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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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Comeaux S, Jamison K, Voeltz M. Contemporary Features and Management of Endocarditis. Diagnostics (Basel) 2023; 13:3086. [PMID: 37835829 PMCID: PMC10572623 DOI: 10.3390/diagnostics13193086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Infective endocarditis is a rare but devastating disease. Morbidity and mortality rates have failed to improve despite new technological advances. The disease has evolved over time with new significant populations at risk-most notably those with prosthetic valves or implantable cardiovascular devices. These devices pose new challenges for achieving a timely and accurate diagnosis of infection. While the modified Duke criteria is accepted as the gold standard for diagnosing native valve endocarditis, it has been shown to have significantly inferior sensitivity when it comes to identifying infections related to right-heart endocarditis, prosthetic valves, and indwelling cardiac devices. Additionally, prosthetic valves and cardiovascular implantable electronic devices can exhibit shadowing and artifact, rendering transthoracic echocardiography and transesophageal echocardiography results inconclusive or even normal. Having a keen awareness of the varying clinical presentations, as well as emerging valvular imaging modalities such as F-fluorodeoxyglucose cardiac positron-emission tomography plus computed tomography, promises to improve the evaluation and diagnosis of infective endocarditis. However, indications for appropriate use of these studies and guidance on modern clinical management are still needed.
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Affiliation(s)
- Shelby Comeaux
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Kiara Jamison
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Michele Voeltz
- Department of Cardiology, Northside Cardiovascular Institute, Lawrenceville, GA 30046, USA
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Salib K, Dardari L, Taha M, Dahat P, Toriola S, Satnarine T, Zohara Z, Adelekun A, Seffah KD, Khan S. Discussing the Prognosis and Complications of Transvenous Lead Extraction in Patients With Cardiac Implantable Electronic Devices (CIED): A Systematic Review. Cureus 2023; 15:e45048. [PMID: 37829955 PMCID: PMC10565517 DOI: 10.7759/cureus.45048] [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: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
An increase in cardiovascular implantable electronic devices (CIEDs) and undoubtedly the complications brought on by these devices coincide with an increase in cardiovascular disorders, particularly heart rhythm abnormalities. The safest procedure to extract these devices is transvenous lead extraction (TLE). Thus, this systematic review aimed to summarize the possibility of success rates and the common complications that could arise during the surgery. Full-text publications in PubMed, MEDLINE, PubMed Central (PMC), and ScienceDirect were used in this study, which was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were reviewed for this systematic review after being screened by title, abstract, full-text availability, and quality appraisal assessment. Heart and vascular tears, along with tricuspid regurgitation (TR), are common adverse events. Pulmonary embolism, hemothorax, hemopericardium, and ghost appearance in echo are less common consequences. In addition, the longer the dwelling time of the leads, the greater the chance of infection due to an increase in lead adhesions and fibrous tissue that has made the procedure unsafe as time passes. However, we concluded that TLE is a successful method across all age groups with an excellent probability of clinical and procedural success in a majority of studies.
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Affiliation(s)
- Korlos Salib
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lana Dardari
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Maher Taha
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Purva Dahat
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Stacy Toriola
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Travis Satnarine
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zareen Zohara
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ademiniyi Adelekun
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kofi D Seffah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Piedmont Athens Regional Medical, Athens, GRC
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Frei C, Hofer D, Jan S, Grebmer C, Breitenstein A. Single center experience with the novel rotating dilator sheath TightRail TM Sub-C in transvenous lead extraction. J Cardiovasc Electrophysiol 2023; 34:1738-1743. [PMID: 37343057 DOI: 10.1111/jce.15970] [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: 07/14/2022] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) in transvenous lead extraction. METHODS For this retrospective single-center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at the University Heart Center Zurich. RESULTS A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45) occurred, but neither was directly related to the Sub-C. CONCLUSION This retrospective single-center analysis suggests that transvenous lead extraction with a routine use of the TightRailTM Sub-C extraction sheath is a safe strategy resulting in high success rates that may offer useful theoretical benefits. Future studies are needed to evaluate the incremental benefit of a routine use of short extraction sheaths including the Sub-C during TLE procedures.
