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Maille B, Behar N, Jacon P, Hourdain J, Franceschi F, Koutbi L, Tovmassian L, Bierme C, Seder E, Klein V, Postzich M, Resseguier N, Leclerq C, Defaye P, Deharo JC. Two-in-one procedure for transvenous lead extraction and leadless pacemaker reimplantation in pacemaker-dependent patients with device infection: streamlined patient flow. Europace 2024; 26:euae162. [PMID: 39031020 DOI: 10.1093/europace/euae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Affiliation(s)
- Baptiste Maille
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Nathalie Behar
- Department of Cardiology and Vascular Disease Division, Rennes University Hospital, Rennes, France
| | - Peggy Jacon
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Jerome Hourdain
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Frederic Franceschi
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Linda Koutbi
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Lilith Tovmassian
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Cédric Bierme
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Elena Seder
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Victor Klein
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Martin Postzich
- CEReSS-Health Service Research and Quality of Life Center, School of Medicine, Aix-Marseille University, Marseille, France
| | - Noemie Resseguier
- CEReSS-Health Service Research and Quality of Life Center, School of Medicine, Aix-Marseille University, Marseille, France
| | - Christophe Leclerq
- Department of Cardiology and Vascular Disease Division, Rennes University Hospital, Rennes, France
| | - Pascal Defaye
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Claude Deharo
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
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Mourad A, Niehaus ED, Fowler VG, Holland TL. Leadless pacemaker infective endocarditis: a case report and review of the literature. Clin Microbiol Infect 2024:S1198-743X(24)00275-1. [PMID: 38851425 DOI: 10.1016/j.cmi.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Ahmad Mourad
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Emily D Niehaus
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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Beccarino N, Saleh M, Epstein LM. Leadless pacemakers: Where are we? Trends Cardiovasc Med 2024:S1050-1738(24)00018-5. [PMID: 38522582 DOI: 10.1016/j.tcm.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/10/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
Pacemakers have been the cornerstone of brady-arrhythmia management since the mid-20th century. Despite the widespread use and success of traditional transvenous pacemakers, they are associated with an estimated 15 % complication rate at three years. Driven by the advantages over traditional transvenous pacemakers including a lack of transvenous leads, resistance to infection, and ease of implantation, the number of leadless pacemakers placed annually in the United States has dramatically increased since their initial approval. While current iterations of leadless pacemakers lack the versatility offered by transvenous devices, recent advances in leadless pacing offer an increasingly diverse range of therapeutic options. This review will discuss the past, present, and future emerging technologies, and strategies in leadless pacing.
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Affiliation(s)
- Nicholas Beccarino
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States.
| | - Moussa Saleh
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
| | - Laurence M Epstein
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
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Iioka Y, Yamasaki H, Ishizu T. Leadless Pacemaker Implantation From the Jugular Vein Ipsilateral to the Dialysis Catheter: Last Resort for Patients With Limited Vascular Routes. Can J Cardiol 2024:S0828-282X(24)00206-X. [PMID: 38494120 DOI: 10.1016/j.cjca.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Yuto Iioka
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Gwechenberger M. Leadless Pacemaker Implantation After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device. Am J Cardiol 2024; 212:139-140. [PMID: 38103762 DOI: 10.1016/j.amjcard.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Affiliation(s)
- M Gwechenberger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria.
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Ali H, Foresti S, De Ambroggi G, Cappato R, Lupo P. Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis. J Clin Med 2023; 12:6908. [PMID: 37959373 PMCID: PMC10649089 DOI: 10.3390/jcm12216908] [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: 08/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system's resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors' experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients' management and clinical outcomes.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy; (S.F.); (G.D.A.); (R.C.); (P.L.)
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Huang J, Bhatia NK, Lloyd MS, Westerman S, Shah A, Leal M, Delurgio D, Patel AM, Tompkins C, Leon AR, El-Chami MF, Merchant FM. Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions. J Cardiovasc Electrophysiol 2023; 34:2216-2222. [PMID: 37727925 DOI: 10.1111/jce.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Permanent pacing indications are common after cardiac surgery and transcatheter structural valve interventions. Leadless pacemakers (LPs) have emerged as a useful alternative to transvenous pacemakers. However, current commercially available LPs are unable to provide atrial pacing or cardiac resynchronization and relatively little is known about LP outcomes after cardiac surgery and transcatheter valve interventions. METHODS This retrospective study included patients who received a Micra VR (MicraTM MC1VR01) or Micra AV (MicraTM MC1AVR1) (Medtronic) leadless pacemaker following cardiac surgery or transcatheter structural valve intervention between September 2014 and September 2022. Device performance and clinical outcomes, including ventricular pacing burden, ejection fraction, and need for conversion to transvenous pacing systems, were evaluated during follow-up. RESULTS A total of 78 patients were included, of whom 40 received a Micra VR LP implant, and 38 received a Micra AV LP implant. The mean age of the cohort was 65.9 ± 17.9 years, and 48.1% were females. The follow-up duration for the entire cohort was 1.3 ± 1.1 years: 1.6 ± 1.3 years for the Micra VR group and 0.8 ± 0.5 years for the Micra AV group. Among the cohort, 50 patients had undergone cardiac surgery and 28 underwent transcatheter structural valve interventions. Device electrical performance was excellent during follow-up, with a small but clinically insignificant increase in ventricular pacing threshold and a slight decrease in pacing impedance. The mean right ventricle pacing (RVP) burden significantly decreased over time in the entire cohort (74.3% ± 37.2% postprocedure vs. 47.7% ± 40.6% at last follow-up, p < .001), and left ventricle ejection fraction (LVEF) showed a modest but significant downward trend during follow-up (55.0% ± 10.6% vs. 51.5% ± 11.2% p < .001). Patients with Micra VR implants had significantly reduced LVEF during follow-up (54.1% ± 11.9% vs. 48.8% ± 11.9%, p = .003), whereas LVEF appeared stable in the Micra AV group during follow-up (56.1% ± 9.0% vs. 54.6% ± 9.7%, p = .06). Six patients (7.7%) required conversion to transvenous pacing systems, four who required cardiac resynchronization for drop in LVEF with high RVP burden and two who required dual-chamber pacemakers for symptomatic sinus node dysfunction. CONCLUSION Leadless pacemakers provide a useful alternative to transvenous pacemakers in appropriately selected patients after cardiac surgery and transcatheter structural valve interventions. Device performance is excellent over medium-term follow-up. However, a significant minority of patients require conversion to transvenous pacing systems for cardiac resynchronization or atrial pacing support, demonstrating the need for close electrophysiologic follow-up in this cohort.
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Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Stacy Westerman
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Anand Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Miguel Leal
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - David Delurgio
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Anshul M Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Christine Tompkins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Angel R Leon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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Younis A, Wilkoff BL. Leadless pacing in patients undergoing transvenous lead extraction due to infection: A small step in a long journey. Heart Rhythm 2023; 20:861-862. [PMID: 36858160 DOI: 10.1016/j.hrthm.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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