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Igbinomwanhia E, Jiwani S, Karim S, Pimentel R. Case Series and Review of Literature for Superior Vena Cava Injury During Laser Lead Extraction. Card Electrophysiol Clin 2024; 16:117-124. [PMID: 38749629 DOI: 10.1016/j.ccep.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Transvenous laser lead extraction poses a risk of major complications (0.19%-1.8%), notably injury to the superior vena cava (SVC) in 0.19% to 0.96% of cases. Various factors contribute to SVC injury, which can be categorized as patient-related (such as female gender, low body mass index, diabetes, renal problems, anemia, and reduced ejection fraction), device-related (including the number, dwell time, and type of leads), or procedural-related (such as reason for extraction, venous obstructions, and bilateral lead placements).
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Affiliation(s)
- Efehi Igbinomwanhia
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
| | - Sania Jiwani
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
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2
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Mehta VS, Ma Y, Wijesuriya N, DeVere F, Howell S, Elliott MK, Mannkakara NN, Hamakarim T, Wong T, O'Brien H, Niederer S, Razavi R, Rinaldi CA. Enhancing transvenous lead extraction risk prediction: Integrating imaging biomarkers into machine learning models. Heart Rhythm 2024; 21:919-928. [PMID: 38354872 DOI: 10.1016/j.hrthm.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Machine learning (ML) models have been proposed to predict risk related to transvenous lead extraction (TLE). OBJECTIVE The purpose of this study was to test whether integrating imaging data into an existing ML model increases its ability to predict major adverse events (MAEs; procedure-related major complications and procedure-related deaths) and lengthy procedures (≥100 minutes). METHODS We hypothesized certain features-(1) lead angulation, (2) coil percentage inside the superior vena cava (SVC), and (3) number of overlapping leads in the SVC-detected from a pre-TLE plain anteroposterior chest radiograph (CXR) would improve prediction of MAE and long procedural times. A deep-learning convolutional neural network was developed to automatically detect these CXR features. RESULTS A total of 1050 cases were included, with 24 MAEs (2.3%) . The neural network was able to detect (1) heart border with 100% accuracy; (2) coils with 98% accuracy; and (3) acute angle in the right ventricle and SVC with 91% and 70% accuracy, respectively. The following features significantly improved MAE prediction: (1) ≥50% coil within the SVC; (2) ≥2 overlapping leads in the SVC; and (3) acute lead angulation. Balanced accuracy (0.74-0.87), sensitivity (68%-83%), specificity (72%-91%), and area under the curve (AUC) (0.767-0.962) all improved with imaging biomarkers. Prediction of lengthy procedures also improved: balanced accuracy (0.76-0.86), sensitivity (75%-85%), specificity (63%-87%), and AUC (0.684-0.913). CONCLUSION Risk prediction tools integrating imaging biomarkers significantly increases the ability of ML models to predict risk of MAE and long procedural time related to TLE.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - YingLiang Ma
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | - Nadeev Wijesuriya
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Felicity DeVere
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sandra Howell
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark K Elliott
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nilanka N Mannkakara
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tatiana Hamakarim
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tom Wong
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Hugh O'Brien
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Reza Razavi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Heart Vascular & Thoracic Institute, Cleveland Clinic London, London, United Kingdom
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Schiedat F, Fischer J, Aweimer A, Schöne D, El-Battrawy I, Hanefeld C, Mügge A, Kloppe A. Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis. Sci Rep 2023; 13:22964. [PMID: 38151554 PMCID: PMC10752869 DOI: 10.1038/s41598-023-50372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
There is a rising number in complications associated with more cardiac electrical devices implanted (CIED). Infection and lead dysfunction are reasons to perform transvenous lead extraction. An ideal anaesthetic approach has not been described yet. Most centres use general anaesthesia, but there is a lack in studies looking into deep sedation (DS) as an anaesthetic approach. We report our retrospective experience for a large number of procedures performed with deep sedation as a primary approach. Extraction procedures performed between 2011 and 2018 in our electrophysiology laboratory have been included retrospectively. We began by applying a bolus injection of piritramide followed by midazolam as primary medication and would add etomidate if necessary. For extraction of leads a stepwise approach with careful traction, locking stylets, dilator sheaths, mechanical rotating sheaths and if needed snares and baskets has been used. A total of 780 leads in 463 patients (age 69.9 ± 12.3, 31.3% female) were extracted. Deep sedation was successful in 97.8% of patients. Piritramide was used as the main analgesic medication (98.5%) and midazolam as the main sedative (94.2%). Additional etomidate was administered in 15.1% of cases. In 2.2% of patients a conversion to general anaesthesia was required as adequate level of DS was not achieved before starting the procedure. Sedation related complications occurred in 1.1% (n = 5) of patients without sequalae. Deep sedation with piritramide, midazolam and if needed additional etomidate is a safe and feasible strategy for transvenous lead extraction.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany.
