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Lee JZ, Talaei F, Tan MC, Srivathsan K, Sorajja D, Valverde A, Scott L, Asirvatham SJ, Kusumoto F, Mulpuru SK, Cha YM. Long-term outcomes with abandoning versus extracting sterile leads: A 10-year population-based study. Pacing Clin Electrophysiol 2024; 47:626-634. [PMID: 38488756 DOI: 10.1111/pace.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Long-term outcomes of sterile lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) remain unclear. METHODS We performed a retrospective study of a population residing in southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE of sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10 years or until their death were included. RESULTS A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. Indications for subsequent lead extraction arose in 9.1% (n = 14) of patients with initial LA and 5.3% (n = 1) in patients with initial TLE, after an average of 7 years. Moreover, 28.6% of patients in the LA cohort who required subsequent extraction did not proceed with the extraction, and among those who proceeded, 60% had clinical success and 40% had a clinical failure. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges (5.2% vs. 5.3%). There was no difference in 10-year survival probability among the LA group and the TLE group (p = .64). CONCLUSION An initial lead abandonment strategy was associated with more complicated subsequent extraction procedures compared to patients with an initial transvenous lead extraction strategy. However, there was no difference in 10-year survival probability between both lead management approaches.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fred Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Kutarski A, Jacheć W, Czajkowski M, Stefańczyk P, Kosior J, Tułecki Ł, Nowosielecka D. Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures. J Clin Med 2024; 13:2349. [PMID: 38673622 PMCID: PMC11051408 DOI: 10.3390/jcm13082349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
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Tan MC, Ang QX, Yeo YH, Thong JY, Tolat A, Scott LR, Lee JZ. Effect of age on in-hospital outcomes of transvenous lead extraction for infected cardiac implantable electronic device. Pacing Clin Electrophysiol 2024; 47:577-582. [PMID: 38319639 DOI: 10.1111/pace.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The real-world data on the safety profile of transvenous lead extraction (TLE) for infected cardiac implantable electronic devices (CIED) among elderly patients is not well-established. This study aimed to evaluate the hospital outcomes between patients of different age groups who underwent TLE for infected CIED. METHOD Using the Nationwide Readmissions Database, our study included patients aged ≥18 years who underwent TLE for infected CIED between 2017 and 2020. We divided the patients into four groups: Group A. Young (<50 years), Group B. Young intermediate (50-69 years old), Group C. Older intermediate (70-79 years old), and Group D. Octogenarian (≥80 years old). We then analyzed the in-hospital outcome and 30-day readmission between these age groups. RESULTS A total of 10,928 patients who were admitted for TLE of infected CIED were included in this study: 982 (9.0%) patients in group A, 4,234 (38.7%) patients in group B, 3,204 (29.3%) patients in group C and 2,508 (23.0%) of patients in group D. Our study demonstrated that the risk of early mortality increased with older age (Group B vs. Group A: OR: 1.92, 95% CI: 1.19-3.09, p < .01; Group C vs. Group A: OR: 2.47, 95% CI: 1.51-4.04, p < .01; Group D vs. Group A: OR: 2.82, 95% CI: 1.69-4.72, p < .01). The risk of non-home discharge also increased in elderly groups (Group B vs. Group A: OR: 1.89; 95% CI: 1.52-2.36; p < .01; Group C vs. Group A: OR: 2.82; 95% CI 2.24-3.56; p < .01; Group D vs. Group A: OR: 4.16; 95% CI: 3.28-5.28; p < .01). There was no significant difference in hospitalization length and 30-day readmission between different age groups. Apart from a higher rate of open heart surgery in group A, the procedural complications were comparable between these age groups. CONCLUSION Elderly patients had worse in-hospital outcomes in early mortality and non-home discharge following the TLE for infected CIED. There was no significant difference between elderly and non-elderly groups in prolonged hospital stay and 30-day readmission. Elderly patients did not have a higher risk of procedural complications.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Qi Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, Michigan, USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, Michigan, USA
| | - Jia Yean Thong
- Fudan University Shanghai Medical College, Shanghai, China
| | - Aneesh Tolat
- Department of Cardiovascular Medicine, Hartford Healthcare/University of Connecticut, Hartford, Connecticut, USA
| | - Luis R Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Maclean E, Mahtani K, Honarbakhsh S, Butcher C, Ahluwalia N, Dennis AS, Creta A, Finlay M, Elliott M, Mehta V, Wijesuriya N, Shaikh O, Zaw Y, Ogbedeh C, Gautam V, Lambiase PD, Schilling RJ, Earley MJ, Moore P, Muthumala A, Sporton SC, Hunter RJ, Rinaldi CA, Behar J, Martin C, Monkhouse C, Chow A. The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. Circ Arrhythm Electrophysiol 2024; 17:e012446. [PMID: 38258308 PMCID: PMC10949977 DOI: 10.1161/circep.123.012446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology. METHODS A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation. RESULTS In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9-6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4-6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6-17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6-4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446). CONCLUSIONS The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Karishma Mahtani
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Shohreh Honarbakhsh
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Charles Butcher
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Nikhil Ahluwalia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Adam S.C. Dennis
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Antonio Creta
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Malcolm Finlay
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Mark Elliott
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Vishal Mehta
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Nadeev Wijesuriya
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Omar Shaikh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Yom Zaw
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Chizute Ogbedeh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Vasu Gautam
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Pier D. Lambiase
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Richard J. Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Mark J. Earley
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Philip Moore
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Amal Muthumala
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Simon C.E. Sporton
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Ross J. Hunter
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Christopher A. Rinaldi
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Jonathan Behar
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Claire Martin
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Christopher Monkhouse
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Anthony Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
