1
|
Zagkli F, Chiladakis J. A hazardous collateral pathway following asymptomatic lead-related venous occlusion? Clin Case Rep 2024; 12:e9190. [PMID: 39055083 PMCID: PMC11272394 DOI: 10.1002/ccr3.9190] [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: 04/03/2024] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
Routine venography should be performed before the device upgrade. Clinicians should not be unconcerned because of the lack of symptoms following lead-related venous occlusion. Knowledge of collateral anatomy is essential for future interventional plans. The venous pathway's return to the right atrium may entail risks to patient outcomes.
Collapse
Affiliation(s)
- Fani Zagkli
- Cardiology DepartmentUniversity Hospital of PatraPatrasGreece
| | - John Chiladakis
- Cardiology DepartmentUniversity Hospital of PatraPatrasGreece
| |
Collapse
|
2
|
Matteucci A, Pignalberi C, Pandozi C, Magris B, Meo A, Russo M, Galeazzi M, Schiaffini G, Aquilani S, Di Fusco SA, Colivicchi F. Prevention and Risk Assessment of Cardiac Device Infections in Clinical Practice. J Clin Med 2024; 13:2707. [PMID: 38731236 PMCID: PMC11084741 DOI: 10.3390/jcm13092707] [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: 03/30/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
The implantation of cardiac electronic devices (CIEDs), including pacemakers and defibrillators, has become increasingly prevalent in recent years and has been accompanied by a significant rise in cardiac device infections (CDIs), which pose a substantial clinical and economic burden. CDIs are associated with hospitalizations and prolonged antibiotic therapy and often necessitate device removal, leading to increased morbidity, mortality, and healthcare costs worldwide. Approximately 1-2% of CIED implants are associated with infections, making this a critical issue to address. In this contemporary review, we discuss the burden of CDIs with their risk factors, healthcare costs, prevention strategies, and clinical management.
Collapse
Affiliation(s)
- Andrea Matteucci
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
- Department of Experimental Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Carlo Pignalberi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Claudio Pandozi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Barbara Magris
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Antonella Meo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Maurizio Russo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Marco Galeazzi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giammarco Schiaffini
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| |
Collapse
|
3
|
Avison A, Gelzer AR, Reef VB, Wulster Bills KB, de Solis CN, Kraus MS, Slack J, Stefanovski D, Deacon LJ, Underwood C. Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses. J Vet Intern Med 2024; 38:1751-1764. [PMID: 38514200 PMCID: PMC11099695 DOI: 10.1111/jvim.17027] [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: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. OBJECTIVE To describe temporary, medium-term (24 h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. ANIMALS Six healthy adult institutional teaching horses. METHODS Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24 h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6 h, and pacing thresholds were recorded every 6 h. Pacing failure was defined as a period of loss of capture longer than 20 s. RESULTS Pacing leads were placed with both guidance methods and maintained for 24 h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P < 0.05. CONCLUSIONS AND CLINICAL IMPORTANCE Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.
Collapse
Affiliation(s)
- Amanda Avison
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia B. Reef
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Kathryn B. Wulster Bills
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Cris Navas de Solis
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - JoAnn Slack
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Lindsay J. Deacon
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Claire Underwood
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| |
Collapse
|
4
|
Tascini C, Giuliano S, Attanasio V, Segreti L, Ripoli A, Sbrana F, Severino S, Sordelli C, Weisz SH, Zanus-Fortes A, Leanza GM, Carannante N, Di Cori A, Bongiorni MG, Zucchelli G, De Vivo S. Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study. Antibiotics (Basel) 2023; 12:1001. [PMID: 37370320 PMCID: PMC10295375 DOI: 10.3390/antibiotics12061001] [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: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation.
Collapse
Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.G.); (A.Z.-F.)
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.G.); (A.Z.-F.)
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy; (V.A.); (N.C.)
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy; (L.S.); (A.D.C.); (M.G.B.); (G.Z.)