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany.
| | - Julian Fischer
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
| | - Dominik Schöne
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut Für Forschung Und Lehre (IFL), Ruhr-University, Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology at Katholische Kliniken Bochum of the Ruhr University, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
- Department of Cardiology at Katholische Kliniken Bochum of the Ruhr University, Bochum, Germany
| | - Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
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Jacheć W, Nowosielecka D, Ziaja B, Polewczyk A, Kutarski A. LECOM (Lead Extraction COMplexity): A New Scoring System for Predicting a Difficult Procedure. J Clin Med 2023; 12:7568. [PMID: 38137637 PMCID: PMC10743865 DOI: 10.3390/jcm12247568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis of 3741 TLE procedures with and without complicating factors (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a five-point Complex Indicator of Difficulty of (TLE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicate a higher level of procedure complexity. (3) Results: Patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous procedures, passive fixation and multiple leads to be extracted, and a ratio of dwell time of oldest lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrates that a point total (being the sum of the odds ratios of the above variables) of >9.697 indicates a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, a logistic function was calculated, and we constructed a simple equation for lead extraction complexity that can predict the probability of a difficult procedure. The risk of complex extraction (as a percentage) is calculated as [1/(1 + 55.34 · 0.754X)] · 100 (p < 0.001). (4) Conclusion: The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management.
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Affiliation(s)
- Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Bettina Ziaja
- Department of Cardiology, Specialist Hospital, 41-800 Zabrze, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
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Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [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: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
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Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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6
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Xiao Z, He J, Du A, Yang D, An Y, Li X. Predictors for adverse events during cardiac lead extraction - Experience from a large single centre. Int J Cardiol 2023; 371:167-174. [PMID: 36272572 DOI: 10.1016/j.ijcard.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND As the use of cardiac implantable electronic devices (CIED) has increased in recent years, the need for transvenous lead extraction (TLE) has also steadily increased. However, the TLE procedure could lead to serious complications and even death. Clinical decision-making tools are necessary for predicting these adverse events, but the appropriate tools have not yet been developed. OBJECTIVE To explore the possible predictors and develop a clinical model to predict TLE related adverse events. METHODS All the patients who were admitted to our cardiac center for TLE from January 2014 to January 2021 were included in this study. The patient information, device baseline characteristics, procedure-related information, complications and outcomes were recorded. Independent predictors of TLE related adverse events were identified by univariate, LASSO and multivariate analysis. A nomogram for predicting these adverse events was developed based on these independent predictors. Calibration and decision curve analysis were conducted to evaluate the nomogram. RESULTS One thousand and one hundred patients were included in this study, 778 (70.7%) were male and the median age was 68 years old. A total of 2,208 leads were extracted and 2.01±0.74 leads were extracted per procedure. Fifty-five patients (5%) developed adverse events including minor complications (2.4%), major complications (2.3%) and death (0.27%). Seven independent predictors for TLE related adverse events were identified and selected to establish the nomogram including BMI, female gender, hypoalbuminemia, number of extracted leads>3, longest dwell time of the extracted leads and manual traction. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.774. Calibration curve and decision curve analysis showed that the nomogram had good prediction performance. CONCLUSION TLE related adverse events are some of the key issues that concern clinicians. We have identified seven independent factors and established a predictive model that may help clinicians identify at-risk patients and create better plans for lead extraction.
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Affiliation(s)
- Zengli Xiao
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Jinshan He
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Anqi Du
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Dandan Yang
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Youzhong An
- Intensive care unit, Peking University People's Hospital, Beijing, China.
| | - Xuebin Li
- Cardiovascular department, Peking University People's Hospital, Beijing, China.