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Affiliation(s)
- Celine Frei
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Steffel Jan
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
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Talaei F, Tan MC, Trongtorsak A, Lee JZ, Rattanawong P. Heart failure is associated with increased risk of all-cause mortality after transvenous lead extraction: A systematic review and meta-analysis. J Arrhythm 2023; 39:596-606. [PMID: 37560268 PMCID: PMC10407184 DOI: 10.1002/joa3.12880] [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: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is increasingly considered in cardiac implantable electronic device management. Heart failure (HF) might be associated with mortality risks after the TLE procedure. This study aims to assess mortality risk in HF patients undergoing TLE. METHOD We searched MEDLINE and Embase databases from inception to June 2022 to identify articles that included patients with and without HF who underwent TLE, which reported mortality in both groups. The pooled effect size was calculated with a random-effects model and 95% CI to compare post-TLE mortality between the two groups. RESULTS Eleven studies were included in the analysis. Each left ventricular ejection fraction (LVEF) increased by 1% was associated with reduced mortality by 2% (HR = 0.98, 95% CI: 0.97-0.99, I 2 = 74.9%, p < .01). The presence of HF compared to those without HF was associated with higher mortality rates (OR: 3.04, 95% CI: 2.56-3.61, I 2 = 0.0%, p < .531). There was a significant increase in the mortality rates in patients with New York Heart Association (NYHA) function class III (OR: 2.29, 95% CI: 1.29-4.06, I 2 = 0.0%, p = .498) and NYHA IV (OR: 8.5, 95% CI: 2.98-24.3, I 2 = 0.0%, p = .997). CONCLUSIONS Our study found that post-TLE mortality decreases by 2% as LVEF increases by 1%, also mortality is higher in patients with NYHA III and IV.
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Affiliation(s)
- Fahimeh Talaei
- Department of Internal MedicineMcLaren Flint HospitalFlintMichiganUSA
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
| | - Min C. Tan
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Justin Z. Lee
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac ArrhythmiasMassachusetts General Hospital Harvard Medical SchoolBostonMassachusettsUSA
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Chew DS, Piccini JP, Au F, Frazier-Mills CG, Michalski J, Varma N. Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial. Heart Rhythm 2023; 20:440-447. [PMID: 36503177 PMCID: PMC11103640 DOI: 10.1016/j.hrthm.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters. OBJECTIVE The purpose of this study was to conduct a cost-consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1) in-person evaluation (IPE) only; (2) RPM-conventional (hybrid of IPE and RPM); and (3) RPM-alert (alert-based ICD follow-up). METHODS We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost. RESULTS Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI] -$2138 to +$638) and -$1,677 (95% CI -$3134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations. CONCLUSIONS Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Flora Au
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Camille G Frazier-Mills
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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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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Tan MC, Talaei F, Trongtorsak A, Lee JZ, Rattanawong P. Chronic kidney disease is associated with increased all-cause mortality in transvenous lead extraction: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2023; 46:66-72. [PMID: 36441922 DOI: 10.1111/pace.14631] [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: 08/12/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well-established. We performed a systematic review and meta-analysis to explore the association between CKD and all-cause mortality in TLE. METHODS We searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random-effects model. RESULTS Eight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all-cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65-2.77, I2 = 51.1%, p < .001). The risk of overall all-cause mortality increased with the severity of CKD for nonspecific CKD (HR = 2.01, 95% CI: 1.49-2.69, I2 = 53.4, p < .001) and ESRD (HR = 2.79, 95% CI: 1.85-4.23, I2 = 0%, p < .001). The risk of all-cause mortality in CKD is double at follow-up ≤1 year (HR = 1.99, 95% CI: 1.29-3.09, I2 = 50.9%, p = .002) and higher at follow-up >1 year (HR = 2.36, 95% CI: 1.63-3.42, I2 = 59.7%, p < .001). CONCLUSIONS Our meta-analysis demonstrates a significantly increased risk of overall all-cause mortality in patients with CKD who underwent TLE compared to controls.