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy;
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana “Gabriele Monasterio”, Via Moruzzi 1, 56124 Pisa, Italy;
| | - Sergio Severino
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy; (S.S.); (C.S.); (S.H.W.)
| | - Chiara Sordelli
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy; (S.S.); (C.S.); (S.H.W.)
| | - Sara Hana Weisz
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy; (S.S.); (C.S.); (S.H.W.)
| | - Agnese Zanus-Fortes
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.G.); (A.Z.-F.)
| | - Gabriele Maria Leanza
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.G.); (A.Z.-F.)
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy; (V.A.); (N.C.)
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy; (L.S.); (A.D.C.); (M.G.B.); (G.Z.)
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy; (L.S.); (A.D.C.); (M.G.B.); (G.Z.)
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy; (L.S.); (A.D.C.); (M.G.B.); (G.Z.)
| | - Stefano De Vivo
- UOC di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, 80131 Napoli, Italy;
| |
Collapse
|
5
|
Cimmino G, Bottino R, Formisano T, Orlandi M, Molinari D, Sperlongano S, Castaldo P, D’Elia S, Carbone A, Palladino A, Forte L, Coppolino F, Torella M, Coppola N. Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life (Basel) 2023; 13:life13020377. [PMID: 36836734 PMCID: PMC9965398 DOI: 10.3390/life13020377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.
Collapse
Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: or ; Tel.: +39-0815664141
| | - Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Saverio D’Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Lavinia Forte
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| |
Collapse
|
6
|
Raghuram K, Nair KKM, Namboodiri N, Abhilash SP, Valaparambil AK. Clinical profile and outcomes of semi-permanent pacing in a tertiary care institute in southern India. Indian Pacing Electrophysiol J 2022; 23:17-20. [PMID: 36372273 PMCID: PMC9880884 DOI: 10.1016/j.ipej.2022.11.001] [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: 04/14/2022] [Revised: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Semi-permanent pacing (SPP) includes the placement of a permanent lead through the internal jugular vein and connection to a pulse generator on the skin outside the venous access site. AIM To evaluate the clinical profile and outcomes of semi-permanent pacing in a tertiary care institute in Southern India. METHODS This is a retrospective observational study. All patients admitted and requiring management with semi-permanent pacing from January 2017 to June 2020 were included. RESULTS From January 2017 to June 2020, 20 patients underwent semi-permanent pacing (SPP) with a median age of 54 (21-74) years. Males comprised a majority of the patients (55%). Hypertension was noted in 50% of patients and 30% were diabetic. The right internal jugular vein was the most common access in 95% of patients. The most common indication for semi-permanent pacing was pocket site infection in 30% of patients. There were no procedural complications. The median duration on SPP was 7 (5-14) days and the median duration of hospital stay was 13 (8-21) days. Permanent pacemaker implantation was done in 55% of patients. Mortality in our study group was 15% with 10% dying due to cardiogenic shock (post resuscitated cardiac arrest) and 5% dying due to non-cardiac cause (Epidural hematoma). CONCLUSION In our study, semi-permanent pacing was noted to be a safe procedure and was more commonly indicated in emergent conditions with complete heart block secondary to underlying reversible causes and in the management of pocket site infection.
Collapse
|
7
|
Phillips P, Krahn AD, Andrade JG, Chakrabarti S, Thompson CR, Harris DJ, Forman JM, Karim SS, Sterns LD, Fedoruk LM, Partlow E, Bashir J. Treatment and Prevention of Cardiovascular Implantable Electronic Device (CIED) Infections. CJC Open 2022; 4:946-958. [DOI: 10.1016/j.cjco.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/03/2022] [Indexed: 10/15/2022] Open
|
8
|
A Review of Cardiac Implantable Electronic Device Infections for the Practicing Electrophysiologist. JACC Clin Electrophysiol 2021; 7:811-824. [PMID: 34167758 DOI: 10.1016/j.jacep.2021.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
Cardiovascular implantable electronic device (CIED) infections are morbid, costly, and difficult to manage. This review explores the pathophysiology, diagnosis, and management of CIED infections. Diagnostic accuracy has been improved through increased awareness and improved imaging strategies. Pocket or bloodstream infection with virulent organisms often requires complete system extraction. Emerging prophylactic interventions and novel devices have expanded preventative strategies and options for re-implantation. A clear and nuanced understanding of CIED infection is important to the practicing electrophysiologist.