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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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Polewczyk A, Jacheć W, Nowosielecka D, Tomaszewski A, Brzozowski W, Szczęśniak-Stańczyk D, Duda K, Kutarski A. Tricuspid Valve Damage Related to Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912279. [PMID: 36231579 PMCID: PMC9566121 DOI: 10.3390/ijerph191912279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. METHODS This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed. RESULTS In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1-5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE. CONCLUSIONS Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE.
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Affiliation(s)
- Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Andrzej Tomaszewski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | - Wojciech Brzozowski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | | | - Krzysztof Duda
- Department of Cardiac Surgery, Masovian Specialistic Hospital, 26-617 Radom, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
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Kutarski A, Jacheć W, Tułecki Ł, Czajkowski M, Nowosielecka D, Stefańczyk P, Tomków K, Polewczyk A. Disparities in transvenous lead extraction in young adults. Sci Rep 2022; 12:9601. [PMID: 35689031 PMCID: PMC9187694 DOI: 10.1038/s41598-022-13769-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
Adults with cardiac implantable electronic devices (CIEDs) implanted at an early age constitute a specific group of patients undergoing transvenous lead extraction (TLE). The aim of this study is to assess safety and effectiveness of TLE in young adults. A comparative analysis of two groups of patients undergoing transvenous lead extraction was performed: 126 adults who were 19–29 years old at their first CIED implantation (early adulthood) and 2659 adults who were > 40 years of age at first CIED implantation and < 80 years of age at the time of TLE (middle-age/older adulthood). CIED-dependent risk factors were more common in young adults, especially longer implant duration (169.7 vs. 94.0 months). Moreover younger age of patients at first implantation, regardless of the dwell lead time, is a factor contributing to the greater development of connective tissue proliferation on the leads (OR 2.587; p < 0.001) and adhesions of the leads with the heart structures (OR 3.322; p < 0.001), which translates into worse TLE results in this group of patients. The complexity of procedures and major complications were more common in younger group (7.1 vs. 2.0%; p < 0.001), including hemopericardium (4.8 vs 1.3; p = 0.006) and TLE-induced tricuspid valve damage (3.2 vs.0.3%; p < 0.001). Among middle-aged/older adults, there were 7 periprocedural deaths: 6 related to the TLE procedure and one associated with indications for lead removal. No fatal complications of TLE were reported in young adults despite the above-mentioned differences (periprocedural mortality rate was comparable in study groups 0.3% vs 0.0%; p = 0.739). Predictors of TLE-associated major complications and procedure complexity were more likely in young adults compared with patients aged > 40 to < 80 years. In younger aged patients prolonged extraction duration and higher procedure complexity were combined with a greater need for second line tools. Both major and minor complications were more frequent in young adults, with hemopericardium and tricuspid valve damage being predominant.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Marek Czajkowski
- Department. of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland. .,Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Grunwaldzka Str. 45, 25-726, Kielce, Poland.
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10
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Empfehlungen zur Sondenextraktion – Gemeinsame Empfehlungen der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Mehta VS, O'Brien H, Elliott MK, Wijesuriya N, Auricchio A, Ayis S, Blomstrom-Lundqvist C, Bongiorni MG, Butter C, Deharo JC, Gould J, Kennergren C, Kuck KH, Kutarski A, Leclercq C, Maggioni AP, Sidhu BS, Wong T, Niederer S, Rinaldi CA. Machine learning-derived major adverse event prediction of patients undergoing transvenous lead extraction: Using the ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry. Heart Rhythm 2022; 19:885-893. [PMID: 35490083 DOI: 10.1016/j.hrthm.2021.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) remains a high-risk procedure. OBJECTIVE The purpose of this study was to develop a machine learning (ML)-based risk stratification system to predict the risk of major adverse events (MAEs) after TLE. A MAE was defined as procedure-related major complication and procedure-related death. METHODS We designed and evaluated an ML-based risk stratification system trained using the European Lead Extraction ConTRolled (ELECTRa) registry to predict the risk of MAEs in 3555 patients undergoing TLE and tested this on an independent registry of 1171 patients. ML models were developed, including a self-normalizing neural network (SNN), stepwise logistic regression model ("stepwise model"), support vector machines, and random forest model. These were compared with the ELECTRa Registry Outcome Score (EROS) for MAEs. RESULTS There were 53 MAEs (1.7%) in the training cohort and 24 (2.4%) in the test cohort. Thirty-two clinically important features were used to train the models. ML techniques were similar to EROS by balanced accuracy (stepwise model: 0.74 vs EROS: 0.70) and superior by area under the curve (support vector machines: 0.764 vs EROS: 0.677). The SNN provided a finite risk for MAE and accurately identified MAE in 14 of 169 "high (>80%) risk" patients (8.3%) and no MAEs in all 198 "low (<20%) risk" patients (100%). CONCLUSION ML models incrementally improved risk prediction for identifying those at risk of MAEs. The SNN has the additional advantage of providing a personalized finite risk assessment for patients. This may aid patient decision making and allow better preoperative risk assessment and resource allocation.
