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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:622-636. [DOI: 10.1016/j.jcmg.2018.09.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022]
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Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol 2017; 69:2331-2341. [DOI: 10.1016/j.jacc.2017.02.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
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Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure. Heart Rhythm 2015; 12:313-20. [DOI: 10.1016/j.hrthm.2014.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Indexed: 11/24/2022]
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Asmarats L, Maristany J, Pons J, Buendía S, Gómez-Jaume A, Saus C, Macaya F, Pascual M, Bethencourt A, Van Malderen S, Szili-Torok T, Lever N, Webster M. How should I treat a patient with an entrapped infected permanent pacemaker lead? EUROINTERVENTION 2014; 10:403-5. [PMID: 25042269 DOI: 10.4244/eijv10i3a67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Luis Asmarats
- Department of Cardiology, Son Espases Hospital, Palma de Mallorca, Spain
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Severe staphylococcal sepsis in patient with permanent pacemaker. Int J Cardiol 2014; 172:e498-501. [DOI: 10.1016/j.ijcard.2014.01.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 11/19/2022]
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Maytin M, Epstein LM. Lead Extraction Is Preferred for Lead Revisions and System Upgrades: When Less Is More. Circ Arrhythm Electrophysiol 2010; 3:413-24; discussion 424. [DOI: 10.1161/circep.110.954107] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Farooqi FM, Talsania S, Hamid S, Rinaldi CA. Extraction of cardiac rhythm devices: indications, techniques and outcomes for the removal of pacemaker and defibrillator leads. Int J Clin Pract 2010; 64:1140-7. [PMID: 20642712 DOI: 10.1111/j.1742-1241.2010.02338.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide not only for symptomatic bradycardia, but also for the management of arrhythmia and heart failure. Their use in more elderly patients with significant comorbidities is rising steeply and consequently long-term complications are increasingly arising. Such an increase in device therapy is being paralleled by an increase in the requirement for system extraction. Safe lead extraction is central to the management of much of the complications related to pacemakers. The most common indication for lead extraction is system infection Adhesions in chronically implanted leads can become major obstacles to safe lead extraction and life-threatening bleeding and cardiac perforations may occur. Over the last 20 years, specific tools and techniques for transvenous lead extraction have been developed to assist in freeing the lead body from the adhesions. This article provides a comprehensive review of the indications, tools, techniques and outcomes for transvenous lead extraction. The success rate largely depends on the time from implant. Up to 12 months from implant, it is rare that traction alone will not suffice. For longer lead implant duration, no single technique is sufficient to address all extractions, but laser provides the best chance of extracting the entire lead. Operator experience is vital in determining success as familiarity of a wide array of techniques will increase the likelihood of uncomplicated extraction. Long implantation time, lack of operator experience, ICD lead type and female gender are risk factors for life-threatening complications. Lead extraction should therefore, ideally be performed in high volume centres with experienced staff and on-site support from a cardiothoracic surgical team able to deal with bleeding complications from cardiovascular perforation.
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Affiliation(s)
- F M Farooqi
- St Thomas' Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Franceschi F, Thuny F, Giorgi R, Sanaa I, Peyrouse E, Assouan X, Prévôt S, Bastard E, Habib G, Deharo JC. Incidence, Risk Factors, and Outcome of Traumatic Tricuspid Regurgitation After Percutaneous Ventricular Lead Removal. J Am Coll Cardiol 2009; 53:2168-74. [DOI: 10.1016/j.jacc.2009.02.045] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 11/16/2022]
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Successful management of multiple permanent pacemaker complications--infection, 13 year old silent lead perforation and exteriorisation following failed percutaneous extraction, superior vena cava obstruction, tricuspid valve endocarditis, pulmonary embolism and prosthetic tricuspid valve thrombosis. J Cardiothorac Surg 2009; 4:12. [PMID: 19239701 PMCID: PMC2649923 DOI: 10.1186/1749-8090-4-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
A 59 year old man underwent mechanical tricuspid valve replacement and removal of pacemaker generator along with 4 pacemaker leads for pacemaker endocarditis and superior vena cava obstruction after an earlier percutaneous extraction had to be abandoned, 13 years ago, due to cardiac arrest, accompanied by silent, unsuspected right atrial perforation and exteriorisation of lead. Postoperative course was complicated by tricuspid valve thrombosis and secondary pulmonary embolism requiring TPA thrombolysis which was instantly successful. A review of literature of pacemaker endocarditis and tricuspid thrombosis along with the relevant management strategies is presented. We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis.