Collapse
|
9
|
Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [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: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
Collapse
|
10
|
De Schouwer K, Vanhove R, Garweg C, Voros G, Haemers P, Ector J, Willems R. Re-implantation after extraction of a cardiac implantable electronic device. Acta Cardiol 2020; 75:505-513. [PMID: 31145671 DOI: 10.1080/00015385.2019.1620997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: With increasing cardiovascular implantable electronic device (CIED) implantations, growing number of extractions of leads and devices are noted, mainly for complications such as infection and lead dysfunction. The optimal timing for re-implantation remains uncertain. We investigated the time to eventual re-implantation of CIEDs in the University Hospitals Leuven, Belgium.Methods: All consecutive patients, referred for extraction between January 2005 and December 2016, were analysed for the timing of eventual re-implantation.Results: Two-hundred and forty-three patients were included. Mean follow-up was 77 ± 37 months. Global re-implantation rate was 89.3%: 100% for lead dysfunctions versus 80.7% following infections. Median time to re-implantation (TTR) was 0 [0-111] days and 8.5 [0-3025] days, respectively (p < .001). Globally 0 [0-3025] days. Re-implantation was performed in 83.2% of pacemaker patients, compared to 95.8% of defibrillator patients (p < .001). Median TTR was 4 [0-3025] days and 0 [0-345] days, respectively (p < .001). In AV-block related pacemaker indications, 90% were re-implanted, compared to 78% for symptomatic indications (p = .09). Median TTR was 2 [0-3025] and 6 [0-2047] days, respectively (p = .02). Re-implantation was performed in 96.7% of defibrillator patients with a secondary prevention indication, compared to 94.7% with primary prevention indication (p = .59). Median TTR was 0 [0-164] and 0 [0-345] days, respectively (p = .472).Conclusions: Ten percent of CIEDs is not re-implanted after extraction. CIEDs are re-implanted more often and earlier after extraction for lead dysfunction than after extraction for infectious reasons. Pacemakers are re-implanted less and later than defibrillators. Re-implantation is performed faster in stronger clinical CIED indications.
Collapse
Affiliation(s)
- Koen De Schouwer
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruben Vanhove
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Gabor Voros
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| |
Collapse
|
11
|
El-Zein RS, Stelzer M, Hatanelas J, Goodlive TW, Amin AK. A Ghost Left Behind After Transvenous Lead Extraction: A Finding to be Feared. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924243. [PMID: 32713936 PMCID: PMC7414831 DOI: 10.12659/ajcr.924243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient: Male, 72-year-old Final Diagnosis: Infective endocarditis Symptoms: Falls • weakness Medication: — Clinical Procedure: Removal of pacemaker Specialty: Cardiology
Collapse
Affiliation(s)
- Rayan S El-Zein
- Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - Mitchell Stelzer
- Division of Cardiology, Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - John Hatanelas
- Division of Cardiology, Department of Internal Medicine, Doctors Hospital, Columbus, OH, USA
| | - Thomas W Goodlive
- Section of Non-Invasive Cardiology Imaging, Department of Cardiology, Ohio Health Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, Ohio Health Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| |
Collapse
|
12
|
Chew D, Somayaji R, Conly J, Exner D, Rennert-May E. Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis. BMJ Open 2019; 9:e029537. [PMID: 31481556 PMCID: PMC6731831 DOI: 10.1136/bmjopen-2019-029537] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Initial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates. DESIGN Systematic review and meta-analysis. INTERVENTIONS A systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality. RESULTS Of the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15-220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%). CONCLUSIONS The incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation. PROSERO REGISTRATION NUMBER CRD4201810960.