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Affiliation(s)
- Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom.
| | - Hugh O'Brien
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, Marseille, France
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, Goteborg, Sweden
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy; European Society of Cardiology, EORP, Biot, Sophia Antipolis Cedex, France
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Wong
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
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12
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Lachlan T, He H, Aggour H, Sahota P, Harvey S, Patel K, Foster W, Yusuf S, Panikker S, Dhanjal T, Dandekar U, Barker T, Parmar J, Kuehl M, Osman F. Safety and feasibility of trans-venous cardiac device extraction using conscious sedation alone-Implications for the post-COVID-19 era. J Arrhythm 2021; 37:1522-1531. [PMID: 34887957 PMCID: PMC8637087 DOI: 10.1002/joa3.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) for implantable cardiac-devices is traditionally performed under general anesthesia (GA). This can lead to greater risk of exposure to COVID-19, longer recovery-times and increased procedural-costs. We report the feasibility/safety of TLE using conscious-sedation alone with immediate GA/cardiac-surgery back-up if needed. METHODS Retrospective case-series of consecutive TLEs performed using conscious-sedation alone between March 2016 and December 2019. All were performed in the electrophysiology-laboratory using intravenous Fentanyl, Midazolam/Diazepam with a stepwise approach using locking-stylets/cutting-sheaths, including mechanical-sheaths. Baseline patient-characteristics, procedural-details and TLE outcomes (including procedure-related complications/death) were recorded. RESULTS A total of 130 leads were targeted in 54 patients, mean age ± SD 74.6 ± 11.8years, 47(87%) males; dual-chamber pacemakers (n = 26; 48%), cardiac resynchronization therapy-defibrillators (n = 17; 31%) and defibrillators (n = 8; 15%) were commonest extracted devices. Mean ± SD/median (range) lead-dwell times were 11.0 ± 8.8/8.3 (0.3-37) years, respectively. Extraction indications included systemic infection (n = 23; 43%) and lead/pulse-generator erosion (n = 27; 50%); mean 2.1 ± 2.0 leads were removed per procedure/mean procedure-time was 100 ± 54 min. Local anesthetic (LA) was used for all (mean-dose: 33 ± 8 ml 1% lidocaine), IV drug-doses used (mean ± SD) were: midazolam: 3.95 ± 2.44 mg, diazepam: 4.69 ± 0.89 mg and fentanyl: 57 ± 40 µg. Complete lead-extraction was achieved in 110 (85%) leads, partial lead-extraction (<4 cm-fragment remaining) in 5 (4%) leads. Sedation-related hypotension requiring IV fluids occurred in 2 (managed without adverse-consequences) and hypoxia requiring additional airway-management in none. No procedural deaths occurred, one patient required emergency cardiac surgery for localized ventricular perforation, nine had minor complications (transient hypotension/bradycardia/pericardial effusion not requiring intervention). CONCLUSION TLE undertaken using LA/conscious-sedation was safe/feasible in our series and associated with good clinical outcome/low procedural complications. Reduced risk of aerosolization of COVID-19 and quicker patient recovery/reduced anesthetic risk are potential benefits that warrant further study.
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Affiliation(s)
- Thomas Lachlan
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hejie He
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hesham Aggour
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Preet Sahota
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Samuel Harvey
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Kiran Patel
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Will Foster
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- Worcester Royal HospitalWorcesterUK
| | - Shamil Yusuf
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Sandeep Panikker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Tarv Dhanjal
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Uday Dandekar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Thomas Barker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Jitendra Parmar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Michael Kuehl
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Faizel Osman
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
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13
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The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189634. [PMID: 34574558 PMCID: PMC8465436 DOI: 10.3390/ijerph18189634] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival.