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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
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, McLaren Flint Hospital, Flint, Michigan, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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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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Nowosielecka D, Tułecki Ł, Jacheć W, Polewczyk A, Tomków K, Stefańczyk P, Bródka J, Kutarski A. Cardiac tamponade as an inherent but potentially nonfatal complication of transvenous lead extraction: Experience with 1126 procedures performed using mechanical tools. J Cardiovasc Electrophysiol 2022; 33:2625-2639. [PMID: 36054327 DOI: 10.1111/jce.15668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/20/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cardiac tamponade (CT) is one of the most common and dangerous complications of transvenous lead extraction (TLE). So far, however, there has been little discussion about the problem. METHODS We analyzed the occurrence of CT in a group of 1226 patients undergoing TLE at a single reference center between June, 2015 and February, 2021. Using standard mechanical devices as first-line tools, a total of 2092 leads had been extracted. RESULTS CT occurred in 18 patients (1.47%): due to injury to the wall of the right atrium in 14 patients (1.14%) and other cardiac walls in four patients (0.33%). Younger patient age at first implantation, female gender, high left ventricular ejection fraction (LVEF), lower New York Heart Association class, low Charlson comorbidity index, longer implant duration, and the number of previous procedures related to cardiac implantable electronic devices (CIED) are important patient-related risk factors for CT. Significant procedure-related risk factors include the number of extracted leads, extraction of atrial leads and longer dwell time of extracted leads. Intraoperative transoesophageal echocardiography (TEE) provides a lot of information about pulling on various cardiac structures and is able to detect a very early phase of bleeding to the pericardial sac. As a result of implementing best practices guidance in performing extraction procedures and close collaboration with cardiac surgeons that allowed immediate rescue intervention in our series of 18 CT cases, there were no procedure-related deaths (mortality 0%). CONCLUSIONS The need for rescue surgery due to CT has no influence on clinical and procedural success. Early diagnosed (TEE monitoring) and properly managed CT does not generate any additional risk in short- and long-term follow-up after TLE.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland.,Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Wojciech Jacheć
- Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland, 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
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Jarosław Bródka
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 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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12
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Tułecki Ł, Czajkowski M, Targońska S, Polewczyk A, Jacheć W, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. The role of cardiac surgeon in transvenous lead extraction: experience from 3462 procedures. J Cardiovasc Electrophysiol 2022; 33:1357-1365. [PMID: 35474258 DOI: 10.1111/jce.15510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The professional society guidelines recommend that transvenous lead extraction (TLE) operating teams collaborate closely with cardiac surgeons in the management of life-threatening complications. METHODS AND RESULTS We assessed the role of cardiac surgeons participating in 3462 TLE procedures at a high-volume center between 2006 and 2021. The roles for cardiac surgery in TLE can be categorized into five areas: emergency surgical interventions for the management of cardiac laceration and severe bleeding (1.184%), cardiac surgery complementing partially successful TLE or vegetation removal (0.693%), delayed surgical treatment of TLE-related tricuspid valve dysfunction (0.751%), epicardial pacemaker implantation through sternotomy during emergency, complementing or delayed surgical interventions (0.607%) and delayed epicardial lead implantation (0.491%). Isolated damage to the wall of the right atrium was the most common cause of cardiac tamponade (53.66% of emergency surgeries) followed by injury to the right ventricle and vena cava (both 7.317%). CONCLUSIONS Emergency cardiac surgery for the management of severe hemorrhagic complications is still the most common treatment option. The remaining areas include surgery complementing partially successful TLE: repair of tricuspid valve or epicardial ventricular lead placement to achieve permanent cardiac resynchronization. The experience at a single high-volume TLE center indicates the necessity of close collaboration with the cardiac surgeons whose roles appear broader than the mere surgical standby. Mortality in patients who survived cardiac surgery during transvenous lead extraction does not differ from the survival of other patients after TLE without complications requiring surgical intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Sylwia Targońska
