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Okada A, Higuchi S, Shoda M, Tabata H, Kataoka S, Shoin W, Kobayashi H, Okano T, Yoshie K, Kato K, Saigusa T, Ebisawa S, Motoki H, Kuwahara K. Utility of a multipurpose catheter for transvenous extraction of old broken leads: A novel technique for fragile leads. Heart Rhythm 2023; 20:976-981. [PMID: 37001747 DOI: 10.1016/j.hrthm.2023.03.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system and injury to the veins or heart, have been reported. OBJECTIVE The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported. METHODS In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction. RESULTS Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted. CONCLUSION All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.
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Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tama Metropolitan Medical Center, Tokyo, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Togashi S, Isawa T, Honda T, Furuya K, Yamaya K, Taguri M, Toyoda S. Regional Disparities in Transvenous Lead Extraction for Cardiac Implantable Electronic Device Infection in Japan - A Descriptive Study Using the National Database Open Data. Circ J 2023; 87:1000-1006. [PMID: 37197942 DOI: 10.1253/circj.cj-23-0103] [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] [Indexed: 05/19/2023]
Abstract
BACKGROUND Because the penetration of transvenous lead extraction (TLE) for cardiac implantable electronic device (CIED) infection has not been investigated in Japan, we conducted a population-based, retrospective, descriptive study to evaluate regional disparities in the use of TLE for CIED infection and the potential undertreatment of CIED infection using a nationwide insurance claims database. METHODS AND RESULTS Patients who underwent CIED implantation or generator exchange and TLE between April 2018 and March 2020 were identified. Moreover, the penetration ratio of TLE for CIED infection in each prefecture was estimated. CIED implantation and TLE were most prevalent in the age categories of 80-89 years (40.3%) and 80-89 years (36.9%), respectively. There was no correlation between the number of CIED implantations and that of TLE (rho=-0.087, 95% confidence interval -0.374 to 0.211, P=0.56). The median penetration ratio was 0.00 (interquartile range 0.00-1.29). Of the 47 prefectures, 6, comprising Okinawa, Miyagi, Okayama, Fukuoka, Tokyo, and Osaka, showed a penetration ratio ≥2.00. CONCLUSIONS Our study data indicated great regional disparities in the penetration of TLE and potential undertreatment of CIED infection in Japan. Additional measures are needed to address these issues.
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Affiliation(s)
- Shintaro Togashi
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health
- Department of Nursing Care, Sendai Kousei Hospital
| | | | - Taku Honda
- Department of Cardiology, Sendai Kousei Hospital
| | - Kenichi Furuya
- Department of Medical Technology, Sendai Kousei Hospital
| | - Kazuhiro Yamaya
- Department of Cardiovascular Surgery, Sendai Kousei Hospital
| | | | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University
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Safe and effective transvenous lead extraction for elderly patients utilizing non-laser and laser tools: a single-center experience in Japan. Heart Vessels 2021; 36:882-889. [PMID: 33394103 DOI: 10.1007/s00380-020-01761-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Transvenous lead extraction (TLE) for cardiac implantable electric device (CIED) infection is becoming increasingly common, but is believed to be particularly risky in elderly patients. This study aimed to clarify the safety and effectiveness of TLE in the elderly, evaluating the use of both non-laser and laser extraction tools. We retrospectively analyzed the characteristics, device type, indications, procedures, and clinical results in younger (YG; age: 15-79 years; n = 48) and elderly groups (EG; age: ≥ 80 years; n = 27) of patients who underwent percutaneous TLE between April 2014 and December 2019 at our hospital. The average age was 68 and 88 years in the YG and EG, respectively. Indications for TLE were infection in 33 (68.8%) patients and other in 15 (30.6%) patients in the YG, and infection in all 27 (100%) EG patients. Bloodstream infection was detected in 9 and 4 patients in the YG and EG, respectively, with methicillin-resistant Staphylococcus epidermidis being the most common causative pathogen. All TLE procedures were performed under general anesthesia in an operating room with cardiovascular surgeon backup. An excimer laser sheath (76 leads), a laser followed by a mechanical sheath (45 leads), Evolution RL® (17 leads), a mechanical sheath (9 leads), and manual traction (one lead) were employed to extract a total of 148 leads (98 and 50 in the YG and EG, respectively). A mechanical sheath or Evolution RL® was more frequently used in the YG. The respective average implantation durations in the YG and EG were 5.3 and 5.0 years, respectively, which were comparable (p = 0.46). Procedural success rates were identical between the YG and EG (99% vs. 100%, respectively). There was only one procedure-related complication in the entire cohort (cardiac tamponade in a YG patient). Taken together, the success rates of TLE were high in the EG, with no complications, with extraction being the indication for infection in all EG patients. Percutaneous TLE was safe and effective in elderly patients using both non-laser and laser techniques.