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14
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Tułecki Ł, Polewczyk A, Jacheć W, Nowosielecka D, Tomków K, Stefańczyk P, Kosior J, Duda K, Polewczyk M, Kutarski A. Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179100. [PMID: 34501689 PMCID: PMC8431163 DOI: 10.3390/ijerph18179100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 01/28/2023]
Abstract
Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (Ł.T.); (K.T.)
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-369 Kielce, Poland
- Correspondence:
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland;
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (Ł.T.); (K.T.)
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital of Radom, 26-617 Radom, Poland;
| | - Krzysztof Duda
- Department of Cardiac Surgery,
Masovian Specialist Hospital of Radom, 26-617 Radom, Poland;
| | - Maciej Polewczyk
- Faculty of Medicine and Health Studies, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-509 Lublin, Poland;
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15
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Issa ZF. Transvenous lead extraction in 1000 patients guided by intraprocedural risk stratification without surgical backup. Heart Rhythm 2021; 18:1272-1278. [PMID: 33781982 DOI: 10.1016/j.hrthm.2021.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) carries a significant risk of morbidity and mortality. Reliable preprocedural risk predictors to guide resource allocation and optimize procedural safety are lacking. OBJECTIVE The aim of this study was to evaluate an intraprocedural approach to risk stratification during elective TLE procedures. METHODS This is a single-center retrospective study of consecutive patients who underwent elective TLE of a pacemaker or implantable cardioverter-defibrillator lead for noninfectious indications. The risk of TLE is judged intraprocedurally only after an attempt is made to extract the target lead as long as high-risk extraction techniques are avoided. TLE was performed in a well-equipped electrophysiology laboratory with rescue strategies in place but in the absence of surgical staff. RESULTS During the study period, 1000 patients were included in this analysis (527 female (52.7%); mean age 61.5 ± 10.2 years). TLE was attempted for 1362 leads, with a mean lead dwell time of 73 ± 43 months (median 70 months; interquartile range 12-180 months). TLE was successful in 914 patients, partially successful in 10, and failed in 76 patients. A laser sheath was required for extraction of 926 leads (68%). Only 1 patient developed intraprocedural cardiac tamponade requiring emergency pericardiocentesis. None of the patients developed hemothorax or required surgical intervention. CONCLUSION At experienced centers, intraprocedural risk stratification for TLE that avoids high-risk extraction techniques achieved successful TLE in the majority of patients and can potentially help optimize the balance between efficacy, safety, and efficiency in lead extraction.
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Affiliation(s)
- Ziad F Issa
- Division of Cardiac Electrophysiology, Prairie Heart Institute, Springfield, Illinois.
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16
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Sidhu BS, Ayis S, Gould J, Elliott MK, Mehta V, Kennergren C, Butter C, Deharo JC, Kutarski A, Maggioni AP, Auricchio A, Kuck KH, Blomström-Lundqvist C, Bongiorni MG, Rinaldi CA. Risk stratification of patients undergoing transvenous lead extraction with the ELECTRa Registry Outcome Score (EROS): an ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry analysis. Europace 2021; 23:1462-1471. [PMID: 33615342 DOI: 10.1093/europace/euab037] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Transvenous lead extraction is associated with a significant risk of complications and identifying patients at highest risk pre-procedurally will enable interventions to be planned accordingly. We developed the ELECTRa Registry Outcome Score (EROS) and applied it to the ELECTRa registry to determine if it could appropriately risk-stratify patients. METHODS AND RESULTS EROS was devised to risk-stratify patients into low risk (EROS 1), intermediate risk (EROS 2), and high risk (EROS 3). This was applied to the ESC EORP European Lead Extraction ConTRolled ELECTRa registry; 57.5% EROS 1, 31.8% EROS 2, and 10.7% EROS 3. Patients with EROS 3 or 2 were significantly more likely to require powered sheaths and a femoral approach to complete procedures. Patients with EROS 3 were more likely to suffer procedure-related major complications including deaths (5.1 