar O, Eickholt C, Nägele H, Reichenspurner H, Gessler N, Willems S, Butter C, Hakmi S. Atrial Fibrillation and Transvenous Lead Extraction-A Comprehensive Subgroup Analysis of the GermAn Laser Lead Extraction RegistrY (GALLERY). MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111685. [PMID: 36422224 PMCID: PMC9697767 DOI: 10.3390/medicina58111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the procedural outcome and risk-factors of patients with atrial fibrillation (AF) undergoing TLE. Methods: We performed a subgroup analysis of all AF patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for all-cause mortality were assessed. Results: A total number of 510 patients with AF were identified with a mean age of 74.0 ± 10.3 years. Systemic infection (38.4%) was the leading cause for TLE, followed by local infection (37.5%) and lead dysfunction (20.4%). Most of the patients (45.9%) presented with pacemaker systems to be extracted. The total number of leads was 1181 with a 2.3 ± 0.96 leads/patient. Clinical procedural success was achieved in 97.1%. Occurrence of major complications was 1.8% with a procedure-related mortality of 1.0%. All-cause mortality was high with 5.9% and septic shock being the most common cause. Systemic device infection (OR: 49.73; 95% CI: 6.56−377.09, p < 0.001), chronic kidney disease (CKD; OR: 2.67; 95% CI: 1.01−7.03, p = 0.048) and a body mass index < 21 kg/m2 (OR: 6.6; 95% CI: 1.68−25.87, p = 0.007) were identified as independent predictors for all-cause mortality. Conclusions: TLE in AF patients is effective and safe, but in patients with systemic infection the mortality due to septic shock is high. Systemic infection, CKD and body mass index <21 kg/m2 are risk factors for death in patient with AF undergoing TLE.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, 61231 Bad Nauheim, Germany
| | - Omar Anwar
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Christian Eickholt
- Department of Internal Medicine & Cardiology, Hospital Itzehoe, 25524 Itzehoe, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, 22457 Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, 16816 Neuruppin, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Correspondence:
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Kutarski A, Jacheć W, Polewczyk A, Nowosielecka D, Miszczak-Knecht M, Brzezinska M, Bieganowska K. Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14594. [PMID: 36361474 PMCID: PMC9657280 DOI: 10.3390/ijerph192114594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lead management in children and young adults is still a matter of debate. METHODS To assess the course of transvenous lead extraction (TLE) in adults with pacemakers implanted in childhood (CIP) we compared 98 CIP patients with a control group consisting of adults with pacemakers implanted in adulthood (AIP). RESULTS CIP patients differed from AIP patients with respect to indications for TLE and pacing history. CIP patients were four-eight times more likely to require second-line or advanced tools. Furthermore, CIP patients more often than AIP were prone to developing complications: major complications (MC) (any) 2.6 times; hemopericardium 3.2 times; severe tricuspid valve damage 4.4 times; need for rescue cardiac surgery 3.7 times. The rate of procedural success was 11% lower because of 4.8 times more common lead remnants and 3.1 times more frequent permanently disabling complications. CONCLUSIONS Due to system-related risk factors TLE in CIP patients is more difficult and complex. TLE in CIP is associated with an increased risk of MC and incomplete lead removal. A conservative strategy of lead management, acceptable in very old patients seems to be less suitable in CIP because it creates a subpopulation of patients at high risk of major complications during TLE in the future.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University, 41-800 Katowice, Poland
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Maria Miszczak-Knecht
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Monika Brzezinska
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Katarzyna Bieganowska
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