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Endo Y, O'Mara JE, Weiner S, Han J, Goldberger MH, Gordon GM, Nanna M, Ferrick KJ, Gross JN. Clinical Utility of Intraprocedural Transesophageal Echocardiography during Transvenous Lead Extraction. J Am Soc Echocardiogr 2008; 21:861-7. [DOI: 10.1016/j.echo.2008.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Indexed: 10/22/2022]
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SMITH MACYC, LOVE CHARLESJ. Extraction of Transvenous Pacing and ICD Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:736-52. [DOI: 10.1111/j.1540-8159.2008.01079.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Stoner S, Baddour LM. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007; 49:1851-9. [PMID: 17481444 DOI: 10.1016/j.jacc.2007.01.072] [Citation(s) in RCA: 476] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 12/11/2006] [Accepted: 01/02/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We describe the management and outcome of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction. BACKGROUND Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined. METHODS A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed. RESULTS A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p < 0.001]). Median follow-up after hospital discharge was 175 days. Ninety-six percent of patients were cured with both complete device removal and antibiotic administration. CONCLUSIONS Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
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Affiliation(s)
- Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Uslan DZ, Sohail MR, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Baddour LM. Frequency of Permanent Pacemaker or Implantable Cardioverter-Defibrillator Infection in Patients with Gram-Negative Bacteremia. Clin Infect Dis 2006; 43:731-6. [PMID: 16912947 DOI: 10.1086/506942] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 06/02/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite the frequent occurrence of bacteremia due to gram-negative organisms in patients with underlying permanent pacemakers (PPMs) or implantable cardioverter defibrillators (ICDs), the outcome and treatment of these patients has received scant attention. In patients with PPMs or ICDs who have Staphylococcus aureus bacteremia, 45% have PPM/ICD infection. METHODS We conducted a retrospective cohort study over a 7-year period to assess the clinical features and frequency of PPM/ICD infection in patients with gram-negative bacteremia, as well as the incidence of relapse in patients for whom the device was not removed. RESULTS Forty-nine patients were included in the study; 3 (6%) had either definite (2 patients) or possible (1 patient) PPM/ICD infection. Both patients with definite PPM/ICD infection had clear infection of the generator pocket. None of the other patients with alternate sources of bacteremia developed PPM/ICD infection. Thirty-four patients with retained PPM/ICD were observed for >12 weeks (median time, 759 days), and 2 (6%) developed relapsing bacteremia, although they each had alternative sources of relapse. CONCLUSIONS In sharp contrast to S. aureus infection, PPM/ICD infection in patients with gram-negative bacteremia was rare, and no patients appeared to have secondary PPM/ICD infection due to hematogenous seeding of the system. Despite infrequent system removal in these patients, relapsing bacteremia among patients who survived initial bacteremia was rarely seen. If secondary PPM/ICD infection occurs in patients with gram-negative bacteremia, it is either uncommon or it is cured with antimicrobial therapy despite device retention.
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Affiliation(s)
- Daniel Z Uslan
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Abstract
PURPOSE OF REVIEW Use of electrophysiologic devices (permanent cardiac pacemaker and implantable cardioverter/defibrillator) has been increasing. Infection of these cardiac devices is a devastating complication, and medical treatment alone without device removal is often unsuccessful and frequently leads to infection relapse. This article reviews recent publications that address the diagnosis and management of infected electrophysiologic devices. RECENT FINDINGS Recent studies have shed new light on the incidence, risk factors, management, and outcome of cardiac device infection. Rates of both cardiac device implantation and infection have been increasing, although the rate of increase of cardiac device infection has outdistanced that of implantation and this has had enormous economic and clinical consequences. SUMMARY The large majority of cardiac device infections are likely due to pocket site contamination at the time of device placement. Hematogenous seeding from a distant focus of infection, particularly due to Staphylococcus aureus, can account for late-onset infection. Although no prospective studies have been conducted to date, management with parenteral antibiotics and complete device removal is the current standard of care. Further study is needed to better define optimal diagnostic and management interventions, particularly in patients with bloodstream infection and no local chest wall or echocardiographic evidence of cardiac device infection.