vs. 1.3%; P < 0.0001), both intra-procedural (3.5 vs. 0.8%; P = 0.0001) and post-procedural (1.6 vs. 0.5%; P = 0.0192). They were more likely to suffer post-procedural deaths (0.8 vs. 0.2%; P 0.0449), cardiac avulsion or tear (3.8 vs. 0.5%; P < 0.0001), and cardiovascular lesions requiring pericardiocentesis, chest tube, or surgical repair (4.6 vs. 1.0%; P < 0.0001). EROS 3 was associated with procedure-related major complications including deaths [odds ratio (OR) 3.333, 95% confidence interval (CI) 1.879-5.914; P < 0.0001] and all-cause in-hospital major complications including deaths (OR 2.339, 95% CI 1.439-3.803; P = 0.0006). CONCLUSION EROS successfully identified patients who were at increased risk of significant procedural complications that require urgent surgical intervention.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, 41345 Goteborg, Sweden
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, 16321 Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego Street Nr 8, 20-090 Lublin, Poland
| | - Aldo P Maggioni
- European Society of Cardiology, EORP, 2035 route des Colles, Biot, Sophia Antipolis, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstraße 5, D-20099 Hamburg, Germany
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
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Pichtchoulin S, Selmeryd I, Freyhult E, Hedberg P, Selmeryd J. Staphylococcus aureus bacteremia and cardiac implantable electronic devices in a county hospital setting: a population-based retrospective cohort study. Ups J Med Sci 2021; 126:5653. [PMID: 33777330 PMCID: PMC7962178 DOI: 10.48101/ujms.v126.5653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Due to a high incidence of cardiac implantable electronic device-associated infective endocarditis (CIED-IE) in cases of Staphylococcus aureus bacteremia (SAB) and high mortality with conservative management, guidelines advocate device removal in all subjects with SAB. We aimed to investigate the clinical course of SAB in patients with a CIED (SAB+CIED) in a Swedish county hospital setting and relate it to guideline recommendations. METHODS All CIED carriers with SAB, excluding clinical pocket infections, in the County of Västmanland during 2010-2017 were reviewed retrospectively. RESULTS There were 61 cases of SAB+CIED during the study period, and CIED-IE was diagnosed in 13/61 (21%) cases. In-hospital death occurred in 19/61 (31%) cases, 34/61 (56%) cases were discharged with CIED device retained, and 8/61 (13%) cases were discharged after device removal. Subjects dying during hospitalization were elderly and diseased. No events was seen if the CIED was removed. Among four discharged cases with conservatively managed CIED-IE one relapse occured. Among 30 cases discharged with retained CIED and no evidence of IE, 22/30 (73%) cases had an uneventful follow-up, whereas adverse events secondary to overlooked CIED-IE were likely in 1/30 (3%) cases and could not be definitely excluded in additionally 4/30 (13%) cases. CONCLUSIONS During the study period, management became more active and prognosis improved. The heterogeneity within the population of SAB+CIED suggests that a management strategy based on an individual risk/benefit analysis could be an alternative to mandatory device removal.
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Affiliation(s)
- Sara Pichtchoulin
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
| | - Ingrid Selmeryd
- Department of Infectious Diseases, Västmanland County Hospital, Västerås, Sweden
| | - Elisabeth Freyhult
- Department of Microbiology, Västmanland County Hospital, Västerås, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Jonas Selmeryd
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
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18
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Sidhu BS, Gould J, Bunce C, Elliott M, Mehta V, Kennergren C, Butter C, Deharo JC, Kutarski A, Maggioni AP, Auricchio A, Kuck KH, Blomström-Lundqvist C, Bongiorni MG, Rinaldi CA. The effect of centre volume and procedure location on major complications and mortality from transvenous lead extraction: an ESC EHRA EORP European Lead Extraction ConTRolled ELECTRa registry subanalysis. Europace 2020; 22:1718-1728. [DOI: 10.1093/europace/euaa131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Transvenous lead extraction (TLE) should ideally be undertaken by experienced operators in a setting that allows urgent surgical intervention. In this analysis of the ELECTRa registry, we sought to determine whether there was a significant difference in procedure complications and mortality depending on centre volume and extraction location.