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Kutarski A, Jacheć W, Stefańczyk P, Polewczyk A, Kosior J, Nowosielecka D. VDD Lead Extraction-Differences with Other Leads and Practical Tips in Management. J Clin Med 2024; 13:800. [PMID: 38337494 PMCID: PMC10856487 DOI: 10.3390/jcm13030800] [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: 12/26/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Background: VDD (atrial sensing, ventricular sensing/pacing) leads are relatively rarely implanted; therefore, experience in their extraction is very limited. We aimed to investigate whether VDD lead removal may be a risk factor for the increased complexity of transvenous lead extraction (TLE) or major complications. Methods: We retrospectively analyzed 3808 TLE procedures (including 103 patients with VDD leads). Results: If TLE included VDD lead removal, procedure duration (lead dilation time) was prolonged, complicated extractions were slightly more common, and more advanced tools were required. This is partly due to longer implant duration (in patients with VDD systems-135.2 months; systems without VDD leads-109.3 months; p < 0.001), more frequent presence of abandoned leads (all systems containing VDD leads-22.33% and all systems without VDD leads-10.77%), and partly to the younger age of patients with VDD leads (51.74 vs. 57.72 years; p < 0.001, in the remaining patients) at the time of system implantation. VDD lead extraction does not increase the risk of major complications (1.94 vs. 2.34%; p = 0.905). Conclusions: The extraction of VDD leads may be considered a risk factor for increased procedure complexity, but not for major complications. However, this is not a direct result of VDD lead extraction but specific characteristics of the patients with VDD leads. Operator skill and team experience combined with special custom maneuvers can enable favorable results to be achieved despite the specific design of VDD leads, even with older VDD lead models.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, The John Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
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6
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Kwon S, Lee E, Choi EK, Lee SR, Oh S, Choi YS. Long-term outcomes of abandoned leads of cardiac implantable electronic devices. Heart Rhythm 2023; 20:1639-1646. [PMID: 37543304 DOI: 10.1016/j.hrthm.2023.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Evidence of the long-term outcomes of abandoned leads (ALs) in patients with cardiac implantable electronic devices (CIEDs) is scarce. OBJECTIVE This study aimed to investigate the long-term outcomes of ALs. METHODS This retrospective cohort study reviewed a single-center CIED registry of 2962 procedures performed from 1984-2018 and identified 130 patients with AL (AL group). We matched 2 controls without AL (by age, sex, device type, and device revision/removal date) to each patient with AL (n = 260) and compared CIED-related infection, venous thrombosis/stenosis, and all-cause mortality between groups using a Cox proportional hazard model analysis. RESULTS For a mean follow-up period of 11.2 ± 8.2 years, 14 (3.6%), 7 (1.8%), and 143 (36.7%) patients had a CIED-related infection, venous thrombosis/stenosis, or experienced all-cause mortality, respectively. The AL group had more comorbidities than the control group. Lead malfunction was the most common cause of abandonment (64.6%). After adjustment for covariates, no significant intergroup differences were noted in the risks of infection, venous thrombosis/stenosis, or all-cause mortality (adjusted hazard ratio [aHR] 2.52; 95% confidence interval [CI] 0.77-8.25; aHR 1.18; 95% CI 0.25-5.64; aHR 1.26; 95% CI 0.89-1.80, respectively). Patients with multiple ALs had increased risks of infection and all-cause mortality vs controls (aHR 8.61; 95% CI 2.13-34.84; aHR 2.42; 95% CI 1.17-5.00, respectively). CONCLUSION Patients with a single AL showed similar risks of CIED-related infections, venous thrombosis/stenosis, and all-cause mortality as those without ALs, whereas those with multiple ALs showed increased risks of infection and all-cause mortality.
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Affiliation(s)
- Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Cardiovascular Medicine, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun-Shik Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Rexha E, Chung DU, Burger H, Ghaffari N, Madej T, Ziaukas V, Hassan K, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction-a GALLERY subgroup analysis. Front Cardiovasc Med 2023; 10:1251055. [PMID: 37745113 PMCID: PMC10511873 DOI: 10.3389/fcvm.2023.1251055] [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: 06/30/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Background The prevalence of young patients with cardiac implantable electronic devices (CIED) is steadily increasing, accompanied by a rise in the occurrence of complications related to CIEDs. Consequently, transvenous lead extraction (TLE) has become a crucial treatment approach for such individuals. Objective The purpose of this study was to examine the characteristics and procedural outcomes of young patients who undergo TLE, with a specific focus on identifying independent risk factors associated with adverse events. Methods All patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) were categorized into two groups based on their age at the time of enrollment: 45 years or younger, and over 45 years. A subgroup analysis was conducted specifically for the younger population. In this analysis, predictor variables for all-cause mortality, procedural complications, and procedural failure were evaluated using multivariable analyses. Results We identified 160 patients aged 45 years or younger with a mean age of 35.3 ± 7.6 years and 42.5% (n = 68) female patients. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2 ± 1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. The all-cause in-hospital mortality rate was 2.5%, with septic shock identified as the primary cause of mortality. Multivariable analysis revealed CKD (OR: 19.0; 95% CI: 1.84-194.9; p = 0.018) and systemic infection (OR: 12.7; 95% CI: 1.14-142.8; p = 0.039) as independent predictor for all-cause mortality. Lead age ≥ 10 years (OR: 14.58, 95% CI: 1.36-156.2; p = 0.027) was identified as sole independent risk factor for procedural complication. Conclusion TLE in young patients is safe and effective with a procedure-related mortality rate of 0.0%. CKD and systemic infection are predictors for all-cause mortality, whereas lead age ≥ 10 years was identified as independent risk factor for procedural complications in young patients undergoing TLE.
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Affiliation(s)
- Enida Rexha
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Tomas Madej
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Virgilijus Ziaukas
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Kambiz Hassan
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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8
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Bracke FA, Rademakers LM, van Veghel D. Extraction of non-infected redundant pacing and defibrillator leads does not result in better patient outcomes. Neth Heart J 2023; 31:327-329. [PMID: 37010738 PMCID: PMC10444728 DOI: 10.1007/s12471-023-01770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 04/04/2023] Open
Abstract
The introduction of dedicated tools for pacing and defibrillator lead extraction has resulted in relatively high success and low complication rates. The confidence this elicits has broadened the indications from device infections to non-functional or redundant leads and the latter make up an increasing share of extraction procedures. Proponents of extracting these leads point to the higher complication burden of lead extraction in patients with longstanding abandoned leads when compared one-to-one with extraction when these leads become redundant. However, this does not translate into better patient outcomes on a population level: complications are rare with properly abandoned leads and thus most patients will never be subjected to an extraction procedure and the ensuing complications. Therefore, not extracting redundant leads minimises the risk for the patients and avoids many expensive procedures.