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Affiliation(s)
- Daniel Z Uslan
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Kinoshita O, Amano J, Takano T, Kitahara H, Itou K, Uchikawa SI, Yazaki Y, Imamura H, Hongo M, Kubo K. Bacteremia caused by late-infected pacemaker lead--a case report. Angiology 2005; 55:697-9. [PMID: 15547657 DOI: 10.1177/00033197040550i612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 73-year-old man with bradycardia and atrial fibrillation underwent implantation of a transvenous pacemaker system on the left anterior chest wall in 1995. Six years later, he was admitted for bacteremia from coagulase-negative Staphylococcus. Repeated treatment employing antibiotic therapy was ineffective. The infected electrode was removed under cardiopulmonary bypass. His electrode had become firmly encased with fibrous tissue within the right ventricle and atrium. It was removed under direct vision during complete cardiac arrest. The postoperative course was uneventful and there has been no recurrence after 1 year.
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Affiliation(s)
- Osamu Kinoshita
- Center of Cardiovascular Disease, Shinshu University School of Medicine, Matsumoto, Japan.
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Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000; 23:544-51. [PMID: 10793452 DOI: 10.1111/j.1540-8159.2000.tb00845.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The procedure of lead removal has recently matured into a definable, teachable art with its own specific tools and techniques. It is now time to recognize and formalize the practice of lead removal according to the current methods of medicine and the health care industry. In addition, since at this time the only prospective scientific study of lead extraction is the PLEXES trial, we suggest that studies relating to the techniques of and indications for lead extraction be designed. Recommendations for a common set of definitions, for a framework of training and reviewing physicians in the art, for general methods of reimbursement, and for consistency among clinical trials have been made. Implementation of these recommendations will require additional effort and cooperation from practicing physicians, medical societies, hospital administrations, and industry.
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Abstract
Extraction of chronically implanted pacing leads involves a thorough understanding of the pathophysiology of lead maturation and the problems that may occur. It also requires specific knowledge of lead construction and the idiosyncrasies of individual lead models. Though we have evolved to use a standardized approach to lead extraction, each patient and lead removal is unique. The operator must be ready to adapt the technique and tools used to the situation at hand. The more experience and the more tools available to the operator, the more likely that there will be a safe and successful outcome to the procedure. Preparation for disaster is mandatory, such that when a complication does occur, one may respond quickly and therefore salvage the patient.
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Affiliation(s)
- C J Love
- Arrhythmia Device Services, Ohio State University, Columbus, USA.
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Assayag P, Thuaire C, Benamer H, Sebbah J, Leport C, Brochet E. Partial rupture of the tricuspid valve after extraction of permanent pacemaker leads: detection by transesophageal echocardiography. Pacing Clin Electrophysiol 1999; 22:971-4. [PMID: 10392401 DOI: 10.1111/j.1540-8159.1999.tb06828.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Traumatic lesions of the tricuspid valve complicating pacemaker lead extractions appear to be rare. We report two cases of partial rupture of the tricuspid valve, following apparently uneventful extraction of permanent ventricular leads, resulting in severe regurgitation and, in one case, chronic heart failure. TEE was useful to identify the traumatic mechanism of tricuspid regurgitation (TR) and the extent of valvular lesions in these patients. Such etiology should be suspected, and TEE performed, in patients developing TR or heart failure late after lead extraction.
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Affiliation(s)
- P Assayag
- Service de Cardiologie, Hôpital Bichat-Claude Bernard, Université Paris VII, France
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Abstract
Infections following cardiac surgery, although generally uncommon, are associated with difficult management decisions and significant morbidity and mortality. They often present while the patient is either in a critical care unit, or requires CCU management. This review analyzes infections related to median sternotomy wounds, prosthetic heart valves, transvenous permanent pacemakers, automatic implantable cardioverter-defibrillators, and left ventricular assist devices. The diagnosis, microbiology, treatment and outcome of each is also discussed.