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Patel D, Vatterott P, Piccini J, Epstein LM, Hakmi S, Syed I, Koweek LM, Bolen M, Schoenhagen P, Tarakji KG, Francis N, Shao M, Wilkoff BL. Prospective Evaluation of the Correlation Between Gated Cardiac Computed Tomography Detected Vascular Fibrosis and Ease of Transvenous Lead Extraction. Circ Arrhythm Electrophysiol 2022; 15:e010779. [PMID: 36306341 PMCID: PMC10503543 DOI: 10.1161/circep.121.010779] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Difficulty of lead extraction does not track well with procedural complications, but several small retrospective studies have lead fibrosis on computed tomography as an important indicator of difficult lead extraction. The purpose of the present study was to apply a standardized gated cardiac computed tomography (CT) protocol to assess fibrosis and study it prospectively to examine the need for powered sheaths and risk outcomes. METHODS We performed a prospective, blinded, multicenter, international study at high-volume lead extraction centers and included patients referred for transvenous lead extraction with at least one lead with a dwell time >1 year and ability to receive a cardiac CT. The degree of fibrosis (as measured by amount of lead adherence to vessel wall) was graded on a scale of 1 to 4 by dedicated CT readers in 3 zones (vein entry to superior vena cava, superior vena cava, and right atrium to lead tip). The primary outcome of the study was number of extractions requiring powered sheaths at zone 2 for each fibrosis group. RESULTS A total of 200 patients were enrolled in the trial with 196 completing full gated CT and lead extraction analysis. The primary endpoint of powered sheath (laser and mechanical) sheath use was significantly higher in patients with higher fibrosis seen on CT (scores 3+4; 67.8%) at the zone 2 compared to patients with lower fibrosis (scores 1+2; 38.6%; P<0.001). There were 5 major complications with 3 vascular lacerations all occurring in zone 2 in the study. CONCLUSIONS Gated, contrasted CT can predict the need for powered sheaths by identification of fibrosis but did not identify an absolute low-risk cohort who would not need powered sheaths. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03772704.
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Affiliation(s)
- Divyang Patel
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
| | | | | | | | - Samer Hakmi
- University Heart Center Hamburg, Germany (S.H.)
| | - Imran Syed
- Allina Health Minneapolis, MN (P.V., I.S.)
| | | | - Michael Bolen
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
| | | | | | | | - Mingyuan Shao
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
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Kutarski A, Głowniak A, Kosior J, Jacheć W, Nowosielecka D, Czajkowski M, Polewczyk A. Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years-A Large Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14184. [PMID: 36361063 PMCID: PMC9655673 DOI: 10.3390/ijerph192114184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. METHODS Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10-20 years, 20-30 years (old) and over 30 years (very old). RESULTS Rate of removal of old and very old leads almost doubles with successive five-year periods (3-6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium-from 0.3 to 12.1%, severe tricuspid valve damage-from 0.2 to 2.1%, need for rescue cardiac surgery-from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10-20 years increases 6.7 times, aged 20-30 years-14.3 times (amounting to 8.4%), and aged 30 and more years-20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. CONCLUSIONS 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital in Radom, 20-617 Radom, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, Pope John Paul II Hospital of Zamość, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
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41
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Rotational mechanical dilator sheaths for effective transvenous lead extraction. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
An exponential rise in clinical demand for cardiac implantable electronic device (CIED) therapy is observed all over the world due to the rapidly expanding lifespan. Accordingly, appropriate lead management including lead extraction is becoming increasingly essential components for the comprehensive care of patients with various CIEDs.
Main body
With a high success rate and a low complication rate, transvenous lead extraction (TLE) has now been established as first-line therapy for lead extraction. However, TLE is often challenging when there are heavily calcified fibrous adhesions between leads and cardiovascular structures. Recently, rotational mechanical dilator (RMD) sheaths were introduced to resolve this issue and facilitate TLE procedure. There are two types of commercially available RMD sheaths, Evolution® systems and TightRail™. Thorough knowledge of the proper use of the RMD devices is essential to increase success rate and to reduce complications of TLE. In the present review, mechanical features, various techniques, and clinical data of RMD sheaths will be described.
Conclusion
According to recent advancement of device technology, the clinical outcomes of TLE using the RMD sheaths are continuously improving. However, as the RMD sheath is a potentially aggressive tool, special care should be taken when used in patients with longer lead ages.