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Affiliation(s)
- Frank A Bracke
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | - Leonard M Rademakers
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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9
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Haeberlin A, Noti F, Breitenstein A, Auricchio A, Reichlin T, Conte G, Klersy C, Curti M, Pruvot E, Domenichini G, Schaer B, Kühne M, Gruszczynski M, Burri H, Kobza R, Grebmer C, Regoli FD. Transvenous Lead Extraction during Cardiac Implantable Device Upgrade: Results from the Multicenter Swiss Lead Extraction Registry. J Clin Med 2023; 12:5175. [PMID: 37629216 PMCID: PMC10455660 DOI: 10.3390/jcm12165175] [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: 07/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce. METHODS This is a post hoc analysis of the investigator-initiated multicenter Swiss TLE registry. The objectives were to assess patient and procedural factors influencing TLE outcomes at the time of device upgrades. RESULTS 941 patients were included, whereof 83 (8.8%) had TLE due to a device upgrade. Rotational mechanical sheaths were more often used in upgraded patients (59% vs. 42.7%, p = 0.015) and total median procedure time was longer in these patients (160 min vs. 105 min, p < 0.001). Clinical success rates of upgraded patients compared to those who received TLE due to other reasons were not different (97.6% vs. 93.0%, p = 0.569). Moreover, multivariable analysis showed that upgrade procedures were not associated with a greater risk for complications (HR 0.48, 95% confidence interval 0.14-1.57, p = 0.224; intraprocedural complication rate of upgraded patients 7.2% vs. 5.5%). Intraprocedural complications of upgraded patients were mostly associated with the implantation and not the extraction procedure (67% vs. 33% of complications). CONCLUSIONS TLE during device upgrade is effective and does not attribute a disproportionate risk to the upgrade procedure.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | | | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Moreno Curti
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Etienne Pruvot
- Department of Cardiology, CHUV, 1011 Lausanne, Switzerland
| | | | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | | | - Haran Burri
- Department of Cardiology, HUG, 1205 Geneva, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - François D. Regoli
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Cardiology Service, San Giovanni Hospital, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
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10
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Akhtar Z, Sohal M, Sheppard MN, Gallagher MM. Transvenous Lead Extraction: Work in Progress. Eur Cardiol 2023; 18:e44. [PMID: 37456768 PMCID: PMC10345938 DOI: 10.15420/ecr.2023.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiac implantable electronic devices are the cornerstone of cardiac rhythm management, with a significant number of implantations annually. A rising prevalence of cardiac implantable electronic devices coupled with widening indications for device removal has fuelled a demand for transvenous lead extraction (TLE). With advancement of tools and techniques, the safety and efficacy profile of TLE has significantly improved since its inception. Despite these advances, TLE continues to carry risk of significant complications, including a superior vena cava injury and mortality. However, innovative approaches to lead extraction, including the use of the jugular and femoral accesses, offers potential for further gains in safety and efficacy. In this review, the indications and risks of TLE are discussed while examining the evolution of this procedure from simple traction to advanced methodologies, which have contributed to a significant improvement in safety and efficacy.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Mary N Sheppard
- Cardiac Risk in the Young, Cardiovascular Pathology Unit, St George's University of LondonLondon, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
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11
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Kutarski A, Jacheć W, Nowosielecka D, Polewczyk A. Unexpected Procedure Difficulties Increasing the Complexity of Transvenous Lead Extraction: The Single Centre Experience with 3721 Procedures. J Clin Med 2023; 12:jcm12082811. [PMID: 37109149 PMCID: PMC10143656 DOI: 10.3390/jcm12082811] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) should be completed, even when facing difficulties which have yet to be described. The aim was to explore unexpected TLE obstacles (the circumstances of the occurrence and influence on TLE outcome). METHODS The retrospective analysis of a single centre database containing 3721 TLEs. RESULTS Unexpected procedure difficulties (UPDs) occurred in 18.43% of cases (singles in 12.20% of cases and multiples in 6.26% of cases). These included blockages in the lead venous approach in3.28% of cases, functional lead dislodgement in 0.91% of cases, and loss of broken lead fragment in 0.60% of cases. All of them, including implant vein-in 7.98% of cases, lead fracture during extraction-in 3.84% of cases, and lead-to-lead adherence-in 6.59% of cases, Byrd dilator collapse-in 3.41% of cases, including the use of an alternative prolonged the procedure but had no influence on long-term mortality. Most of the occurrences were associated with lead dwell time, younger patient age, lead burden, and poorer procedure effectiveness and complications (common cause). However, some of the problems seemed to be related to cardiac implantable electronic devices (CIED) implantation and the subsequent lead management strategy. A more complete list of all tips and tricks is still required. CONCLUSIONS (1) The complexity of the lead extraction procedure combines both prolonged procedure duration and the occurrence of lesser-known UPDs. (2) UPDs are present in nearly one fifth of the TLE procedures, and can occur simultaneously. (3) UPDs, which usually force the extractor to expand the range of techniques and tools, should become part of the training in transvenous lead extraction.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
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12
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Miguelena Hycka J, López Menéndez J, Martín García M, Muñoz Pérez R, Castro Pinto M, Torres Terreros CB, García Chumbiray PF, Rodriguez-Roda J. Electrodos no funcionantes ¿Extracción o abandono? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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13
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Tułecki Ł, Jacheć W, Polewczyk A, Czajkowski M, Targońska S, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. Assessment of the impact of organisational model of transvenous lead extraction on the effectiveness and safety of procedure: an observational study. BMJ Open 2022; 12:e062952. [PMID: 36581437 PMCID: PMC9806044 DOI: 10.1136/bmjopen-2022-062952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the impact of the organisational model of transvenous lead extraction (TLE) on effectiveness and safety of procedures. DESIGN Post hoc analysis of patient data entered prospectively into a computer database. SETTING Data of all patients undergoing TLE in three centres in Poland between 2006 and 2021 were analysed. PARTICIPANTS 3462 patients including: 985 patients undergoing TLE in a hybrid room (HR), with cardiac surgeon (CS) as co-operator, under general anaesthesia (GA), with arterial line (AL) and with transoesophageal echocardiography (TEE) monitoring (group 1), 68 patients-TLE in HR with CS, under GA, without TEE (group 2), 406 patients-TLE in operating theatre (OT) using 'arm-C' X-ray machine with CS under GA and with TEE (group 3), 154 patients-TLE in OT with CS under GA, without TEE (group 4), 113 patients-TLE in OT with anaesthesia team, using the 'arm-C' X-ray machine, without CS (group 5), 122 patients-TLE in electrophysiology lab (EPL), with CS under intravenous analgesia without TEE and AL (group 6), 1614 patients-TLE in EPL, without CS, under intravenous analgesia without TEE and AL (group 7). KEY OUTCOME MEASURE Effectiveness and safety of TLE depending on organisational model. RESULTS The rate of major complications (MC) was higher in OT/HR than in EPL (2.66% vs 1.38%), but all MCs were treated successfully and there was no MC-related death. The use of TEE during TLE increased probability of complete procedural succemss achieving about 1.5 times (OR=1.482; p<0.034) and were connected with reduction of minor complications occurrence (OR=0.751; p=0.046). CONCLUSIONS The most important condition to avoid death due to MC is close co-operation with cardiac surgery team, which permits for urgent rescue cardiac surgery. Continuous TEE monitoring plays predominant role in immediate decision on rescue sternotomy and improves the effectiveness of procedure.