Collapse
Affiliation(s)
- Derek Chew
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John Conly
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Exner
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Elissa Rennert-May
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
13
|
Nakajima T, Kaminishi Y, Kato H, Gomi S, Mathis BJ, Hiramatsu Y, Sakamoto H. Surgical extraction of a giant intracardiac lead vegetation and epicardial pacemaker reimplantation in a pacemaker-dependent hemodialysis patient. J Card Surg 2019; 34:877-879. [PMID: 31269268 DOI: 10.1111/jocs.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 57-year old male with a dual-chamber pacemaker and 40-year history of hemodialysis and autoinflammatory disease developed a large, 35 × 35 mm intracardiac vegetation on the right ventricular pacing lead. As this mass was large enough to occlude the tricuspid valve orifice, transvenous lead extraction was deemed unsuitable. Instead, an urgent surgical extraction of the whole pacemaker system, including leads and vegetation, was conducted under cardiopulmonary bypass. In light of a high risk of recurrent blood infection, a new dual-chamber pacing system was then immediately re-established using epicardial pacing leads on the right atrium and ventricle instead of transvenous electrodes. This case of a rare, giant intracardiac lead vegetation lacked most known causal factors, except for renal failure, but a possibly immunosuppressed cardiac microenvironment due to long-term steroid therapy may have been an important influencing factor.
Collapse
Affiliation(s)
- Tomomi Nakajima
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichiro Kaminishi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Seigo Gomi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
14
|
Bergeron N, Lafrenière-Bessi V, Laflamme M, Philippon F, Jacques F. Concurrent Epicardial Cardiac Resynchronization at Time of Complicated Biventricular Device Extraction: A Potentially Life-Saving Option. Can J Cardiol 2019; 35:796.e13-796.e16. [PMID: 31151718 DOI: 10.1016/j.cjca.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022] Open
Abstract
A 60-year-old man with cardiac resynchronization therapy defibrillator (CRT-D) lead endocarditis underwent transvenous lead extraction that was complicated by coronary sinus laceration and tamponade. Severe left ventricular dysfunction and unstable hemodynamic parameters persisted after emergent sternotomy, drainage, and repair. Reinstitution of cardiac resynchronization therapy with an epicardial device resulted in immediate hemodynamic improvement. Our case illustrates the potentially life-saving nature of single-stage extraction and reimplantation in resynchronization responders.
Collapse
Affiliation(s)
- Nicolas Bergeron
- Cardiac Surgery Division, Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Laval, Québec, Canada
| | - Valérie Lafrenière-Bessi
- Cardiac Surgery Division, Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Laval, Québec, Canada
| | - Maxime Laflamme
- Cardiac Surgery Division, Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Laval, Québec, Canada
| | - François Philippon
- Electrophysiology Division, Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Laval, Québec, Canada
| | - Frédéric Jacques
- Cardiac Surgery Division, Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Laval, Québec, Canada.
| |
Collapse
|
15
|
Suarez K, Banchs JE. A Review of Temporary Permanent Pacemakers and a Comparison with Conventional Temporary Pacemakers. J Innov Card Rhythm Manag 2019; 10:3652-3661. [PMID: 32477730 PMCID: PMC7252718 DOI: 10.19102/icrm.2019.100506] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/28/2018] [Indexed: 11/06/2022] Open
Abstract
Temporary cardiac pacing is commonly used in patients with life-threatening bradycardia and serves as a bridge to implantation of a permanent pacemaker (PPM). For years, passive fixation leads have been used for this purpose, offering the advantage of that they can be placed at bedside. The downside, however, is that patients must remain on telemetry and bed rest until lead removal due to the risk of displacement and failure to capture. Even then, the latter cannot always be prevented. Temporary cardiac pacing with passive fixation leads has also been related to a higher incidence of infection and venous thrombosis, delayed recovery, and increased length of stay. Thus, over the last couple of decades, pacemaker leads with an active fixation mechanism have become increasingly used. This is known as a temporary PPM (TPPM) approach, which carries a very low risk of lead dislodgement and allows patients to ambulate, among other advantages. Here, we performed a review of the literature