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Carretero EG, de Alarcón González A, de la Borbolla MG, Ciriza GG, Herrera V, Rueda EA, Pedrote A, Smani T, Fernández AO, Pérez IV. Infections of cardiac implantable electronic devices and how to improve transvenous lead extraction by the virtual reality. Indian J Thorac Cardiovasc Surg 2024; 40:138-149. [PMID: 38827540 PMCID: PMC11139837 DOI: 10.1007/s12055-023-01663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 06/04/2024] Open
Abstract
Introduction Infections in cardiac implantable electronic devices (CIED) are increasing over time and associated with substantially mortality and healthcare costs. The best approach is the complete removal of the system by transvenous lead extraction (TLE). However, when leads are more than 10 years old, this technique requires considerable expertise and failures with the result of abandoned leads or serious complications may occur. The aim of this study is to describe our experience using virtual and mixed reality in the preoperative planning of complex cases. Patients and methods Consecutive patients from a referral centre with CIED infections in which TLE was judged difficult. Synchronized computed tomography (CT) scan images were processed and transferred to a fully immersive virtual reality room and also to the operative room (mixed reality) for better guidance during the extracting procedure. Results Ten patients (seven with local and three with systemic infections) were preoperative evaluated. Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach. The anticipated difficulty was confirmed by the higher times of fluoroscopy. All leads were extracted and no complications were registered. Conclusions Preoperative planning is essential for evaluation of TLE difficulty and prevention of unexpected situations. Virtual reality seems an estimable aid for operators in planning difficult cases and also an excellent tool for teaching. Supplementary information The online version contains supplementary material available at 10.1007/s12055-023-01663-9.
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Affiliation(s)
- Encarnación Gutiérrez Carretero
- Department of Cardiovascular Surgery, Hospital Virgen Del Rocio, Av Manuel Siurot S/N 41013, Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, Seville, Spain
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Arístides de Alarcón González
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - Gorka Gómez Ciriza
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | | | | | - Alonso Pedrote
- Department of Cardiology, Hospital Virgen Del Rocio, Seville, Spain
| | - Tarik Smani
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Antonio Ordoñez Fernández
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Israel Valverde Pérez
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Department of Paediatrics, School of Medicine, University of Seville, Seville,, Spain
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Gutiérrez Carretero E, de Alarcón González A. Infecciones en dispositivos implantables de electroestimulación cardiaca (IDEC): una realidad emergente, reconocible y curable. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Maciel ADS, Silva RMFLD. Clinical Profile and Outcome of Patients with Cardiac Implantable Electronic Device-Related Infection. Arq Bras Cardiol 2021; 116:1080-1088. [PMID: 33825793 PMCID: PMC8288527 DOI: 10.36660/abc.20190546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
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Latal J, Pazdernik M, Holicka M, Pelouch R, Widimsky J, Pudich J, Vancata R, Siranec M, Blechova K, Butta T, Mikulcova M, Mikulica M, Wohlfahrt P, Hutyra M, Precek J. Cardiac device-related infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:168-172. [PMID: 33724263 DOI: 10.5507/bp.2021.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. PATIENTS AND METHODS National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. RESULTS Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. CONCLUSIONS The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.
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Affiliation(s)
- Jan Latal
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Michal Pazdernik
- Department of Cardiology, IKEM, Prague, Czech Republic.,Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Maria Holicka
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
| | - Jiri Widimsky
- Department of Cardiology, Regional Hospital Liberec, Czech Republic
| | - Jiri Pudich
- Department of Cardiovascular Diseases, University Hospital in Ostrava, Czech Republic
| | - Radek Vancata
- Department of Cardiology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Siranec
- 2nd Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kamila Blechova
- Cardiocenter, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Tadeas Butta
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marketa Mikulcova
- Cardiovascular Center for Adults, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Michal Mikulica
- Cardiovascular Center for Adults, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/CT with 18F-FDG in suspected intracardiac device-related infections: analysis of performance and diagnostic usefulness. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:238-246. [PMID: 32471719 DOI: 10.1016/j.rec.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/24/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality. METHODS Retrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT. RESULTS We included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection. CONCLUSIONS PET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.