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Polewczyk A, Jacheć W, Nowosielecka D, Tomaszewski A, Brzozowski W, Szczęśniak-Stańczyk D, Duda K, Kutarski A. Tricuspid Valve Damage Related to Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912279. [PMID: 36231579 PMCID: PMC9566121 DOI: 10.3390/ijerph191912279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. METHODS This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed. RESULTS In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1-5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE. CONCLUSIONS Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE.
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Affiliation(s)
- Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Andrzej Tomaszewski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | - Wojciech Brzozowski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | | | - Krzysztof Duda
- Department of Cardiac Surgery, Masovian Specialistic Hospital, 26-617 Radom, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
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Patient Characteristics, Procedural Characteristics, and Outcomes in Patients Having Lead Extraction in a High-Volume Center. Am J Cardiol 2022; 176:51-57. [PMID: 35613955 DOI: 10.1016/j.amjcard.2022.04.022] [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] [Received: 01/28/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/22/2022]
Abstract
The rate of transvenous lead extraction (TLE) is increasing, with an increasing rate of complex devices being implanted. TLE is now a routine part of cardiac device management and up-to-date data on the safety and efficacy of TLE with modern tools and techniques is essential to management decisions regarding noninfectious indications for lead extraction. We present a contemporary, prospective review of TLE at our high-volume cardiac center. All patients who underwent TLE from June 2016 to June 2019 were enrolled in our local database, and baseline clinical data, procedural information, and outcome data were collected. In total, 561 leads were explanted (n = 153) or extracted (n = 408) from 341 patients over the study period. Patients were predominantly male (71%), with a mean age of 65 ± 17 years. The most common indication for lead removal was lead failure (45.2%, n = 154), followed by infection of the pocket or device (29.3%, n = 100). In total, complete success was achieved in 96.4% (n = 541) leads, clinical success in a further 2.1% (n = 12), and failure only in 1.4% (n = 8). There was an overall complication rate of 0.9% (3/341) for major complications and 1.5% (5/341) for minor complications. There were no deaths. In conclusion, our data suggest that there are ongoing improvements in the safety profile and success rates of lead extraction undertaken by experienced operators. The major complication rate now is <1%.
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Leo M, Sharp AJ, Gala ABE, Pope MTB, Betts TR. Transvenous or subcutaneous implantable cardioverter defibrillator: a review to aid decision-making. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01299-6. [PMID: 35835888 DOI: 10.1007/s10840-022-01299-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is a proven treatment for preventing sudden cardiac death. Transvenous leads are associated with significant mortality and morbidity, and the subcutaneous ICD (S-ICD) addresses this. However, it is not without limitations, in particular the absence of anti-tachycardia pacing. The decision of which device is most suitable for an individual patient is often complex. Here, we review the relative merits and weaknesses of both the transvenous and S-ICD. We summarise the available evidence for each device in particular patient cohorts, namely: ischaemic and non-ischaemic cardiomyopathy, idiopathic ventricular fibrillation, Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and hypertrophic cardiomyopathy.