Methods and results
Analysis of the ESC EORP European Lead Extraction ConTRolled ELECTRa registry was conducted. Low-volume (LoV) centres were defined as <30 procedures/year, and high-volume (HiV) centres as ≥30 procedures/year. Three thousand, two hundred, and forty-nine patients underwent TLE by a primary operator cardiologist; 17.1% in LoV centres and 82.9% in HiV centres. Procedures performed by primary operator cardiologists in LoV centres were less likely to be successful (93.5% vs. 97.1%; P < 0.0001) and more likely to be complicated by procedure-related deaths (1.1% vs. 0.4%; P = 0.0417). Transvenous lead extraction undertaken by primary operator cardiologists in LoV centres were associated with increased procedure-related major complications including death (odds ratio 1.858, 95% confidence interval 1.007–3.427; P = 0.0475). Transvenous lead extraction locations varied; 52.0% operating room, 9.5% hybrid theatre and 38.5% catheterization laboratory. Rates of procedure-related major complications, including death occurring in a high-risk environment (combining operating room and hybrid theatre), were similar to those undertaken in the catheterization laboratory (1.7% vs. 1.6%; P = 0.9297).
Conclusion
Primary operator cardiologists in LoV centres are more likely to have extractions complicated by procedure-related deaths. There was no significant difference in procedure complications between different extraction settings. These findings support the need for TLE to be performed in experienced centres with appropriate personnel present.
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Affiliation(s)
- Baldeep S Sidhu
- Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Justin Gould
- Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Catey Bunce
- Department of Population Health and Environmental Sciences, King's College London, London, UK
| | - Mark Elliott
- Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Vishal Mehta
- Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, 41345 Goteborg, Sweden
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, 16321 Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego Street Nr 8, 20-090 Lublin, Poland
| | - Aldo P Maggioni
- European Society of Cardiology, 2035 route des Colles, Biot, Sophia Antipolis, France
- ANMCO Research Center, Via Alfonso la Marmora, 36, 50121 Florence, Italy
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstraße 5, D-20099 Hamburg, Germany
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Christopher A Rinaldi
- Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
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19
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Diagnosis and management of inadvertently placed pacemaker lead in the left ventricle following sinus venosus atrial septal defect repair surgery. HeartRhythm Case Rep 2020; 6:279-282. [PMID: 32461895 PMCID: PMC7244627 DOI: 10.1016/j.hrcr.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Bontempi L, Curnis A, Della Bella P, Cerini M, Radinovic A, Inama L, Melillo F, Salghetti F, Marzi A, Gargaro A, Giacopelli D, Mazzone P. The MB score: a new risk stratification index to predict the need for advanced tools in lead extraction procedures. Europace 2020; 22:613-621. [DOI: 10.1093/europace/euaa027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
Aims
A validated risk stratification schema for transvenous lead extraction (TLE) could improve the management of these procedures. We aimed to derive and validate a scoring system to efficiently predict the need for advanced tools to achieve TLE success.
Methods and results
Between November 2013 and March 2018, 1960 leads were extracted in 973 consecutive TLE procedures in two national referral sites using a stepwise approach. A procedure was defined as advanced extraction if required the use of powered sheaths and/or snares. The study population was a posteriori 1:1 randomized in derivation and validation cohorts. In the derivation cohort, presence of more than two targeted leads (odds ratio [OR] 1.76, P = 0.049), 3-year-old (OR 3.04, P = 0.001), 5-year-old (OR 3.48, P < 0.001), 10-year-old (OR 3.58, P = 0.008) oldest lead, implantable cardioverter-defibrillator (OR 3.84, P < 0.001), and passive fixation lead (OR 1.91, P = 0.032) were selected by a stepwise procedure and constituted the MB score showing a C-statistics of 0.82. In the validation group, the MB score was significantly associated with the risk of advanced extraction (OR 2.40, 95% confidence interval 2.02-2.86, P < 0.001) and showed an increase in event rate with increasing score. A low value (threshold = 1) ensured 100% sensibility and 100% negative predictive value, while a high value (threshold = 5) allowed a specificity of 92.8% and a positive predictive value of 91.9%.
Conclusion
In this study, we developed and tested a simple point-based scoring system able to efficiently identify patients at low and high risk of needing advanced tools during TLE procedures.