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Affiliation(s)
- Łukasz Tułecki
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Wojciech Jacheć
- Cardiology, Faculty of Medical Science, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Physiology, Patophysiology and Clinical Immunology, Jan Kochanowski University of Kielce Collegium Medicum, Kielce, Poland
- Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | | | | | - Konrad Tomków
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Kamil Karpeta
- Cardiac Surgery, Masovian Specialistic Hospital, Radom, Poland
| | - Dorota Nowosielecka
- Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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14
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Stefańczyk P, Nowosielecka D, Polewczyk A, Jacheć W, Głowniak A, Kosior J, Kutarski A. Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:291. [PMID: 36612613 PMCID: PMC9819767 DOI: 10.3390/ijerph20010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. METHODS We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. RESULTS The need for an upgrade was the leading indication for TLE in only 36-66% of patients. In 42.0-57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1-76.4% of patients, functional leads were retained in 20.2-31.9%, non-functional leads were left in place in 0.0-1.1%, and non-functional superfluous leads were extracted in 3.6-8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). CONCLUSIONS Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.
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Affiliation(s)
- Paweł Stefańczyk
- Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University in Katowice, 41-800 Zabrze, Poland
| | - Andrzej Głowniak
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital, 26-617 Radom, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
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15
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Kutarski A, Jacheć W, Nowosielecka D, Czajkowski M, Tułecki Ł, Polewczyk A. Repeat Transvenous Lead Extraction-Predictors, Effectiveness, Complications and Long-Term Prognostic Significance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15602. [PMID: 36497674 PMCID: PMC9740863 DOI: 10.3390/ijerph192315602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. METHODS Retrospective analysis of a large single-center database of 3654 TLEs. RESULTS Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. CONCLUSIONS Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University, 20-059 Lublin, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
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16
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Kutarski A, Głowniak A, Kosior J, Jacheć W, Nowosielecka D, Czajkowski M, Polewczyk A. Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years-A Large Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14184. [PMID: 36361063 PMCID: PMC9655673 DOI: 10.3390/ijerph192114184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. METHODS Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10-20 years, 20-30 years (old) and over 30 years (very old). RESULTS Rate of removal of old and very old leads almost doubles with successive five-year periods (3-6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium-from 0.3 to 12.1%, severe tricuspid valve damage-from 0.2 to 2.1%, need for rescue cardiac surgery-from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10-20 years increases 6.7 times, aged 20-30 years-14.3 times (amounting to 8.4%), and aged 30 and more years-20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. CONCLUSIONS 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital in Radom, 20-617 Radom, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, Pope John Paul II Hospital of Zamość, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
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17
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Step by Step through the Years-High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques. J Clin Med 2022; 11:jcm11164884. [PMID: 36013123 PMCID: PMC9410501 DOI: 10.3390/jcm11164884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 12/07/2022] Open
Abstract
Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the stepwise approach. Baseline characteristics, procedural details and outcome of patients with high energy lead (ICD group) vs. without high energy lead (non-ICD group) were compared. Results: Out of 667 extractions, 991 leads were extracted in 405 procedures (60.7%) in the ICD group and 439 leads in 262 procedures (39.3%) in the non-ICD group. ICD patients were significantly younger (median 67 vs. 74 years) and were significantly less often female (18.1% vs. 27.7%, p < 0.005 for both). Advanced extraction tools were used significantly more often in the ICD group (73.2% vs. 37.5%, p < 0.001), but there were no significant differences in the successful removal (98.8% vs. 99.2%) or complications (4.7% vs. 3.1%) between the groups (p > 0.2 for both). Discussion: Using the stepwise approach, overall procedural success was high and complication rate was low in a high-volume centre. In patients with a high energy lead, the TLE procedure was more complex, but outcome was similar to comparator patients.