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Centrum of Cardiology, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Kamil Karpeta
- Department of Cardiac Surgery Masovian Specialistic Hospital of Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
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13
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Soontornmanokati N, Sirikhamkorn C, Methachittiphan N, Chintanavilas K, Apakuppakul S, Ngarmukos T, Apiyasawat S, Lohawijarn W, Chandanamattha P. Transvenous Lead Extraction (TLE) Procedure: Experience from a Tertiary Care Center in Thailand. Indian Pacing Electrophysiol J 2022; 22:123-128. [PMID: 35219811 PMCID: PMC9091722 DOI: 10.1016/j.ipej.2022.02.021] [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: 11/05/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transvenous Lead Extraction (TLE) is a standard treatment for some late Cardiac Implantable Electronics Device (CIED) complications. The outcome of transvenous lead extraction procedure in Thailand is not robust. Methods A Single-center retrospective cohort of TLE procedures performed at Ramathibodi hospital between January 2008 and December 2020 was studied. Results There were 157 leads from 105 patients who underwent lead removal procedure during the specified period. Data analysis was performed from 79 TLE patients due to incomplete data and lead explant procedure of the excluded subjects. Mean patients’ age was 57.7 ± 18.7 years, with 70.9% male. There were 82 pacemaker leads, 35 ICD leads, and 5 CS leads (mean number of leads were 1.54 ± 0.66 per patient), with mean implanted duration of 87.8 ± 68.2 months. Main indication for TLE was infection-related, which accounted for 67.1% of the cases. Overall clinical success rate was 97.5%. Mean operative time was 163.8 ± 69.5 min. Major complications occurred in 4 patients (5.1%) with one in-hospital mortality from severe sepsis. Conclusion TLE using laser sheath and rotating mechanical sheath for transvenous lead extraction is effective and safe, even outside high-volume center.
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Affiliation(s)
- Natcha Soontornmanokati
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Chulaporn Sirikhamkorn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Nilubon Methachittiphan
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Kumpol Chintanavilas
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sanatcha Apakuppakul
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Tachapong Ngarmukos
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirin Apiyasawat
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wachara Lohawijarn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Pakorn Chandanamattha
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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14
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Lee JZ, Majmundar M, Kumar A, Thakkar S, Patel HP, Sorajja D, Valverde AM, Kalra A, Cha YM, Mulpuru SK, Asirvatham SJ, Desimone CV, Deshmukh AJ. Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices. Heart Rhythm 2021; 19:768-775. [PMID: 34968739 DOI: 10.1016/j.hrthm.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality and morbidity. OBJECTIVE This study sought to evaluate the impact of early versus delayed transvenous lead removal (TLR) on in-hospital mortality and outcomes in patients with CIED infection. METHODS Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2016, to December 31, 2018. The timing of the TLR procedure was determined based on hospitalization days after initial admission for CIED infection. The impact of early (≤ 7 days) versus delayed (> 7 days) TLR on mortality and major adverse events was studied. RESULTS Of 12,999 patients who underwent TLR for CIED infections, 8,834 patients underwent early TLR versus 4,165 patients who underwent delayed TLR. Delayed TLR was associated with a significant increase in in-hospital mortality (8.3% vs. 3.5%, adjusted odds ratio:1.70; 95% confidence interval, 1.43-2.03; P value<0.001). Subgroup analysis of patients with CIED infection and systemic infection showed that delayed TLR in patients with systemic infection was associated with a higher rate of in-hospital mortality compared with early TLR (10.4% vs. 7.5%, adjusted odds ratio:1.24; 95% confidence interval, 1.04-1.49; P value<0.019). Delayed TLR was also associated with significantly higher adjusted odds of major adverse events and post-procedural length of stay. CONCLUSIONS These data suggest that delayed transvenous lead removal in patients with CIED infections is associated with increased in-hospital mortality and major adverse events, especially in patients with systemic infection.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, NY; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH
| | | | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL
| | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Arturo M Valverde
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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15
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Wacker M, Thewes L, Lux A, Busk H, Zardo P, Scherner M, Awad G, Varghese S, Veluswamy P, Wippermann J, Slottosch I. Monitoring excimer laser-guided cardiac lead extractions by uniportal video-assisted thoracoscopy: A single center experience. Asian Cardiovasc Thorac Ann 2021; 30:561-566. [PMID: 34693749 DOI: 10.1177/02184923211054883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Though laser guided extractions of cardiac implantable electronic devices leads have become a routine procedure, the severe complications are associated with a high mortality. Here, we report our single center experience using uniportal video-assisted thoracoscopy for laser lead extraction and compare it to stand-alone laser lead extraction. METHODS The intraoperative data and postoperative clinical outcomes of patients undergoing laser lead extraction with concomitant thoracoscopy (N = 28) or without (N = 43) in our institution were analyzed retrospectively. RESULTS Neither the median x-ray time (612.0 s for the thoracoscopy group vs. 495.5 s for the non-thoracoscopy group, p = 0.962), length of the operation (112.5 vs. 100.0 min, p = 0.676) or the median length of hospital stay (9.0 vs. 10.0 days, p = 0.990) differed significantly. The mean intensive care unit stay was longer for patients in the non-thoracoscopy group (0.8 vs. 2.5 days, p = 0.005). The 30-day-mortality in the thoracoscopy group was zero, whereas five patients died in the non-thoracoscopy group. Furthermore, four patients in the non-thoracoscopy group had encountered haemothorax, while none were observed in the thoracoscopy group (p = 0.148). CONCLUSIONS The adoption of uniportal video-assisted thoracoscopy during laser-guided lead extraction of cardiac implantable electronic devices can be considered safe and does not lengthen the operating time or hospital stay. It might be useful in the detection of severe complications and, in experienced hands, possibly allow direct bleeding control.
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Affiliation(s)
- Max Wacker
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Lena Thewes
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Henning Busk
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - George Awad
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Sam Varghese
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Priya Veluswamy
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
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16
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A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910416. [PMID: 34639716 PMCID: PMC8508178 DOI: 10.3390/ijerph181910416] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Background: Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Methods: Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Results: Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Conclusions: Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools.
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17
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Issa ZF. Outcome of transvenous lead extraction of leads older than 20 years. J Cardiovasc Electrophysiol 2021; 32:3042-3048. [PMID: 34453369 DOI: 10.1111/jce.15229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients undergoing transvenous lead extraction (TLE), lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications. OBJECTIVES The aim of this study was to evaluate the safety and effectiveness of TLE in patients with pacemaker or ICD leads with a dwell time of ≥20 years. METHODS This is a single-center retrospective study of all patients who underwent TLE of at least 1 pacemaker or ICD leads a dwell time of ≥20 years. RESULTS During the study period, 124 patients were included in this analysis (50.8% female, mean age: 74.6 ± 10.7 years). Device-related infection was the most common (92.7%) indication for TLE. Extraction was attempted for a total 313 leads, of which 182 leads had dwell times ≥20 years (median: 276 months; interquartile range: 255-300 months). Complete procedural success was achieved in 112/124 patients (90.3%), and clinical success in 119/124 patients (96.0%). Complete removal was achieved for 294 leads (93.9%), partial removal in 10 leads, and failure in 9 leads. Clinical success (combined complete and partial success) rates were higher for leads with dwell times <20 years compared to older leads (99.2% vs. 95.6%, p = .017). Major procedural complications (including 1 death) occurred in 7/124 patients (5.6%). Minor complications were observed in 8 patients (6.5%). CONCLUSIONS TLE of very old (≥20 years) leads can be performed with reasonable success and safety when conducted at centers with expertise in lead management.