on the use of TPPMs and their advantages over temporary pacemakers with passive fixation leads and in order to evaluate the advantages and disadvantages of active and passive fixation leads in temporary cardiac pacing. Most articles found were case reports and case series, with few prospective studies. We excluded documents such as editorials and image case reports that provided little to no useful information for the final analysis. The literature search was performed in PubMed, Google Scholar, and other databases and articles written in English and Spanish were considered. Articles were screened up to January 2017. The search keywords used were "temporary permanent pacemaker," "external permanent pacemaker," "active fixation lead," "explantable pacemaker," "hybrid pacing," "temporary permanent generator," "prolonged temporary transvenous pacing," and "semipermanent pacemaker." A total of 24 studies with 770 patients were ultimately included in our review. The age group was primarily above the sixth decade of life, with the exception of one that included pediatric patients. Indications for pacing included device infection, sick sinus syndrome, atrioventricular block, ventricular tachycardia, and bradyarrhythmias associated with systemic illness. The duration of TPPM usage varied from a few days up to 336 days. A total of 18 (2.3%) TPPM-related infections were reported, in which the duration of TPPM use was less than 30 days in at least 15 patients. Loss of capture was documented in only eight patients (1.0%). Complication rates varied from 0% to 30%, with the highest event rates being present in studies that used femoral venous access. In conclusion, although no high-quality studies were identified in our literature search, we found the data retrieved suggest the association of overall favorable outcomes with the use of TPPMs. Device placement and removal typically involve a simple procedure, although fluoroscopy, usually applied in the cardiac catheterization laboratory, is necessary for implantation, which could represent an additional risk in a patient who is already hemodynamically unstable. When possible, a screw-in-lead pacemaker should be used for temporary pacing.
Collapse
Affiliation(s)
- Keith Suarez
- Section of Electrophysiology & Pacing, Division of Cardiology, Department of Medicine, Baylor Scott & White Temple Memorial Hospital, Baylor Scott & White Health, Dallas, TX, USA
| | - Javier E Banchs
- Section of Electrophysiology & Pacing, Division of Cardiology, Department of Medicine, Baylor Scott & White Temple Memorial Hospital, Baylor Scott & White Health, Dallas, TX, USA
| |
Collapse
|
16
|
Kempa M, Laskawski G, Budrejko S, Slawinski G, Raczak G, Rogowski J. Implantation of a dual-chamber pacemaker with epicardial leads in adults using a minimally invasive subxyphoid approach. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:537-541. [PMID: 30828826 DOI: 10.1111/pace.13651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/09/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implantation of transvenous pacemaker systems is a standard method used to treat patients with bradycardia. There are some clinical settings in which that method cannot be used despite existing indications (such as developmental defects of the cardiovascular system and limited venous access or infections). In such cases, an epicardial pacing system may be implanted with cardiac surgery techniques, at a cost of certain surgical risks. The least invasive approach is subxyphoid, but it traditionally allows to place only a ventricular lead and achieve a single-chamber VVI pacing system. AIM The aim of our study was to determine the feasibility of subxyphoid implantation of dual-chamber pacing systems using thoracoscopic tools, as well as to and examine the short- and mid-term outcomes of such procedures. METHODS Patients were qualified for an epicardial pacemaker system in case of absolute indications for permanent pacing therapy and coexisting contraindications for a transvenous system. DDD systems were implanted in 10 consecutive patients, in general anesthesia, in a cardiac surgery operating room, using subxyphoid access to pericardial space and a standard set of minimally invasive thoracoscopic tools. RESULTS Implantation of a dual-chamber pacing system using the above approach was successful in all attempts. No serious complications were observed. Pacing and sensing parameters were appropriate at implantation and remained such during the follow-up of 2-27 months. CONCLUSION Implantation of a dual-chamber pacing system using a minimally invasive subxyphoid approach is feasible. Appropriate pacing and sensing values may be obtained and they remain stable during follow-up.