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Affiliation(s)
- Begoña Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Víctor Castro Urda
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Servicio de Medicina Interna (Infectología), Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/TC con 18F-FDG en la sospecha de infección asociada a dispositivos intracardiacos: rendimiento y utilidad diagnóstica. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Utilidad del quirófano híbrido en la extracción de dispositivos implantables: experiencia inicial de un centro. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cano Ó, Bueno M, Osca J, Sancho-Tello MJ, Hornero F, Martínez-Dolz L. Utility of the Hybrid Operating Room for Lead Extraction: Initial Experience in a Single Center. ACTA ACUST UNITED AC 2018; 72:507-509. [PMID: 30025932 DOI: 10.1016/j.rec.2018.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Óscar Cano
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - María Bueno
- Servicio de Cirugía Cardiaca, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Osca
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María-José Sancho-Tello
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Fernando Hornero
- Servicio de Cirugía Cardiaca, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez-Dolz
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Wider scope for Nuclear Cardiology. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Casáns Tormo I. Mayor campo de actuación de la cardiología nuclear. Rev Esp Med Nucl Imagen Mol 2018; 37:139-140. [DOI: 10.1016/j.remn.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Arana-Rueda E, Pedrote A, Frutos-López M, Acosta J, Jauregui B, García-Riesco L, Arce-León Á, Gómez-Pulido F, Sánchez-Brotons JA, Gutiérrez-Carretero E, de Alarcón-González A. Repeated procedures at the generator pocket are a determinant of implantable cardioverter-defibrillator infection. Clin Cardiol 2017. [PMID: 28636098 DOI: 10.1002/clc.22743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rates of cardiac-device infections have increased in recent years, but the current incidence and risk factors for infection in patients with implantable cardioverter-defibrillators (ICDs) are not well known. HYPOTHESIS The increasing number of ICD infections is related to accumulated pocket manipulations over time. METHODS This single-center, prospective study included patients that underwent ICD implantation from 2008 to 2015. The endpoint was time to infection. Multivariate analysis was performed to identify independent risk factors related to infection. RESULTS The study included a total of 570 patients, of whom 419 (73.5%) underwent a first implantation. Mean age was 59 ± 14 years, and 80% were male. During a median follow-up of 36 months (interquartile range, 18-61 months; 1887 patient-years), infection was identified in 26 patients (4.56%), an incidence of 14.9 × 1000 patient-years. Median time to infection was 9.7 months (interquartile range, 1.35-23.4 months), and 38.5% were late infections (beyond 12 months of follow-up). In patients with replacement implants, the incidence was 3-fold higher than in first implantations (27.7 vs 9.1 × 1000 patient-years; P = 0.002). Cox regression identified 2 independent predictors of ICD infection: cumulative number of interventions at the generator pocket (hazard ratio: 1.92, 95% confidence interval: 1.42-2.6, P < 0.001) and pocket hematoma (hazard ratio: 7.0, 95% confidence interval: 2.7-17.9, P < 0.0001). CONCLUSIONS The incidence of infection in ICD patients is greater than previously reported, largely due to late infections. Each new cumulative intervention at the same generator pocket nearly doubles the risk of infection.
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Affiliation(s)
| | - Alonso Pedrote
- Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan Acosta
- Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Beatriz Jauregui
- Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Álvaro Arce-León
- Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain
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San Román JA, Rubio J. Cardiac Device Infections: Accepted Concepts and Controversial Issues. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:320-322. [PMID: 28214245 DOI: 10.1016/j.rec.2016.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
| | - Jerónimo Rubio
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
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Infección de dispositivos cardiacos: conceptos aceptados y controvertidos. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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