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Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Lorenza Inama
- Division of Cardiology, Manerbio Hospital, Manerbio, Italy
| | | | - Francesca Salghetti
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
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21
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Jacheć W, Polewczyk A, Polewczyk M, Tomasik A, Kutarski A. Transvenous Lead Extraction SAFeTY Score for Risk Stratification and Proper Patient Selection for Removal Procedures Using Mechanical Tools. J Clin Med 2020; 9:jcm9020361. [PMID: 32013032 PMCID: PMC7073714 DOI: 10.3390/jcm9020361] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background: To ensure the safety and efficacy of the increasing number of transvenous lead extractions (TLEs), it is necessary to adequately assess the procedure-related risk. Methods: We analyzed potential clinical and procedural risk factors associated with 2049 TLE procedures. The TLEs were performed between 2006 and 2016 using only simple tools for lead extraction. Logistic regression analysis was used to develop a risk prediction scoring system for TLEs. Results: Multivariate analysis showed that the sum of lead dwell times, anemia, female gender, the number of procedures preceding TLE, and removal of leads implanted in patients under the age of 30 had a significant influence on the occurrence of major complications during a TLE. This information served as a basis for developing a predictive SAFeTY TLE score, where: S = sum of lead dwell times, A = anemia, Fe = female, T = treatment (previous procedures), Y = young patients, and TLE = transvenous lead extraction. In order to facilitate the use of the SAFeTY TLE Score, a simple calculator was constructed. Conclusion: The SAFeTY TLE score is easy to calculate and predicts the potential occurrence of procedure-related major complications. High-risk patients (scoring more than 10 on the SAFeTY TLE scale) must be treated at high-volume centers with surgical backup.
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Affiliation(s)
- Wojciech Jacheć
- Second Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, 40-055 Katowice, Poland; (W.J.); (A.T.)
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland;
- Department of Cardiology, Swietokrzyskie Cardiology Center, 45, Grunwaldzka St., 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-41-367-1508; Fax: +48-41-367-145
| | - Maciej Polewczyk
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland;
- Acute Cardiac Care Unit, Swietokrzyskie Cardiology Center, 45, Grunwaldzka St., 25-736 Kielce, Poland
| | - Andrzej Tomasik
- Second Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, 40-055 Katowice, Poland; (W.J.); (A.T.)
| | - Andrzej Kutarski
- Department of Cardiology, Medical University Lublin, 20-059 Lublin, Poland;
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22
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Afzal MR, Daoud EG, Matre N, Shoben A, Burnside M, Gilliam C, Pinkhas D, Okabe T, Tyler J, Houmsse M, Kalbfleisch SS, Crestanello JA, Turner K, Weiss R, Hummel JD, Love CJ, Augostini RS. RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol). J Cardiovasc Electrophysiol 2019; 30:2453-2459. [DOI: 10.1111/jce.14151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Muhammad R. Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Emile G. Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Nancy Matre
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Abigail Shoben
- Department of Public Health, Division of Biostatistics, College of Public Health The Ohio State University Columbus Ohio
| | - Melissa Burnside
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Courtney Gilliam
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Daniel Pinkhas
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Steven S. Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | | | - Katja Turner
- Department of Internal Medicine, Electrophysiology Section, Division of Anesthesiology Ross Heart Hospital at the Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - John D. Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Charles J. Love
- Department of Internal Medicine, Division of Cardiovascular Medicine Johns Hopkins Hospital Baltimore Maryland
| | - Ralph S. Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
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23
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Rinaldi CA, Bosco P. The necessity of immediate cardio-thoracic surgical cover for high-risk transvenous lead extraction procedures: the Art of lead extraction. Int J Cardiol 2019; 286:85-86. [PMID: 30979604 DOI: 10.1016/j.ijcard.2019.04.005] [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: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Christopher A Rinaldi
- Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom of Great Britain and Northern Ireland
| | - Paolo Bosco
- Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom of Great Britain and Northern Ireland
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24
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Corazza I, Diemberger I, Martignani C, Ziacchi M, Rossi PL, Lombi A, Zannoli R, Biffi M. Wireless Endocardial Atrial (and Ventricular) Sensing with no Implanted Power Source: a Proposal. J Med Syst 2019; 43:159. [DOI: 10.1007/s10916-019-1277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/05/2019] [Indexed: 12/15/2022]
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