Collapse
Affiliation(s)
- Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Laskawski
- Department of Cardiac & Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Slawinski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Jan Rogowski
- Department of Cardiac & Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
17
|
Perrin T, Maille B, Lemoine C, Resseguier N, Franceschi F, Koutbi L, Hourdain J, Deharo JC. Comparison of epicardial vs. endocardial reimplantation in pacemaker-dependent patients with device infection. Europace 2019; 20:e42-e50. [PMID: 28582500 DOI: 10.1093/europace/eux111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/30/2017] [Indexed: 12/29/2022] Open
Abstract
Aims Reimplantation of cardiac implantable electronic devices (CIEDs) after extraction due to device infection is a major issue in pacemaker-dependent patients. We compared in-hospital and long-term outcomes with two techniques: epicardial reimplantation (EPI) before CIED extraction and temporary pacing (TP) with a view to delayed endocardial reimplantation. Methods and results Two cohorts of consecutive pacemaker-dependent patients who underwent transvenous lead extraction at our tertiary centre were included in this retrospective cohort study. According to successive policies, either the EPI or the TP approach was used. In-hospital complications occurred at similar rates in the EPI (n = 59) and TP (n = 52) cohorts (37.3% vs. 32.7%, respectively; P = 0.61). Thirteen (25.0%) patients in the TP cohort eventually were reimplanted epicardially, mainly because of infection of the temporary lead. Finally, 65 patients were discharged with an epicardial device and 37 with an endocardial device. Median follow-up was 41.7 (interquartile range 34.1-51.5) months. No difference was observed in long-term mortality according to the reimplantation strategy, but use of TP was associated with a reduced risk of late endocarditis and device reintervention (hazard ratio (HR) 0.25, 95% confidence interval (CI) 0.09-0.069, P = 0.01), whereas epicardial device reimplantation was associated with an increased risk (HR 3.62, 95% CI 1.07-12.21, P = 0.04). Conclusion We observed similar in-hospital outcomes in our EPI and TP cohorts. Twenty-five percent of the patients initially paced by a TP strategy finally needed an epicardial device, mainly because of infection of their TP lead. Use of TP resulted in lower rates of late endocarditis and device reintervention.
Collapse
Affiliation(s)
- Tilman Perrin
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Baptiste Maille
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Coralie Lemoine
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Noémie Resseguier
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Frédéric Franceschi
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Linda Koutbi
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Jérôme Hourdain
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Jean-Claude Deharo
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| |
Collapse
|
18
|
Abstract
The number of implanted cardiovascular implantable electronic devices (CIEDs) has increased significantly in the last 30 years, which has led to an upsurge in CIED complications, such as infection and lead malfunction requiring CIED extraction. The decision-making process of CIED reimplantation requires meticulous planning that includes careful consideration of several aspects: the reason for extraction, the indication for CIED reimplantation, patients' wishes, timing of reimplantation, the need for a bridging device, and the type and location of device to be reimplanted. In this article, the authors review this decision-making process and the necessary steps to achieve optimal patient outcomes.
Collapse
Affiliation(s)
- Mohamed B Elshazly
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Khaldoun G Tarakji
- Department of Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland, OH 44195, USA.
| |
Collapse
|
19
|
Jacques F, Côté JM, Philippon F. Long-term outcome of transvenous pacemaker implantation in infants: a retrospective cohort study. Europace 2018; 20:1227. [PMID: 29040464 DOI: 10.1093/europace/eux210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frédéric Jacques
- Service of Cardiac Surgery, Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval.,Service of Paediatric Cardiac Surgery, Department of Surgery, Centre mère-enfant Soleil, CHU de Québec-Université Laval
| | - Jean-Marc Côté
- Service of Electrophysiology, Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, 2725 Ch Ste-Foy, Ville de Québec, QC, Canada.,Service of Cardiology, Department of Paediatrics, Centre mère-enfant Soleil, 2705, boulevard Laurier, Ville de Québec, QC, Canada
| | - François Philippon
- Service of Electrophysiology, Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, 2725 Ch Ste-Foy, Ville de Québec, QC, Canada
| |
Collapse
