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Mekary W, Hebbo E, Shah A, Westerman S, Bhatia N, Byku I, Babaliaros V, Greenbaum A, Merchant FM, El-Chami MF. Managing superior vena cava syndrome in patients with cardiac implantable electronic device leads: Strategies and considerations. Heart Rhythm 2024:S1547-5271(24)02870-4. [PMID: 38969051 DOI: 10.1016/j.hrthm.2024.06.060] [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: 06/01/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Data on transvenous (TV) lead-associated superior vena cava (SVC) syndrome are limited. The management of this problem might require a multidisciplinary approach, often involving transvenous lead extraction (TLE) followed by angioplasty and stenting. OBJECTIVE The purpose of this study was to describe the management and outcome of TV lead-associated SVC syndrome. METHODS We retrospectively identified patients with a diagnosis of SVC syndrome and TV leads at Emory Healthcare between 2015 and 2023. RESULTS Fifteen patients with lead-related SVC syndrome were identified. The cohort average age was 50 years. Symptoms included swelling of the face, neck, and upper extremities (67%); shortness of breath (53%); and lightheadedness (40%). Patients had an average of 2 ± 0.7 leads crossing the SVC, with a lead dwell time of 9.8 ± 7.5 years. Thirteen patients were managed with TLE, followed by SVC stenting and angioplasty in 10 and angioplasty alone in 2; 1 patient had no intervention after TLE. One patient was managed with anticoagulation, and another had angioplasty and stenting with lead jailing. One patient experienced SVC perforation and cardiac tamponade during SVC stenting, which was managed successfully with a covered stent and pericardiocentesis. Among the 12 patients with TLE and angioplasty ± stenting, 7 underwent reimplantation of a transvenous lead. Two of those patients had symptoms recurrence, and none of the 5 patients without lead reimplantation had recurrence of symptoms. CONCLUSION Lead-related SVC syndrome management requires a multidisciplinary approach often including TLE followed by angioplasty and stenting. Avoiding TV lead reimplantation might help reduce symptoms recurrence.
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Affiliation(s)
- Wissam Mekary
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Elsa Hebbo
- Division of Cardiology, Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Neal Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Division of Cardiology, Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam Greenbaum
- Division of Cardiology, Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
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Isawa T, Nomura T, Honda T, Yamaya K, Toyoda S. A "one-step" treatment for symptomatic lead-related venous obstruction using percutaneous lead extraction, venous stenting, and new device implantation. HeartRhythm Case Rep 2024; 10:394-397. [PMID: 38983887 PMCID: PMC11228062 DOI: 10.1016/j.hrcr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Affiliation(s)
- Tsuyoshi Isawa
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Takehiro Nomura
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Taku Honda
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kazuhiro Yamaya
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, Sendai, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
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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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Iwakawa H, Suzuki T, Terata K, Watanabe H. Successful treatment of lead-related superior vena cava syndrome in combination with transvenous lead extraction and venous stenting. J Arrhythm 2023; 39:813-815. [PMID: 37799792 PMCID: PMC10549838 DOI: 10.1002/joa3.12920] [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: 05/17/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
We experienced a case of lead-related SVC syndrome, which was successfully treated using unique transvenous lead extraction technique and endovascular stenting. This case also suggests that intravascular ultrasound facilitates decision-making on whether the interventionist should perform TLE alone or add stenting in case of a lead-related venous obstruction.
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Affiliation(s)
- Hidehiro Iwakawa
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Tomohito Suzuki
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Ken Terata
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Hiroyuki Watanabe
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
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Morita J, Kondo Y, Haraguchi T, Kitai T, Fujita T. Rocket-shape crossing technique: A combination of lead extraction and modified venoplasty for device upgrade with venous occlusion. J Arrhythm 2023; 39:621-622. [PMID: 37560292 PMCID: PMC10407171 DOI: 10.1002/joa3.12875] [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: 01/31/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 08/11/2023] Open
Abstract
This case discusses an upgrade method to cardiac resynchronization therapy defibrillator for a 54 year old man with superior vena cava occlusion. Right ventricular lead extraction with modified venoplasty, Rocket shape Crossing Technique (RCT), was performed. In RCT the integration of the inflated balloon, halfway inside the laser sheath, and the laser sheath are advanced through the occlusion like a rocket shape crossing.