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Affiliation(s)
- L I Lutwick
- Department of Medicine, Brooklyn Veterans Medical Center, Brooklyn, New York, USA
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Alt E, Neuzner J, Binner L, Göhl K, Res JC, Knabe UH, Zehender M, Reinhardt J. Three-year experience with a stylet for lead extraction: a multicenter study. Pacing Clin Electrophysiol 1996; 19:18-25. [PMID: 8848372 DOI: 10.1111/j.1540-8159.1996.tb04786.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The extraction of chronically implanted and infected pacemaker and defibrillator leads is an important issue. This article describes the experience gathered between 1990 and 1994 by seven European centers regarding a locking stylet that is uniformly applicable for a wide variety of internal pacing coil diameters. This interventional locking stylet for lead extraction has an outer diameter of 0.4 mm (0.016 inches). The stylet consists of a hollow shaft in which an inner traction wire is embedded. At the tip of the inner traction wire an anchoring mechanism, which can be opened by retraction, is applied. Removal attempts were made for 150 leads, 110 in ventricular and 40 in atrial positions. RESULTS Complete removal was possible in 122 cases (81%). Partial removal was possible in 18 cases (12%). Failure to remove the lead with the extraction stylet was experienced in 10 cases (7%). In seven patients, the leads were removed by cardiothoracic surgery; 3 defective leads were left in place. There were no serious complications associated with the procedure. None of the patients died. CONCLUSION The experience with this extraction stylet for lead removal has shown good results. Despite a low complication rate thus far, each case for lead removal should be judged on the individual basis of benefit-to-risk ratio.
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Affiliation(s)
- E Alt
- Klinikum rechts der Isar, Munich, Germany
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Sisson D, Thomas WP, Woodfield J, Pion PD, Luethy M, DeLellis LA. Permanent transvenous pacemaker implantation in forty dogs. J Vet Intern Med 1991; 5:322-31. [PMID: 1779425 DOI: 10.1111/j.1939-1676.1991.tb03145.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Permanent transvenous cardiac pacemakers were implanted in 40 dogs. Electrocardiographic diagnoses included persistent atrial standstill (3 dogs), sick sinus syndrome (8 dogs), and high-grade second-degree or third-degree atrioventricular (AV) block (29 dogs). Thirteen dogs were alive and well 4 to 42 months after pacemaker implantation (mean, 16.9 months). The mean and median survival times of the 26 dogs that died or were euthanatized during the study were 17.9 months and 13 months, respectively. Most of these dogs succumbed to problems unrelated to the arrhythmia and pacemaker implant. One dog was lost to follow-up. Complications associated with permanent transvenous pacemaker implantation included lead dislodgement, infection, hematoma formation, skeletal muscle stimulation, ventricular arrhythmia, migration of the pulse generator, and skin erosion. Lead dislodgement was the most common complication, occurring in 7 of 9 dogs paced using untined electrode leads and in 6 of 30 dogs paced using tined leads. Lead dislodgement did not occur in the only dog paced using an actively fixed endocardial lead. It was concluded that permanent transvenous cardiac pacing is a feasible, less traumatic alternative to epimyocardial pacing in dogs, but that successful use of this technique requires careful implantation technique and anticipation of the potential complications.
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Affiliation(s)
- D Sisson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61801
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Parry G, Goudevenos J, Jameson S, Adams PC, Gold RG. Complications associated with retained pacemaker leads. Pacing Clin Electrophysiol 1991; 14:1251-7. [PMID: 1719502 DOI: 10.1111/j.1540-8159.1991.tb02864.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Retention of functionless pacemaker leads may occur following mechanical or infective problems (potentially or definitely infected) or after electrical failure of the lead. One hundred nineteen patients with a pacemaker lead (or leads) retained between 1970 and 1990 were reviewed retrospectively. Lead retention after an intervention dictated by potential or definite infection of the pacing system resulted in complications in 27 of 53 patients (51%), which in 22 patients (42%) were major (septicemia, superior vena cava syndrome, and further surgery under general anesthesia for recurrent "infective" problems) including three deaths. Complications were less likely if lead retention occurred after electrical failure with three minor and two major (surgery under general anesthesia, superior vena cava syndrome) complications in 66 patients (P less than 0.001). Bacteriology of swabs taken at the time of retention in the patients with potential or definite infection was unhelpful in predicting future complications: 8/18 patients (44%) whose swabs were negative had complications of which 5/18 (28%) were major. In our experience retention of functionless pacemaker leads after an intervention dictated by potential or definite infection of the pacing system, is associated with significant morbidity and mortality and should be avoided.