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Affiliation(s)
- Milena Leo
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander J Sharp
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Andre Briosa E Gala
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael T B Pope
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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45
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Pecha S, Burger H, Chung DU, Möller V, Madej T, Maali A, Osswald B, De Simone R, Monsefi N, Ziaukas V, Erler S, Elfarra H, Perthel M, Wehbe MS, Ghaffari N, Sandhaus T, Busk H, Schmitto JD, Bärsch V, Easo J, Albert M, Treede H, Nägele H, Zenker D, Hegazy Y, Ahmadi D, Gessler N, Ehrlich W, Romano G, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. The GermAn Laser Lead Extraction GallerY: GALLERY. Europace 2022; 24:1627-1635. [PMID: 35718878 DOI: 10.1093/europace/euac056] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS The GermAn Laser Lead Extraction GallerY (GALLERY) is a retrospective, national multicentre registry, investigating the safety and efficacy of laser lead extraction procedures in Germany. METHODS AND RESULTS Twenty-four German centres that are performing laser lead extraction have participated in the registry. All patients, treated with a laser lead extraction procedure between January 2013 and March 2017, were consecutively enrolled. Safety and efficacy of laser lead extraction were investigated. A total number of 2524 consecutive patients with 6117 leads were included into the registry. About 5499 leads with a median lead dwell time of 96 (62-141) months were treated. The mean number of treated leads per patient was 2.18 ± 1.02. The clinical procedural success rate was 97.86% and the complete lead removal was observed in 94.85%. Additional extraction tools were used in 6.65% of cases. The rate of procedural failure was 2.14% with lead age ≥10 years being its only predictor. The overall complication rate was 4.32%, including 2.06% major and 2.26% minor complications. Procedure-related mortality was 0.55%. Female sex and the presence of abandoned leads were predictors for procedure-related complications. The all-cause in-hospital mortality was 3.56% with systemic infection being the strongest predictor, followed by age ≥75 years and chronic kidney disease. CONCLUSION In the GALLERY, a high success- and low procedure-related complication rates have been demonstrated. In multivariate analysis, female sex and the presence of abandoned leads were predictors for procedure-related complications, while the presence of systemic infection, age ≥75 years, and chronic kidney disease were independent predictors for all-cause mortality.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Viviane Möller
- Department of Cardiology, Heart Center Brandenburg and Brandenburg Medical School, Bernau, Germany
| | - Tomas Madej
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Alaa Maali
- Department of Cardiovascular Surgery, MediClin Heart Center, Coswig, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadeja Monsefi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Virgilijus Ziaukas
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Stefan Erler
- Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany
| | - Hamdi Elfarra
- Department for Cardiovascular Surgery, Hospital of the Philipps-University of Marburg, Marburg, Germany
| | - Mathias Perthel
- Department of Cardiac Surgery, Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - Mahmoud S Wehbe
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Henning Busk
- Division of Cardiothoracic Surgery, University Hospital of Magdeburg, Magdeburg, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Volker Bärsch
- Department of Cardiology, St Marien Hospital, Siegen, Germany
| | - Jerry Easo
- Department of Cardiac Surgery, University Hospital Essen, Essen, Germany
| | - Marc Albert
- Department of Cardiac Surgery, Robert-Bosch Hospital, Stuttgart, Germany
| | - Hendrik Treede
- Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | - Dieter Zenker
- Department of Thoracic and Cardiovascular Surgery, Georg August University Medical Center, Göttingen, Germany
| | - Yasser Hegazy
- Department of Cardiac Surgery, MediClin Heart Institute, Lahr/Baden, Germany
| | - Donja Ahmadi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Wolfgang Ehrlich
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg and Brandenburg Medical School, Bernau, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
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Tarakji KG, Korantzopoulos P, Philippon F, Biffi M, Mittal S, Poole JE, Kennergren C, Lexcen DR, Lande JD, Hilleren G, Seshadri S, Wilkoff BL. Risk factors for hematoma in patients undergoing cardiac device procedures: A WRAP-IT trial analysis. Heart Rhythm O2 2022; 3:466-473. [PMID: 36340491 PMCID: PMC9626743 DOI: 10.1016/j.hroo.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Implant site hematoma is a known complication of cardiac device procedures and can lead to major consequences. Objectives To evaluate risk factors for hematoma and further understand the relationship between anticoagulant (AC), antiplatelet (AP) use, and hematoma development. Methods We included 6800 patients from the WRAP-IT trial. To assess baseline and procedural characteristics associated with hematoma within the first 30 days postprocedure, a stepwise Cox regression model was implemented with minimal Akaike information criterion. Cox regressions were also used to evaluate AC/AP use and hematoma risk. Results The overall rate of hematoma was 2.2%. The model identified 11 baseline and procedural characteristics associated with hematoma risk. AC use (hazard ratio [HR]: 2.44, P < .001), lower body mass index (HR: 1.06, P < .001), and history of valve surgery (HR: 2.11, P < .001) were associated with the highest risk. AP use, male sex, history of coronary artery disease, existing pocket, history of nonischemic cardiomyopathy, number of previous cardiac implantable electronic device (CIED) procedures, procedure time, and lead revision were associated with moderate risk. Antithrombotic use was high overall (86%) and AC+AP use was highly predictive of hematoma risk. Regardless of AC status, AP use was associated with an almost doubling of risk vs no AP (HR = 1.85, P = .0006) in the general cohort. Interruption of AC was associated with the lowest hematoma risk (HR = 2.35) while heparin bridging (HR = 4.98) and AP use vs no AP use (HR = 1.85) was associated with the highest hematoma risk. Conclusion The results of this analysis highlight risk factors associated with the development of hematoma in patients undergoing CIED procedures and can inform antithrombotic management.