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Shoda M, Kusano K, Goya M, Nishii N, Imai K, Okamoto Y, Takegami M, Nakao YM, Miyamoto Y, Nogami A. Study Design of the Nationwide Japanese Lead Extraction (J-LEX) Registry: Protocol for a Prospective, Multicenter, Open Registry. J Arrhythm 2020; 36:849-853. [PMID: 33024462 PMCID: PMC7532273 DOI: 10.1002/joa3.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transvenous lead extractions (TLEs) in Japan have grown to become the standard therapy since the approval of the laser extraction system in 2008. However, little is known about the current indications, methods, success rate, and acute complications in the real-world setting. METHODS The Japanese Lead EXtraction (J-LEX) registry is a nationwide, multicenter, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. This study is a nationwide registry ordered by the JHRS and its data are collected prospectively using the Research Electronic Data Capture (REDCap) system. The acute success rate at discharge and complications associated with TLEs will be collected in all cases. Based on the provided information, the annual incidence and predictive factors for the outcomes will be investigated by the Event Assessment Committee (EAC). This registry started in July 2018 and the number of participating medical institutions will be more than 50 hospitals and the target number of procedures will be 500-1000 per year. We will also compare the results with other registries in foreign countries. RESULT The results of this study are currently under investigation. CONCLUSION The J-LEX registry will provide real-world data regarding the results and complications of TLEs for the various types of indications, methods, and performing hospitals in Japan.
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Affiliation(s)
- Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Department of Cardiovascular Medicine Shinshu University School of Medicine Matsumoto Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine Heart Rhythm Center Tokyo Medical and Dental University Tokyo Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery Kure Medical Center & Chugoku Cancer Center National Hospital Organization Kure Japan
| | - Yoji Okamoto
- Department of Cardiology Kawasaki Medical School General Medical Center Okayama Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Suita Japan
| | - Yoko M Nakao
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center National Cerebral and Cardiovascular Center Suita Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center National Cerebral and Cardiovascular Center Suita Japan
| | - Akihiko Nogami
- Department of Cardiology Faculty of Medicine University of Tsukuba Tsukuba Japan
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Ishiguchi H, Ishikura M, Yoshida M, Imoto K, Sonoyama K, Kawabata T, Ishihara Y, Yoshiga Y, Shimizu A, Oda T. Incidence and risk factors for cardiac implantable electronic device infection in current clinical settings in a Japanese population: A 20-year single-center observational study. J Cardiol 2020; 76:115-122. [DOI: 10.1016/j.jjcc.2020.01.006] [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: 09/29/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
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Transvenous excimer laser-assisted lead extraction of cardiac implantable electrical devices in the Japanese elderly population. J Cardiol 2020; 75:410-414. [DOI: 10.1016/j.jjcc.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
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Nishii N, Morimoto Y, Miyoshi A, Tsukuda S, Miyamoto M, Kawada S, Nakagawa K, Watanabe A, Nakamura K, Morita H, Morimatsu H, Kusano N, Kasahara S, Shoda M, Ito H. Prognosis after lead extraction in patients with cardiac implantable electronic devices infection: Comparison of lead-related infective endocarditis with pocket infection in a Japanese single-center experience. J Arrhythm 2019; 35:654-663. [PMID: 31410236 PMCID: PMC6686345 DOI: 10.1002/joa3.12164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/08/2019] [Indexed: 11/07/2022] Open
Abstract
Background The increase in the use of cardiac implantable electronic devices (CIEDs) has been associated with an increase in CIED-related infections. Transvenous lead extraction is safe and effective for patients with CIED-related infections; however, the mortality rate in these patients is high. The prognosis after transvenous lead extraction in Japanese patients, especially those with lead-related infective endocarditis, has not been evaluated. Then, the purpose of this study is to clarify the prognosis after transvenous lead extraction in Japanese patients with CIED-related infections at a single Japanese center. Methods A total of 107 patients who underwent transvenous lead extraction were retrospectively reviewed. The patients were divided into a lead-related infective endocarditis group (n = 32) and a pocket infection group (n = 75). Procedure success rate and prognosis after lead extraction were evaluated between the two groups. Results Procedure success rate was not significantly different between the groups. There were no deaths associated with the procedure or with infection. The survival rate was not significantly different at 1 year or at a median of 816 days (lead-related infective endocarditis vs pocket infection; 93.7% vs 94.7%, P = 1.000; 78.1% vs 81.3%, P = 0.791) Time to reimplantation and duration of hospital stay and antibiotics therapy were significantly longer for patients with lead-related infective endocarditis. Conclusion In this study, the prognosis for patients with lead-related infective endocarditis after transvenous lead extraction was favorable. Thus, extraction should be strongly recommended, even if the general condition of the patient is poor.
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Affiliation(s)
- Nobuhiro Nishii
- Department of Cardiovascular Therapeutics Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Yoshimasa Morimoto
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Saori Tsukuda
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Nobuchika Kusano
- Department of Infectious Disease Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine Tokyo Women's Medical University Tokyo Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
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Korkerdsup T, Ngarmukos T, Sungkanuparph S, Phuphuakrat A. Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes. J Arrhythm 2018; 34:632-639. [PMID: 30555607 PMCID: PMC6288561 DOI: 10.1002/joa3.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied. METHODS A retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case-control study was performed to determine the factors associated with CIED infection. RESULTS Incidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0-75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter-defibrillator, and cardio-resynchronization therapy-related infection, respectively. Gram-positive cocci were the most common organism (24 episodes, 44.4%). Gram-negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72-633.62; P = 0.003 and OR 19.99, 95% CI 1.28-333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52-85.73; P = 0.018). CONCLUSIONS In Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.
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Affiliation(s)
- Theerawat Korkerdsup
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Tachapong Ngarmukos
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical InstituteFaculty of Medicine Ramathibodi HospitalMahidol UniversitySamut PrakanThailand
| | - Angsana Phuphuakrat
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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Transvenous extraction of advisory implantable cardioverter defibrillator leads with a relatively long implant duration. J Cardiol 2018; 72:316-320. [DOI: 10.1016/j.jjcc.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/05/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
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