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Affiliation(s)
- G Parry
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Ebe K, Funazaki T, Aizawa Y, Shibata A, Fukuda T. Experimental study about removal of the implanted tined polyurethane ventricular lead by radiofrequency waves through the lead. Pacing Clin Electrophysiol 1991; 14:1222-7. [PMID: 1719497 DOI: 10.1111/j.1540-8159.1991.tb02859.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Polyurethane pacemaker leads are widely used nowadays. However, only a few studies have been done to investigate the fixation mechanism of polyurethane leads. To elucidate how pacemaker leads are fixed at the early phase after implantation, polyurethane-insulated tined ventricular leads were implanted in seven mongrel dogs. One to 4 months later, tips of the leads were anchored among the trabeculae and the distal part of the leads were encapsulated by whitish fibrous tissue. It was found that not organized thrombi, but cell reaction with various stages of inflammatory cells was responsible for forming the fibrous tissue. We attempted to remove the lead by delivering radiofrequency wave through the lead. However, no lead could be removed.
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Affiliation(s)
- K Ebe
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
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Byrd CL, Schwartz SJ, Hedin N, Beach M. Intravascular techniques for extraction of permanent pacemaker leads. J Thorac Cardiovasc Surg 1991. [DOI: 10.1016/s0022-5223(19)36615-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Myers MR, Parsonnet V, Bernstein AD. Extraction of implanted transvenous pacing leads: a review of a persistent clinical problem. Am Heart J 1991; 121:881-8. [PMID: 2000756 DOI: 10.1016/0002-8703(91)90203-t] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Within a few months of implantation, permanent pacemaker leads become ensheathed in fibrocollagenous tissue. This tissue may anchor the lead so that it is difficult, dangerous, or impossible to remove it. Leads with bulbous or finned tips are particularly resistant to extraction. The risks of applying traction to an entrapped lead include induction of bradycardia or ventricular tachycardia and fibrillation, invagination of the right ventricle, avulsion of the right ventricular myocardium or tricuspid valve, hemopericardium, and cardiac tamponade. Forceful traction may result in uncoiling of the conductor, disruption of the insulation, or complete fracture, leaving an intravascular remnant that may embolize or be a source for thrombosis. Although fixation and abandonment of an inactive chronically implanted lead is frequently appropriate and is known to pose little long-term risk, the retained inactive lead may interact adversely with a new active lead and then increase the risk of venous thrombosis, serve as a potential nidus for infection, or produce spurious electrical sensing signals that may be sensed by the pulse generator. Absolute indications for lead removal are those in which there would be a life-threatening situation if the lead were to remain in situ. In the absence of an absolute indication, the decision to proceed with extraction must be made by weighing the potential for serious morbidity or mortality against risks of the extraction technique. Techniques for lead removal include traction and open cardiotomy operations. When a portion of the lead is intravascular, forceps, snares, baskets, countertraction, or lead-transection devices may be used to retrieve the fragment.
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Affiliation(s)
- M R Myers
- Division of Cardiac Electrophysiology, Huntington Hospital, Pasadena, CA 91105
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Abstract
Four permanent ventricular endocardial pacemaker electrodes which could not be removed via their insertion site have been retrieved via the femoral vein using a Dormier basket. Apart from short-lived ventricular arrhythmias no complications occurred in any case. Where removal of an otherwise unaccessible ventricular pacemaker electrode is considered essential the use of a Dormier basket percutaneously appears to be effective and more acceptable than surgical removal.
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Affiliation(s)
- C J Foster
- Department of Cardiology, Manchester Royal Infirmary, U.K
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Dubernet J, Irarrázaval MJ, Lema G, Maturana G, Urzúa J, Morán S, Navarro M, Fajuri A. Surgical removal of entrapped endocardial leads without using extracorporeal circulation. Pacing Clin Electrophysiol 1985; 8:175-80. [PMID: 2580277 DOI: 10.1111/j.1540-8159.1985.tb05747.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Of 267 patients having a tined endocardial lead implanted from 1978 to December 1983, three (1.1%) developed pulse generator pocket infection. Proper treatment of this complication involves removal of the pulse generator, continued external pacing via the implanted lead, pocket drainage and administration of specific antibiotics until the infected area clears. In two patients, the electrode could not be removed by traction. A sternotomy was performed, the pericardium was opened, the endocardial electrode was located by palpation, and a purse string suture (PSS) was prepared around it on the right ventricular wall. A new myocardial electrode with its corresponding generator was then implanted to reestablish pacing. Through the PSS the myocardium was incised, the distal end of the endocardial lead was exteriorized and severed, and the PSS was tied. The remaining lead was withdrawn proximally and the surgical wounds were closed. The results of this procedure have been been excellent, allowing the removal of the entrapped leads, with continuous pacing and without the need for extracorporeal circulation.