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Affiliation(s)
- Junji Morita
- Department of Cardiovascular MedicineSapporo Heart Center, Sapporo Cardiovascular ClinicSapporoJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Takuya Haraguchi
- Department of Cardiovascular MedicineSapporo Heart Center, Sapporo Cardiovascular ClinicSapporoJapan
| | - Takayuki Kitai
- Department of Cardiovascular MedicineSapporo Heart Center, Sapporo Cardiovascular ClinicSapporoJapan
| | - Tsutomu Fujita
- Department of Cardiovascular MedicineSapporo Heart Center, Sapporo Cardiovascular ClinicSapporoJapan
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Ferro EG, Kramer DB, Li S, Locke AH, Misra S, Schmaier AA, Carroll BJ, Song Y, D'Avila AA, Yeh RW, Zimetbaum PJ, Secemsky EA. Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction. J Am Coll Cardiol 2023:S0735-1097(23)05427-X. [PMID: 37204378 DOI: 10.1016/j.jacc.2023.04.017] [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: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The incidence and clinical impact of lead-related venous obstruction (LRVO) among patients with cardiovascular implantable electronic devices (CIEDs) is poorly defined. OBJECTIVES The objectives of this study were to determine the incidence of symptomatic LRVO after CIED implant; describe patterns in CIED extraction and revascularization; and quantify LRVO-related health care utilization based on each type of intervention. METHODS LRVO status was defined among Medicare beneficiaries after CIED implant from October 1, 2015, to December 31, 2020. Cumulative incidence functions of LRVO were estimated by Fine-Gray methods. LRVO predictors were identified using Cox regression. Incidence rates for LRVO-related health care visits were calculated with Poisson models. RESULTS Among 649,524 patients who underwent CIED implant, 28,214 developed LRVO, with 5.0% cumulative incidence at maximum follow-up of 5.2 years. Independent predictors of LRVO included CIEDs with >1 lead (HR: 1.09; 95% CI: 1.07-1.15), chronic kidney disease (HR: 1.17; 95% CI: 1.14-1.20), and malignancies (HR: 1.23; 95% CI: 1.20-1.27). Most patients with LRVO (85.2%) were managed conservatively. Among 4,186 (14.8%) patients undergoing intervention, 74.0% underwent CIED extraction and 26.0% percutaneous revascularization. Notably, 90% of the patients did not receive another CIED after extraction, with low use (2.2%) of leadless pacemakers. In adjusted models, extraction was associated with significant reductions in LRVO-related health care utilization (adjusted rate ratio: 0.58; 95% CI: 0.52-0.66) compared with conservative management. CONCLUSIONS In a large nationwide sample, the incidence of LRVO was substantial, affecting 1 of every 20 patients with CIEDs. Device extraction was the most common intervention and was associated with long-term reduction in recurrent health care utilization.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Siling Li
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew H Locke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shantum Misra
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alec A Schmaier
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brett J Carroll
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andre A D'Avila
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Villegas EG, Torres JN, Domingo EJB, Dorrego MDP, del Rio JIJ, Valdiris UR, Carmona JCR, Fernandez IF, Peinado RP. Superior vena cava syndrome and pacemaker leads. Explant by mechanical dissection system of extraction and percutaneous recanalization with stents for new device implantation. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Domenichini G, Le Bloa M, Carroz P, Graf D, Herrera-Siklody C, Teres C, Porretta AP, Pascale P, Pruvot E. New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions. Front Cardiovasc Med 2022; 9:783576. [PMID: 35282352 PMCID: PMC8904723 DOI: 10.3389/fcvm.2022.783576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
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Zimetbaum P, Carroll BJ, Locke AH, Secemsky E, Schermerhorn M. Lead-Related Venous Obstruction in Patients With Implanted Cardiac Devices: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:299-308. [PMID: 35057916 DOI: 10.1016/j.jacc.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Abstract
Cardiac implantable electronic device implantation rates have increased in recent decades. Venous obstruction of the subclavian, brachiocephalic, or superior vena cava veins represents an important complication of implanted leads. These forms of venous obstruction can result in significant symptoms as well as present a barrier to the implantation of additional device leads. The risk factors for the development of these complications remain poorly understood, and diagnosis relies on clinical recognition and cross-sectional imaging. Anticoagulation remains the mainstay of treatment, and thrombus debulking, lead extraction, venoplasty, and stenting are all important therapeutic interventions. This review provides a multidisciplinary-based approach to the evaluation and management of cardiac implantable electronic device lead-associated venous obstruction.