|
20
|
van den Brink FS, van Dijk VF, Boersma LV, Wijffels MC, Gelissen J, Daeter E, Sonker U, Balt J. A combined epicardial implantation and subsequent extraction strategy in pacemaker device infection in pacemaker-dependent patients. Pacing Clin Electrophysiol 2018; 41:906-911. [PMID: 29790185 DOI: 10.1111/pace.13382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatment infections is challenging in pacemaker (PM) dependent patients. We proposed a novel implantation strategy for this group of patients. METHODS Patients who were PM dependent and were admitted with a PM infection received a combined procedure of left ventricular (LV) epicardial implantation of a PM lead and subsequent extraction of the infected system. No temporary pacing wire was used and the PM generator was placed in the left flank. RESULTS Between 2012 and 2015 we treated 16 patients who were PM dependent and with a PM infection. The majority of patients were male (81% [13/16]) and the median age was 71 years (50-91). The cause of infection was valvular endocarditis in 38% (6/16), lead infection in 25% (4/16), and isolated pocket infection in 38% (6/16). All patients underwent epicardial implantation of a LV lead (1084T bipolar lead; St. Jude Medical Myodex, St. Paul, MN, USA) and extraction of the infected device. There was no occurrence of periprocedural mortality and no postprocedural tamponades. There was one complication in the form of a hemorrhage at the infected device extraction site. In the median follow-up period of 17 months there were four of 16 deaths, none of which were attributable to epicardial LV implantation. LV-lead threshold was 1.1V (±0.7V) upon implantation that increased to 1.2V (±0.6V) at 0.4-ms pulse duration. There were no reinfections of the epicardial lead or device. CONCLUSION Epicardial left ventricle PM implantation and subsequent extraction of an infected PM in PM-dependent patients is feasible and safe with good long-term outcome.
Collapse
Affiliation(s)
| | - Vincent F van Dijk
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Lucas Va Boersma
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - John Gelissen
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Edgar Daeter
- Deparment of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Uday Sonker
- Deparment of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Jippe Balt
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| |
Collapse
|
21
|
Dębski M, Ząbek A, Boczar K, Urbańczyk-Zawadzka M, Lelakowski J, Małecka B. Temporary external implantable cardioverter-defibrillator as a bridge to reimplantation after infected device extraction. J Arrhythm 2018; 34:77-80. [PMID: 29721118 PMCID: PMC5828266 DOI: 10.1002/joa3.12026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/21/2017] [Indexed: 11/11/2022] Open
Abstract
Patients with cardiac implantable electronic devices (CIED) and endovascular infection represent a difficult management group. The explantation of an implantable cardioverter-defibrillator (ICD) system deprives the patient of the protection against life-threatening ventricular tachyarrhythmias. In this study, we describe feasibility and clinical outcomes of bridging with temporary dual-coil ICD lead and external ICD following the extraction of a CIED due to endovascular infection and compare the performance of this approach to other available options.
Collapse
Affiliation(s)
- Maciej Dębski
- Department of Electrocardiology John Paul II Hospital Krakow Poland
| | - Andrzej Ząbek
- Department of Electrocardiology John Paul II Hospital Krakow Poland
| | - Krzysztof Boczar
- Department of Electrocardiology John Paul II Hospital Krakow Poland
| | | | - Jacek Lelakowski
- Department of Electrocardiology John Paul II Hospital Krakow Poland.,Institute of Cardiology Jagiellonian University Medical College Krakow Poland
| | - Barbara Małecka
- Department of Electrocardiology John Paul II Hospital Krakow Poland.,Institute of Cardiology Jagiellonian University Medical College Krakow Poland
| |
Collapse
|
22
|
Claridge S, Johnson J, Sadnan G, Behar JM, Porter B, Sieniewicz B, Jackson T, Webb J, Gould J, Sohal M, Hamid S, Patel N, Gill J, Rinaldi CA. Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:155-160. [DOI: 10.1111/pace.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/23/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Simon Claridge
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jonathan Johnson
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Gazi Sadnan
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jonathan M. Behar
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Bradley Porter
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Benjamin Sieniewicz
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Tom Jackson
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jessica Webb
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Justin Gould