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18
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Wijesuriya N, Elliott MK, Mehta V, Behar JM, Niederer S, Wilkoff BL, Rinaldi CA. Transvenous lead extraction in conduction system pacing. Front Physiol 2022; 13:993604. [PMID: 36035491 PMCID: PMC9410714 DOI: 10.3389/fphys.2022.993604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Conduction System Pacing (CSP) delivered by His Bundle Pacing (HBP) or Left Bundle Pacing (LBP) are exciting novel interventions in the field of Cardiac Resynchronization Therapy (CRT). As the evidence base for CSP grows, the volume of implants worldwide is projected to rise significantly in the coming years. As such, physicians will be confronted with increasingly prevalent and vital issues arising in long-term follow up, including the management of infected, malfunctioning, or redundant CSP leads. Transvenous lead extraction (TLE) is the first-line option for removal of pacing leads when indicated in these circumstances. The evidence base for TLE in the context of CSP is still in its infancy. In this article, we first provide a brief overview of TLE. We then examine the data on the long-term performance of HBP leads. Next, we describe the features of the Medtronic Select Secure 3,830 lead, and how experience of TLE of this lead in the paediatric population has informed our practice. Finally, we review the current evidence for TLE in HBP and LBP, and discuss how future studies can address gaps in our current knowledge.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- *Correspondence: Nadeev Wijesuriya,
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bruce L Wilkoff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Deb Family Endowed Chair in Lead Management, Cleveland Clinic, Cleveland, OH, United States
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, United Kingdom
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19
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Callahan TD. Looking for Lead Adhesions While Planning for Transvenous Lead Extraction. J Cardiovasc Electrophysiol 2022; 33:1041-1044. [PMID: 35245950 DOI: 10.1111/jce.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
The first implantable pacemaker was placed in the 1958, ushering in a new frontier of cardiovascular medicine. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas D Callahan
- Director, Inpatient Electrophysiology Service, Associate Program Director, Cardiovascular Medicine Fellowship.,Cleveland Clinic, Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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20
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Stefańczyk P, Nowosielecka D, Tułecki Ł, Tomków K, Polewczyk A, Jacheć W, Kleinrok A, Borzęcki W, Kutarski A. Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience. Vasc Health Risk Manag 2021; 17:445-459. [PMID: 34385818 PMCID: PMC8352641 DOI: 10.2147/vhrm.s318205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Transvenous lead extraction (TLE) is now a first-line technique for the treatment of complications related to cardiac implantable electronic devices. The aim of the study was to demonstrate that it is possible to safely perform difficult TLE procedures with a maximum reduction of peri-procedural major complications. Methods A total of 1000 consecutive patients undergoing TLE in a single high-volume center from 2016 to 2019 were studied. All procedures were performed in a hybrid room or operating room by a specialized TLE team. TLE was performed under general anesthesia and monitored by transesophageal echocardiography, and the operating room was suitably equipped for immediate surgical intervention. The effectiveness and safety of the procedures were assessed, with particular emphasis on major complications. Results In all, 1952 leads with the mean implant duration of 111.7 ± 77.6 months had been extracted. Complete procedural success of patients was achieved in 95.9% and clinical success in 99.1%. Major complications, predominantly cardiac tamponade (63.3%), occurred in 22 patients (2.2%). Rapid diagnosis and immediate intervention were the key to a 100% survival in patients with this complication. Conclusion Performing procedures in a hybrid operating room under general anesthesia in the presence of a cardiac surgeon and with the use of transesophageal echocardiography significantly improves the safety of transvenous lead extraction.
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Affiliation(s)
- Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology, and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- Silesian Medical University, 2nd Department of Cardiology, Zabrze, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Wojciech Borzęcki
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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21
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Russo V, Viani S, Migliore F, Nigro G, Biffi M, Tola G, Bisignani G, Dello Russo A, Sartori P, Rordorf R, Ottaviano L, Perego GB, Checchi L, Segreti L, Bertaglia E, Lovecchio M, Valsecchi S, Bongiorni MG. Lead Abandonment and Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) Implantation in a Cohort of Patients With ICD Lead Malfunction. Front Cardiovasc Med 2021; 8:692943. [PMID: 34395560 PMCID: PMC8356671 DOI: 10.3389/fcvm.2021.692943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background: When an implantable-cardioverter defibrillator (ICD) lead becomes non-functional, a recommendation currently exists for either lead abandonment or removal. Lead abandonment and subcutaneous ICD (S-ICD) implantation may represent an additional option for patients who do not require pacing. The aim of this study was to investigate the outcomes of a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction. Methods: We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and compared their outcomes with those of patients who underwent extraction and subsequent reimplantation of a single-chamber transvenous ICD (T-ICD). Results: Forty-three patients underwent S-ICD implantation after abandonment of malfunctioning leads, while 62 patients underwent extraction and subsequent reimplantation of a new T-ICD. The two groups were comparable. In the extraction group, no major complications occurred during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, 3 major complications or deaths occurred in the S-ICD group and 11 in the T-ICD group (HR 1.07; 95% CI 0.29–3.94; P = 0.912). Minor complications were 4 in the S-ICD group and 5 in the T-ICD group (HR 2.13; 95% CI 0.49–9.24; P = 0.238). Conclusions: In the event of ICD lead malfunction, extraction avoids the potential long-term risks of abandoned leads. Nonetheless the strategy of lead abandonment and S-ICD implantation was feasible and safe, with no significant increase in adverse outcomes, and may represent an option in selected clinical settings. Further studies are needed to fully understand the potential risks of lead abandonment. Clinical Trial Registration: URL: ClinicalTrials.gov Identifier: NCT02275637
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Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Sartori
- Cardiology Division, Hospital IRCCS San Martino, Genoa, Italy
| | - Roberto Rordorf
- Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luca Ottaviano
- Cardiology Division, Istituto Clinico S. Ambrogio, Milan, Italy
| | | | - Luca Checchi
- Cardiology Division, University of Florence, Florence, Italy
| | - Luca Segreti
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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22
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Diaz JC, Romero J, Costa R, Cuesta A, Biase LD, Alviz I, Velasco A, Gabr M, Duque M, Marin JE, Aristizabal J, Velasquez J, Niño CD, Mazzetti H. Current practice in transvenous lead extraction in Latin America: Latin American Heart Rhythm Association survey. J Cardiovasc Electrophysiol 2021; 32:2715-2721. [PMID: 34288220 DOI: 10.1111/jce.15180] [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: 05/06/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead-related complications. Currently, objective data on TLE in Latin America is lacking. OBJECTIVE To describe the current practice standards in Latin American centers performing TLE. METHODS An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. RESULTS A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty-nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. CONCLUSION This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.