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Madigan NP, Curtis JJ, Sanfelippo JF, Murphy TJ. Difficulty of extraction of chronically implanted tined ventricular endocardial leads. J Am Coll Cardiol 1984; 3:724-31. [PMID: 6693644 DOI: 10.1016/s0735-1097(84)80248-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The dislodgment rate of permanent pacing ventricular and atrial endocardial leads has significantly decreased with the incorporation of tines as a fixation device. In contrast, transvenous manual extraction of chronically implanted endocardial leads is, at times, clinically indicated, particularly when pacemaker system infection is present. The success rate of such extraction attempts for ventricular endocardial leads over the past 5 years was reviewed. Extraction was usually successful (six of seven attempts) in patients with silicone rubber nontined (or short-tined) older ventricular endocardial leads (Group A). However, in patients with newer urethane long-tined ventricular endocardial leads (Group B), extraction was unsuccessful in three of four attempts. Because of entrapment of the distal electrode tip in the right ventricular apex, manual traction of these leads resulted in permanent conductor material stretching with resultant urethane insulator material breakage in the region of the joints with proximal and distal electrodes. The one successful extraction in Group B was technically difficult and appeared to create a significant risk of intracardiac lead separation. This experience indicates that with improved pacemaker lead design decreased lead dislodgment has been obtained at the cost of increased difficulty of ventricular endocardial lead extraction. Such difficulty should be anticipated when a clinical decision is made to attempt to extract the new urethane long-tined ventricular leads.
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Abstract
In patients who have undergone prosthetic tricuspid valve replacement or tricuspid annuloplasty and in whom the pericardial space is obliterated by adhesions from previous operations, the need for ventricular pacing may be met by lead placement in the venous tributaries of the coronary veins. This approach avoids compromise of prosthetic tricuspid valve function and injury to bioprosthetic valves and natural valves repaired by annuloplasty. Although acute stimulation thresholds are slightly higher than those for short-term endocardial implants, stable long-term ventricular pacing has been observed in patients reported in the literature in whom such lead placement was inadvertent and in the 2 patients in the present paper in whom such replacement was deliberate. This method appears to be a safe alternative to standard ventricular pacing techniques under the special circumstances reported here.
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Colosimo LR, Lawrie GM, Roehm JO, Debakey ME. Extraction of chronically infected transvenous pacemaker leads: report of an unusual problem. Pacing Clin Electrophysiol 1983; 6:648-50. [PMID: 6191305 DOI: 10.1111/j.1540-8159.1983.tb05308.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This is a report of a patient with an impacted, chronically infected transvenous pacemaker lead whose management was complicated by the presence of a functioning contralateral transvenous pacemaker. Treatment included sustained traction on the infected lead, a left subcostal thoracotomy for placement of new sutureless epicardial leads, and retrograde right iliac vein cannulation for final snare removal of the mobilized lead. The patient is currently free of infection, and has normal pacemaker function.
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Peters R, Wohl B, Fisher M, Carliner N, Plotnick G. Non-operative removal of a tined-tip endocardial pacemaker catheter. Pacing Clin Electrophysiol 1982; 5:129-31. [PMID: 6181465 DOI: 10.1111/j.1540-8159.1982.tb02200.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gibson TC, Davidson RC, DeSilvey DL. Presumptive tricuspid valve malfunction induced by a pacemaker lead: a case report and review of the literature. Pacing Clin Electrophysiol 1980; 3:88-95. [PMID: 6160499 DOI: 10.1111/j.1540-8159.1980.tb04307.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A 23-year-old woman developed 3 degrees AV block with syncope. Insertion of a permanent pacemaker lead was followed by the onset of a persistent murmur in late systole preceded by single or multiple clicks. The murmur was best heard at the left sternal edge, grade 3-4/6 with two major frequencies (60-250 Hz), increased with inspiration and on assuming the erect posture. It was considered to be tricuspid in origin and related to interference of the tricuspid valve apparatus by the pacemaker lead resulting in tricuspid regurgitation. No tricuspid valve prolapse or flutter was seen on echocardiography. Withdrawal of the pacemaker lead resulted in immediate disappearance of the new auscultatory findings. Review of the literature suggests that the appearance of such a murmur following pacemaker insertion could be associated with later complications in relation to tricuspid valve dysfunction. It is therefore recommended that, under these circumstances, permanent pacemaker leads should be appropriately repositioned.
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Karim AM, Singh SH, Pantazopoulos J. Placement of two transvenous permanent pacemaker leads in a single vein. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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