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Manav Sohal
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Shoaib Hamid
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Nik Patel
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jaswinder Gill
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Christopher A. Rinaldi
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| |
Collapse
|
23
|
Diemberger I, Biffi M, Lorenzetti S, Martignani C, Raffaelli E, Ziacchi M, Rapezzi C, Pacini D, Boriani G. Predictors of long-term survival free from relapses after extraction of infected CIED. Europace 2017; 20:1018-1027. [DOI: 10.1093/europace/eux121] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/12/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Stefano Lorenzetti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Cristian Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Elena Raffaelli
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Claudio Rapezzi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Davide Pacini
- Department of Cardiovascular Surgery, S. Orsola Hospital, Alma Mater Studiorum-University of Bologna
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| |
Collapse
|
24
|
Liang JJ, Schaller RD, Modi DS, Enriquez A, Supple GE, Cooper JM. Low lateral thoracic site for cardiac implantable electronic device implantation: A viable alternative in patients with limited access options after infected device extraction. Heart Rhythm 2017; 14:1506-1514. [PMID: 28603001 DOI: 10.1016/j.hrthm.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Device reimplantation after extraction because of cardiac implantable electronic device (CIED) infection in pacemaker-dependent patients can be challenging in individuals with limited access options. OBJECTIVE The purpose of this study was to describe a straightforward, low lateral thoracic implantation technique for patients with a patent axillary vein but unavailable bilateral pectoral sites. METHODS Nine pacemaker-dependent patients (mean age 70 ± 13 years, 7 male) who underwent CIED extraction and low lateral thoracic reimplantation in whom bilateral pectoral sites were unavailable were included in the study. RESULTS Extraction was performed a median of 10 (interquartile range [IQR] 8-13) days before CIED reimplantation (4 dual-chamber, 3 single-chamber, 2 cardiac resynchronization therapy). The new generator was implanted in the low lateral thoracic region ipsilateral to the extracted generator in 7 patients (78%) and contralateral in 2 patients (22%), via a subcutaneous pocket in 6 (67%) and submuscular pocket in 3 (33%). Median procedure duration was 85 (IQR 61-116) minutes, median fluoroscopy time was 7.2 (IQR 5.7-10.9), minutes and median fluoroscopy exposure was 26.0 (IQR 10.0-110.5) mGy. No acute complications occurred. Over median follow-up of 92 (IQR 31-131) days, 1 patient experienced right atrial lead dislodgment (122 days postimplantation) requiring lead revision. No patients experienced recurrent device infection. CONCLUSION In pacemaker-dependent patients with limited prepectoral and vascular access options, a low lateral thoracic implantation site is a viable alternative to surgical epicardial or femoral pacing systems. This simple implantation technique is a safe and effective option in selected patients who require a single-chamber, dual-chamber, or biventricular pacemaker or implantable cardioverter-defibrillator.
Collapse
Affiliation(s)
- Jackson J Liang
- Electrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Robert D Schaller
- Electrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Danesh S Modi
- Electrophysiology Section, Cardiology Division, Temple University Health System, Philadelphia, Pennsylvania
| | - Andres Enriquez
- Electrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Cooper
- Electrophysiology Section, Cardiology Division, Temple University Health System, Philadelphia, Pennsylvania
| |
Collapse
|
25
|
Da Costa A, Axiotis A, Romeyer-Bouchard C, Abdellaoui L, Afif Z, Guichard JB, Gerbay A, Isaaz K. Transcatheter leadless cardiac pacing. Int J Cardiol 2017; 227:122-126. [DOI: 10.1016/j.ijcard.2016.11.196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022]
|
26
|
Frantz S, Buerke M, Horstkotte D, Levenson B, Mellert F, Naber CK, Thalhammer F. Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie zur Infektiösen Endokarditis. KARDIOLOGE 2016. [DOI: 10.1007/s12181-016-0058-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Maruyama T. Editorial: Trapped pacemaker lead extraction: Necessity, challenge, and beyond. J Cardiol Cases 2016; 13:85-86. [PMID: 30546613 PMCID: PMC6280685 DOI: 10.1016/j.jccase.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Toru Maruyama
- Corresponding author at: Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Tel.: +81 92 642 5235; fax: +81 92 642 5247.
| |
Collapse
|