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Affiliation(s)
| | - Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alejandro Cuesta
- Facultad de Medicina, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Luigi D Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Jorge E Marin
- Hospital Universitario San Vicente Fundación, Rionegro, Colombia
| | | | | | | | - Hector Mazzetti
- Sanatorio de La Trinidad de San Isidro, Buenos Aires, Argentina
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23
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace 2021; 22:515-549. [PMID: 31702000 PMCID: PMC7132545 DOI: 10.1093/europace/euz246] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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24
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Segreti L, Giannotti Santoro M, Di Cori A, Fiorentini F, Zucchelli G, Bernini G, De Lucia R, Viani S, Paperini L, Barletta V, Soldati E, Bongiorni MG. Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads. Europace 2021; 22:1401-1408. [PMID: 32681177 DOI: 10.1093/europace/euaa134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. METHODS AND RESULTS Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07-11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01-1.02; P < 0.001) were associated with a higher risk of clinical failure. CONCLUSION Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.
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Affiliation(s)
- Luca Segreti
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | | | - Andrea Di Cori
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulia Bernini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano Viani
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Luca Paperini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ezio Soldati
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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25
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Elgaard AF, Johansen JB, Nielsen JC, Gerdes C, Riahi S, Philbert BT, Haarbo J, Melchior TM, Larsen JM. Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study. Europace 2021; 22:1097-1102. [PMID: 32447372 DOI: 10.1093/europace/euaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. METHODS AND RESULTS All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. CONCLUSION More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
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26
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Blomstrom-Lundqvist C, Ostrowska B. Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis. Europace 2021; 23:euab071. [PMID: 34037227 PMCID: PMC8221047 DOI: 10.1093/europace/euab071] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 01/19/2023] Open
Abstract
Cardiac implantable electronic devices (CIED) are potentially life-saving treatments for several cardiac conditions, but are not without risk. Despite dissemination of recommended strategies for prevention of device infections, such as administration of antibiotics before implantation, infection rates continue to rise resulting in escalating health care costs. New trials conveying important steps for better prevention of device infection and an EHRA consensus paper were recently published. This document will review the role of various preventive measures for CIED infection, emphasizing the importance of adhering to published recommendations. The document aims to provide guidance on how to prevent CIED infections in clinical practice by considering modifiable and non-modifiable risk factors that may be present pre-, peri-, and/or post-procedure.
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Affiliation(s)
| | - Bozena Ostrowska
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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27
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Attempted lead extraction in low-risk patients without surgical backup: Progress or peril? Heart Rhythm 2021; 18:1279-1280. [PMID: 34023502 DOI: 10.1016/j.hrthm.2021.05.020] [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: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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Transvenous lead extraction in patients with prior extraction procedures: Procedural profiles and outcomes. Heart Rhythm 2020; 17:1904-1908. [PMID: 32512177 DOI: 10.1016/j.hrthm.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subclinical venous injuries are common during transvenous lead extraction (TLE), but their implications for future TLE are unclear. Little is known about whether a prior TLE adds risk or complexity to subsequent extraction procedures. OBJECTIVE The purpose of this study was to assess procedural profiles and outcomes of TLE based on whether patients had prior extraction procedures. METHODS All 3258 consecutive patients undergoing TLE at the Cleveland Clinic (1996-2012) were included. Procedural profiles and outcomes were determined. RESULTS Of 3258 TLEs, 198 had prior TLE. Median number of leads in place was 2 in both groups, but patients with prior TLE were more likely to have defibrillator leads (47% vs 41%; P = .08) and more likely to be pacemaker-dependent (32% vs 25%; P = .02). The age of oldest lead (median 2134 vs 1902 days; P = .4) and combined age of leads (median 2948 vs 2676 days; P = .6) were comparable. Procedures were longer in those with prior TLE (166 ± 79 minutes vs 149 ± 74 minutes; P = .004) with comparable fluoroscopy times (median 13 vs 11 minutes; P = .07), and successful extraction was more likely to require specialized tools (88% vs 81%; P = .006) with higher likelihood of rescue femoral workstation (12% vs 4%; P <.0001). Clinical success rates were comparable in those with prior TLE (99.5% vs 98.9%; P = .8) with similar major (3.0% vs 1.9%; P = .3) and minor (3.0% vs 3.7%; P = .8) complication rates. CONCLUSION Extraction procedures were more challenging in patients with prior TLE compared to those without prior TLE but with excellent success and low complication rates.
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Fardman A, Ram E, Lavee J, Wieder A, Beinart R, Nof E, Peled Y. Complications of retained pacemaker hardware in heart transplant recipients: case series and review of the literature. Infection 2020; 48:635-640. [PMID: 32246271 DOI: 10.1007/s15010-020-01410-x] [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: 12/11/2019] [Accepted: 03/06/2020] [Indexed: 11/26/2022]
Abstract
Heart transplantation (HT) in patients with prior cardiovascular implantable electronic devices (CIEDs) is becoming more common, in parallel with the increased use of CIEDs for patients with advanced heart failure. Complete removal of CIED components during HT is not always feasible, and it is thus surprising that the literature addressing the implications of retained CIED components is limited. Indeed, there are neither guidelines nor consensus regarding the need for removal of these CIED fragments. This issue is nonetheless becoming important in light of the increase in the percentage of HT candidates having CIEDs, on the one hand, and newer therapeutic immunosuppressive protocols with higher bacterial infection potential, on the other. Thus, with the aim to study the implications of retained CIED fragments as a step towards establishing a therapeutic approach for the unique population of HT recipients with CIED remnants, we present here a case series of HT patients with retained CIED fragments who developed complications of infections together with a review of the available literature.