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Affiliation(s)
- Peter Zimetbaum
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew H Locke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Secemsky
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc Schermerhorn
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Magisetty R, Park SM. New Era of Electroceuticals: Clinically Driven Smart Implantable Electronic Devices Moving towards Precision Therapy. MICROMACHINES 2022; 13:161. [PMID: 35208286 PMCID: PMC8876842 DOI: 10.3390/mi13020161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
In the name of electroceuticals, bioelectronic devices have transformed and become essential for dealing with all physiological responses. This significant advancement is attributable to its interdisciplinary nature from engineering and sciences and also the progress in micro and nanotechnologies. Undoubtedly, in the future, bioelectronics would lead in such a way that diagnosing and treating patients' diseases is more efficient. In this context, we have reviewed the current advancement of implantable medical electronics (electroceuticals) with their immense potential advantages. Specifically, the article discusses pacemakers, neural stimulation, artificial retinae, and vagus nerve stimulation, their micro/nanoscale features, and material aspects as value addition. Over the past years, most researchers have only focused on the electroceuticals metamorphically transforming from a concept to a device stage to positively impact the therapeutic outcomes. Herein, the article discusses the smart implants' development challenges and opportunities, electromagnetic field effects, and their potential consequences, which will be useful for developing a reliable and qualified smart electroceutical implant for targeted clinical use. Finally, this review article highlights the importance of wirelessly supplying the necessary power and wirelessly triggering functional electronic circuits with ultra-low power consumption and multi-functional advantages such as monitoring and treating the disease in real-time.
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Affiliation(s)
- RaviPrakash Magisetty
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea;
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea;
- Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea
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Griffiths S, Behar JM, Kramer DB, Debney MT, Monkhouse C, Lefas AY, Lowe M, Amin F, Cantor E, Boyalla V, Karim N, Till J, Markides V, Clague JR, Wong T. The long-term outcomes of cardiac implantable electronic devices implanted via the femoral route. Pacing Clin Electrophysiol 2022; 45:481-490. [PMID: 35043404 PMCID: PMC9305836 DOI: 10.1111/pace.14449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/17/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
Background Conventional superior access for cardiac implantable electronic devices (CIEDs) is not always possible and femoral CIEDs (F‐CIED) are an alternative option when leadless systems are not suitable. The long‐term outcomes and extraction experiences with F‐CIEDs, in particular complex F‐CIED (ICD/CRT devices), remain poorly understood. Methods Patients referred for F‐CIEDs implantation between 2002 and 2019 at two tertiary centers were included. Early complications were defined as ≤30 days following implant and late complications >30 days. Results Thirty‐one patients (66% male; age 56 ± 20 years; 35% [11] patients with congenital heart disease) were implanted with F‐CIEDs (10 ICD/CRT and 21 pacemakers). Early complications were observed in 6.5% of patients: two lead displacements. Late complications at 6.8 ± 4.4 years occurred in 29.0% of patients. This was higher with complex F‐CIED compared to simple F‐CIED (60.0% vs. 14.3%, p = .02). Late complications were predominantly generator site related (n = 8, 25.8%) including seven infections/erosions and one generator migration. Eight femoral generators and 14 leads (median duration in situ seven [range 6–11] years) were extracted without complication. Conclusions Procedural success with F‐CIEDs is high with clinically acceptable early complication rates. There is a notable risk of late complications, particularly involving the generator site of complex devices following repeat femoral procedures. Extraction of chronic F‐CIED in experienced centers is feasible and safe.
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Affiliation(s)
- Samuel Griffiths
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jonathan M Behar
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - Mike T Debney
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | | | - Alicia Y Lefas
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Martin Lowe
- Barts Heart Centre, West Smithfields, London, EC1A 7BE, UK
| | - Fouad Amin
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Emily Cantor
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Vennella Boyalla
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Nabeela Karim
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jan Till
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Vias Markides
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jonathan R Clague
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Tom Wong
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
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Locke AH, Shim DJ, Burr J, Mehegan T, Murphy K, D'Avila A, Schermerhorn ML, Zimetbaum P. Lead-associated Superior Vena Cava Syndrome. J Innov Card Rhythm Manag 2021; 12:4459-4465. [PMID: 33936861 PMCID: PMC8081456 DOI: 10.19102/icrm.2021.120404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a rare complication associated with transvenous cardiac implantable electronic devices that may present with a variety of manifestations. Various strategies such as transvenous lead extraction, anticoagulation, venoplasty, and stenting have been used to treat this condition, but the optimal management protocols have yet to be defined. Subcutaneous implantable cardioverter-defibrillator (ICD) (S-ICD) therapy can be an alternative option to a transvenous system for those who require future ICD surveillance. We present a case of lead-associated SVC syndrome where thoracic venous congestion due to SVC obstruction influenced preimplant S-ICD QRS vector screening. Following treatment of venous obstruction, QRS amplitude may change and patients who were not initially S-ICD candidates may later become eligible.
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Affiliation(s)
- Andrew H Locke
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David J Shim
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Tyler Mehegan
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kelsey Murphy
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - André D'Avila
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Zimetbaum
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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