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Safety and Effectiveness of Transvenous Lead Extraction in Patients with Infected Cardiac Resynchronization Therapy Devices; Is It More Risky than Extraction of Other Systems? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105803. [PMID: 35627340 PMCID: PMC9141355 DOI: 10.3390/ijerph19105803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023]
Abstract
Background: Transvenous lead extraction (TLE) in patients with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices is considered as more risky. The aim of this study was to assess the safety and effectiveness of TLE in patients with infected CRT systems. Methods: Data of 3468 patients undergoing TLE in a single high-volume center in years 2006−2021 were analyzed. The clinical and procedural parameters as well as the efficacy and safety of TLE were compared between patients with infected CRT and pacemakers (PM) and ICD systems. Results: Infectious indications for TLE occurred in 1138 patients, including 150 infected CRT (112 CRT-D and 38 CRT-P). The general health condition of CRT patients was worse with higher Charlson’s comorbidity index. The number of extracted leads was higher in the CRT group, but implant duration was significantly longer in the PM than in the ICD and CRT groups (98.93 vs. 55.26 vs. 55.43 months p < 0.01). The procedure was longer in duration, more difficult, and more complex in patients with pacemakers than in those in the CRT group. The occurrence of major complications and clinical and procedural success as well as procedure-related death did not show any relationship to the type of CIED device. Mortality at more than one-year follow-up after TLE was significantly higher among patients with CRT devices (22.7% vs. 8.7%) than among those in the PM group. Conclusion: Despite the greater burden of lead and comorbidities, the complexity and efficiency of removing infected CRT systems is no more dangerous than removing other infected systems. The duration of the implant seems to play a dominant role.
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Tułecki Ł, Czajkowski M, Targońska S, Polewczyk A, Jacheć W, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. The role of cardiac surgeon in transvenous lead extraction: experience from 3462 procedures. J Cardiovasc Electrophysiol 2022; 33:1357-1365. [PMID: 35474258 DOI: 10.1111/jce.15510] [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: 12/29/2021] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The professional society guidelines recommend that transvenous lead extraction (TLE) operating teams collaborate closely with cardiac surgeons in the management of life-threatening complications. METHODS AND RESULTS We assessed the role of cardiac surgeons participating in 3462 TLE procedures at a high-volume center between 2006 and 2021. The roles for cardiac surgery in TLE can be categorized into five areas: emergency surgical interventions for the management of cardiac laceration and severe bleeding (1.184%), cardiac surgery complementing partially successful TLE or vegetation removal (0.693%), delayed surgical treatment of TLE-related tricuspid valve dysfunction (0.751%), epicardial pacemaker implantation through sternotomy during emergency, complementing or delayed surgical interventions (0.607%) and delayed epicardial lead implantation (0.491%). Isolated damage to the wall of the right atrium was the most common cause of cardiac tamponade (53.66% of emergency surgeries) followed by injury to the right ventricle and vena cava (both 7.317%). CONCLUSIONS Emergency cardiac surgery for the management of severe hemorrhagic complications is still the most common treatment option. The remaining areas include surgery complementing partially successful TLE: repair of tricuspid valve or epicardial ventricular lead placement to achieve permanent cardiac resynchronization. The experience at a single high-volume TLE center indicates the necessity of close collaboration with the cardiac surgeons whose roles appear broader than the mere surgical standby. Mortality in patients who survived cardiac surgery during transvenous lead extraction does not differ from the survival of other patients after TLE without complications requiring surgical intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Sylwia Targońska