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Affiliation(s)
- Alexander Fardman
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eilon Ram
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Lavee
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Wieder
- Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Beinart
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Nof
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Peled
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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31
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Gamalath S, Ekladious A, Wheeler L, Fish L. Complications of retained cardiac defibrillator coil left in situ. BMJ Case Rep 2020; 13:e233512. [PMID: 32102893 PMCID: PMC7046375 DOI: 10.1136/bcr-2019-233512] [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] [Accepted: 02/09/2020] [Indexed: 11/03/2022] Open
Abstract
A 42-year-old man presented to a regional hospital emergency department with a 4-day history of haemoptysis, shortness of breath, pleuritic chest pain, productive cough and subjective fevers. This episode was the third similar presentation in a 2-month period. The patient was known to have dilated cardiomyopathy secondary to amphetamine use and had previously required insertion of automated implantable cardiac defibrillator (AICD). Due to recurrent complications, the AICD had been replaced on two occasions and a superior vena cava (SVC) lead left in situ on its final removal. Clinical examination and investigations revealed lower respiratory tract infection and transthoracic echocardiogram revealed severe left ventricular failure with an ejection fraction of 16%. The patient was admitted under the general medical team for treatment and investigation of suspected bacteraemia and septicaemia secondary to colonisation of the retained AICD lead. He spent 6 days as an in-patient and was discharged on home where he was to be followed up by the advanced heart failure team in a tertiary centre for consideration of new AICD insertion and to explore possibility of retained coil removal. This case report discusses the concerns surrounding retained SVC leads and potential clinical sequalae. As this patient presented three times within a period of 2 months, it was suspected retained SVC lead was a predisposing factor for recurrent lower respiratory infection.
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Affiliation(s)
- Sameera Gamalath
- General Medicine, Bunbury Regional Hospital, WA Country Health Service, Bunbury, Western Australia, Australia
| | - Adel Ekladious
- General Medicine, Bunbury Regional Hospital, Bunbury, Western Australia, Australia
| | - Luke Wheeler
- Department of Anaesthetic, Country Health SA Local Health Network, Adelaide, South Australia, Australia
| | - Louise Fish
- General Medicine, Bunbury Regional Hospital, WA Country Health Service, Bunbury, Western Australia, Australia
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Bracke F, Verberkmoes N, van 't Veer M, van Gelder B. Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads. Europace 2019; 21:1378-1384. [PMID: 31324910 DOI: 10.1093/europace/euz197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/26/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection. METHODS AND RESULTS All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6-38.2) and 11.6 (5.6-17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration. CONCLUSION Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.
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Affiliation(s)
- Frank Bracke
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Niels Verberkmoes
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Marcel van 't Veer
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Berry van Gelder
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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33
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Shenasa M, Krahn AD. Antibiotic prophylaxis for cardiac implantable electronic devices: Is the jury out yet? Pacing Clin Electrophysiol 2019; 42:1079-1080. [DOI: 10.1111/pace.13743] [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: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Mohammad Shenasa
- Heart & Rhythm Medical Group, Department of Cardiovascular ServicesO'Connor Hospital San Jose California USA
| | - Andrew D. Krahn
- Heart Rhythm Vancouver Vancouver British Columbia V6E 1M7 Canada
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34
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol 2019; 42:1006-1017. [DOI: 10.1111/pace.13715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Jacheć
- 2nd Department of CardiologyMedical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze Zabrze Poland
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences KielceThe Jan Kochanowski University Kielce Poland
- Swietokrzyskie Cardiology Center Kielce Poland
| | - Luca Segreti
- Department of CardiologyUniversity Hospital of Pisa Pisa Italy
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35
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Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation. Heart Rhythm 2019; 16:564-571. [DOI: 10.1016/j.hrthm.2018.10.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Indexed: 12/28/2022]
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36
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Segreti L, Rinaldi CA, Claridge S, Svendsen JH, Blomstrom-Lundqvist C, Auricchio A, Butter C, Dagres N, Deharo JC, Maggioni AP, Kutarski A, Kennergren C, Laroche C, Kempa M, Magnani A, Casteigt B, Bongiorni MG. Procedural outcomes associated with transvenous lead extraction in patients with abandoned leads: an ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) Registry Sub-Analysis. Europace 2019; 21:645-654. [DOI: 10.1093/europace/euy307] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luca Segreti
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | | | - Simon Claridge
- Cardiology Department, Guy’s & St Thomas’ Hospitals, London, UK
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carina Blomstrom-Lundqvist
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Angelo Auricchio
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Christian Butter
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Nikolaos Dagres
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Germany
| | | | - Aldo P Maggioni
- CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, Marseille, France
- ANMCO Research Center, Florence, Italy
| | - Andrzej Kutarski
- Scientific Division, European Society of Cardiology, EURObservational Research Programme (EORP), 2035 Route des colles, CS 80179 Biot, Sophia-Antipolis Cedex, France
| | - Charles Kennergren
- Department of Cardiology, Medical University of Lublin, 20-090 Lublin Str., Jaczewskiego 8, Lublin, Poland
| | | | - Maciej Kempa
- Sahlgrenska University Hospital, Cardiothoracic Surgery, Sahlgrenska/SU, Goteborg, Sweden
| | - Andrea Magnani
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Debinki 7 Str., Gdansk, Poland
| | - Benjamin Casteigt
- Cardiology Department, University Hospital Maggiore della Carità, Corso Mazzini 18, Novara, Italy
| | - Maria Grazia Bongiorni
- Clinique Pasteur, Management of Cardiac Arrhythmias, 45 Avenue de Lombez, Toulouse, France
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Recurrent Bacteremia After Heart Transplantation Due to Abandoned Lead Fragment in an Anonymous Vein-A Case Report. Transplant Proc 2018; 50:4071-4074. [PMID: 30577318 DOI: 10.1016/j.transproceed.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/01/2018] [Indexed: 11/21/2022]
Abstract
Heart transplantation (HTx) represents the "gold standard" in end-stage heart failure therapy. Due to their severe heart failure and for prevention of sudden cardiac death, the majority of patients presenting for HTx will have a history of an implanted cardioverter-defibrillator (ICD). Usually, within the scope of HTx, all cardiac-implanted electronic device components are removed. In rare cases these efforts fail and some material remains. The abandoned lead fragments can cause serious complications. The case presented herein involves a patient with recurrent bacteremia after successful HTx originating from an abandoned and infected lead fragment. In 2016, a 64-year-old man received a donor heart transplant due to end-stage heart failure. Unfortunately, during the procedure, not all components of an ICD implanted in 2007 could be removed. An initially event-free period was followed by recurrent fever attacks and staphylococcal bacteremia was diagnosed. After an extensive search, the source of the bacteremia was identified by positron emission tomography-computed tomography (PET-CT), and percutaneous extraction of the abandoned and infected ICD lead fragment was scheduled. The fragment was extracted using a minimally invasive approach via percutaneous femoral vein access. The patient was discharged 3 days later, with no further complications. This case highlights the need for conscientious and complete removal of foreign material in the HTx setting. Difficult-to-diagnose sources of infection could be reliably identified by PET-CT. When required, extraction of the foreign body should be done using a minimally invasive approach.