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Affiliation(s)
- Ziad F Issa
- Department of Cardiac Electrophysiology, Prairie Heart Institute, Springfield, Illinois, USA
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18
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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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Perrin T, Deharo JC. Therapy and outcomes of cardiac implantable electronic devices infections. Europace 2021; 23:iv20-iv27. [PMID: 34160599 PMCID: PMC8221052 DOI: 10.1093/europace/euab016] [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: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac implantable electronic device (CIED) infection causes significant morbidity and mortality without appropriate treatment. It can present as incisional infection, pocket infection, systemic CIED infection, or occult bacteraemia. Complete percutaneous CIED extraction (excepted in case of incisional infection) and appropriate antibiotic therapy are the two main pillars of therapy. Device reimplantation, if needed, should be delayed sufficiently to allow control of the infection. Here, we address the differences in prognosis according to the clinical scenario and the different treatment options.
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Affiliation(s)
- Tilman Perrin
- Department of Cardiology, Solothurner Spitäler Bürgerspital, Solothurn, Switzerland.,Department of Cardiology, Centre Hospitalier Universitaire La Timone, 264 Rue Saint-Pierre, F-13005 Marseille, France
| | - Jean-Claude Deharo
- Department of Cardiology, Centre Hospitalier Universitaire La Timone, 264 Rue Saint-Pierre, F-13005 Marseille, France
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20
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Lin AY, Saul T, Aldaas OM, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Early Versus Delayed Lead Extraction in Patients With Infected Cardiovascular Implantable Electronic Devices. JACC Clin Electrophysiol 2021; 7:755-763. [PMID: 33358664 PMCID: PMC8209117 DOI: 10.1016/j.jacep.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED). BACKGROUND CIED infections are associated with poor outcomes. Prior studies have demonstrated improved survival with CIED extraction compared with antibiotic therapy alone. The impact of timing of CIED extraction has not been well characterized. METHODS All infected CIED extraction cases at our medical center from 2006 to 2019 were reviewed. Patients were divided into 2 groups based on the presence of bacteremia or isolated pocket infection. We assessed the in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, using hospitalization day 7 as cutoff. RESULTS Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Delayed extraction (15.2 days) in bacteremic patients was associated with septic shock (odds ratio [OR]: 5.39; 95% confidence interval [CI]: 1.23 to 23.67; p = 0.026), acute kidney injury (OR: 5.61; 95% CI: 2.15 to 14.63; p < 0.001), respiratory failure (OR: 5.52; 95% CI: 1.25 to 24.41; p = 0.024), and decompensated heart failure (OR: 3.32; 95% CI: 1.10 to 10.05; p = 0.033). Locally infected patients with delayed extraction (10.7 days) were associated with acute kidney injury (OR: 3.45; 95% CI: 1.11 to 10.77; p = 0.033) and respiratory failure (OR: 10.29; 95% CI: 1.26 to 83.93; p = 0.030). Delayed CIED extraction in both groups was associated with increased 1-year mortality. CONCLUSIONS Delayed infected CIED extraction is associated with worse outcomes. This underscores the importance of early detection and a strategy for prompt management including lead extraction.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
| | - Tatiana Saul
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Omar M Aldaas
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Florentino Lupercio
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Gordon Ho
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
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Lin AY, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Safety and Efficacy of Cardiovascular Implantable Electronic Device Extraction in Elderly Patients: A Meta-Analysis and Systematic Review. Heart Rhythm O2 2020; 1:250-258. [PMID: 33604584 PMCID: PMC7889020 DOI: 10.1016/j.hroo.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 - 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 - 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 - 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 - 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 - 2.29, p = 0.13). Conclusion In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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