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Centrum of Cardiology, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Kamil Karpeta
- Department of Cardiac Surgery Masovian Specialistic Hospital of Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
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Callahan TD. Looking for Lead Adhesions While Planning for Transvenous Lead Extraction. J Cardiovasc Electrophysiol 2022; 33:1041-1044. [PMID: 35245950 DOI: 10.1111/jce.15436] [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: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
The first implantable pacemaker was placed in the 1958, ushering in a new frontier of cardiovascular medicine. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas D Callahan
- Director, Inpatient Electrophysiology Service, Associate Program Director, Cardiovascular Medicine Fellowship.,Cleveland Clinic, Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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50
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Modi RM, Liu CL, Isaza N, Raber I, Calvachi P, Zimetbaum P, Bellows BK, Kramer DB, Kazi DS. Cost-Effectiveness of Antibiotic-Eluting Envelope for Prevention of Cardiac Implantable Electronic Device Infections in Heart Failure. Circ Cardiovasc Qual Outcomes 2022; 15:e008443. [PMID: 35105176 DOI: 10.1161/circoutcomes.121.008443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Use of an antibiotic-eluting envelope (AEE) during cardiac implantable electronic device procedures reduces infection risk but increases procedural costs. We aim to estimate the cost-effectiveness of AEE use during cardiac implantable electronic device procedures among patients with heart failure. METHODS A state-transition cohort model of heart failure patients undergoing cardiac implantable electronic device implantation or generator replacement was developed with input parameters estimated from randomized trials, registries, surveys, and claims data. Effectiveness was estimated from the World-Wide Randomized Antibiotic Envelope Infection Prevention Trial. AEE was assumed to cost $953 per unit. The model projected mortality, quality-adjusted life-years, costs, and the incremental cost-effectiveness ratio of AEE use compared with usual care from a US healthcare sector perspective over a lifetime horizon. We assumed a cost-effectiveness threshold of $100 000 per quality-adjusted life-year gained. RESULTS Compared with usual care, AEE use in initial implantations produced an incremental cost-effectiveness ratio of $112 000 per quality-adjusted life-year gained (39% probability of being cost-effective). In generator replacement procedures, AEE use produced an incremental cost-effectiveness ratio of $54 000 per quality-adjusted life-year gained (84% probability of being cost-effective). Results were sensitive to the underlying rate of infection, cost of the AEE, and durability of AEE effectiveness. CONCLUSIONS Universal AEE use for cardiac implantable electronic device procedures in patients with heart failure with reduced ejection fraction is unlikely to be cost-effective, reinforcing the need for individualized risk assessment to guide uptake of the AEE in clinical practice. Selective use in patients at increased risk of infection, such as those undergoing generator replacement procedures, is more likely to meet health system value benchmarks.
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Affiliation(s)
- Ronuk M Modi
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Chia-Liang Liu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.).,Harvard T.H. Chan School of Public Health, Boston, MA (C.-L.L.)
| | - Nicolas Isaza
- Department of Internal Medicine (N.I.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Inbar Raber
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Paola Calvachi
- Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Peter Zimetbaum
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.).,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.)
| | - Brandon K Bellows
- Division of General Medicine, Columbia University Department of Medicine, New York City, NY (B.K.B.)
| | | | - Dhruv S Kazi
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.).,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.)
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