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38
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Fowler LH. Nursing Management for Patients Postoperative Cardiac Implantable Electronic Device Placement. Crit Care Nurs Clin North Am 2018; 31:65-76. [PMID: 30736936 DOI: 10.1016/j.cnc.2018.11.007] [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: 10/27/2022]
Abstract
As cardiac implantable electronic devices (CIEDs) continue to evolve and patients continue to live longer, the use of these devices increases. CIEDs include permanent pacemakers, implanted cardioverter-defibrillators, and cardiac resynchronization therapy devices. Over the last 2 decades, the functionality of these devices has increased and can be complex. Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative CIED placement and for patients admitted to critical care units with CIEDs already in place. Patients with CIEDs are a vulnerable population with special needs and considerations for management.
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Affiliation(s)
- Leanne H Fowler
- LSU Health New Orleans School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.
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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.
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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.
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40
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Abstract
Infections associated with cardiac implantable electronic devices are increasing and are associated with significant morbidity and mortality. This article reviews the epidemiology, microbiology, and risk factors for acquisition of these infections. The complex diagnostic and management strategies associated with these serious infections are reviewed with an emphasis on recent updates and advances, as well as existing controversies. Additionally, the latest in preventative strategies are reviewed.
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Affiliation(s)
- Christopher J Arnold
- Division of Infectious Diseases and International Health, University of Virginia Health System, PO Box 800545, Charlottesville, VA 22908-0545, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Hospital, Duke Box 102359, Durham, NC 27710, USA.
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41
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Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:233-235. [PMID: 29894362 DOI: 10.1097/imi.0000000000000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.
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42
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Merchant FM, Tejada T, Patel A, El-Khalil J, Desai Y, Keeling B, Lattouf OM, Leon AR, El-Chami MF. Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads. Heart Rhythm 2018; 15:855-859. [DOI: 10.1016/j.hrthm.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 10/18/2022]
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43
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Bontempi L, Vassanelli F, Cerini M, Inama L, Mitacchione G, Giacopelli D, Curnis A. Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | - Lorenza Inama
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | | | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
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44
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Tarakji KG, Saliba W, Markabawi D, Rodriguez ER, Krauthammer Y, Brunner MP, Hussein AA, Baranowski B, Cantillon DJ, Kanj M, Niebauer M, Rickard J, Callahan T, Shao M, Martin DO, Wazni OM, Wilkoff BL, Tan CD. Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction. Heart Rhythm 2018; 15:318-325. [DOI: 10.1016/j.hrthm.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 11/28/2022]
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45
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Holzhauser L, Imamura T, Nayak HM, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Patel A, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation-An Underrecognized Problem. J Card Fail 2018; 24:101-108. [PMID: 29325797 PMCID: PMC5945281 DOI: 10.1016/j.cardfail.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. METHODS We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). RESULTS A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. CONCLUSION RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
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Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hemal M Nayak
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nitasha Sarswat
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sara Kalantari
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Onsager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
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Barakat AF, Wazni OM, Tarakji KG, Callahan T, Nimri N, Saliba WI, Shah S, Abdur Rehman K, Rickard J, Brunner MP, Martin DO, Kanj M, Baranowski B, Cantillon D, Niebauer M, Dresing T, Lindsay BD, Wilkoff BL, Hussein AA. Transvenous Lead Extraction in Chronic Kidney Disease and Dialysis Patients With Infected Cardiac Devices. Circ Arrhythm Electrophysiol 2018; 11:e005706. [DOI: 10.1161/circep.117.005706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Amr F. Barakat
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Oussama M. Wazni
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Khaldoun G. Tarakji
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Callahan
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Nayef Nimri
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Walid I. Saliba
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Shailee Shah
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Karim Abdur Rehman
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - John Rickard
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Michael P. Brunner
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - David O. Martin
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Kanj
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bryan Baranowski
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Daniel Cantillon
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mark Niebauer
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Dresing
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce D. Lindsay
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce L. Wilkoff
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ayman A. Hussein
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
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47
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Barakat AF, Wazni OM, Tarakji K, Saliba WI, Nimri N, Rickard J, Brunner M, Bhargava M, Kanj M, Baranowski B, Martin DO, Cantillon D, Callahan T, Dresing T, Niebauer M, Chung M, Lindsay BD, Wilkoff B, Hussein AA. Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes. Heart Rhythm 2017; 14:1807-1811. [DOI: 10.1016/j.hrthm.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 10/19/2022]
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Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, Zeitler EP, Al-Khatib SM, Hegland DD, Piccini JP. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation 2017; 136:1387-1395. [DOI: 10.1161/circulationaha.117.027636] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Abstract
Background:
Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.
Methods:
Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.
Results:
Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years;
P
<0.0001), were less likely to be male (65% versus 68%;
P
=0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years;
P
<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7–14.4) and 54.3% (95% CI, 52.8–55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62–0.97;
P
=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.
Conclusions:
Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.
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Affiliation(s)
- Sean D. Pokorney
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Xiaojuan Mi
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Robert K. Lewis
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Melissa Greiner
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Laurence M. Epstein
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Roger G. Carrillo
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Emily P. Zeitler
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Sana M. Al-Khatib
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Donald D. Hegland
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Jonathan P. Piccini
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
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