1
|
Keyser A, Schopka S, Jungbauer C, Foltan M, Schmid C. Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture. J Cardiothorac Surg 2018; 13:102. [PMID: 30285786 PMCID: PMC6169062 DOI: 10.1186/s13019-018-0795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/26/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In cases of lead failure after implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD) early lead replacement may be challenging. Puncture of the subclavian vein bears possible complications such as pneumothorax, hematothorax, and damage of leads to be left in place. To avoid venous puncture PM or ICD leads were replaced using a flexible polypropylene sheath (Byrd-sheath). METHOD From January 2010 through December 2017, 55 patients underwent early lead exchange avoiding venous puncture. Early lead exchange for this study was defined as a reintervention within 14 days after the initial lead implantation. The connector of the malfunctioning lead was cut off, and stabilized by a stiff stylet. After having cut off the plastic knob of the stylet, the lead was passed through the polypropylene sheath and the latter advanced into the subclavian vein with gentle rotational movements to gain access to the subclavian vein. After lead removal the polypropylene sheath was replaced by a peel away sheath a new lead inserted. RESULTS Overall, 23 defibrillation leads and 34 pacing leads (16 right atrial leads, 17 right ventricular leads, and 1 left ventricular lead) were successfully explanted. Access to the subclavian vein was uneventful, and blood loss minimal. Radiation exposure and fluoroscopy time were also negligible. CONCLUSION The Byrd-sheath technique proved to be safe and successful in providing vein access within 2 weeks after initial lead implantation using the previously implanted lead and thus avoiding puncture of the subclavian vein.
Collapse
Affiliation(s)
- Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II/Cardiology, University Medical Center, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| |
Collapse
|
2
|
Trucco E, Mont L. Extraction of sterile leads is the preferred approach rather than implanting a new lead: the con perspective. Card Electrophysiol Clin 2015; 7:427-431. [PMID: 26304522 DOI: 10.1016/j.ccep.2015.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.
Collapse
Affiliation(s)
- Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain.
| |
Collapse
|
3
|
Segreti L, Di Cori A, Zucchelli G, Soldati E, Coluccia G, Viani S, Paperini L, Bongiorni MG. A Questionable Indication For ICD Extraction After Successful VT Ablation. J Atr Fibrillation 2015; 7:1172. [PMID: 27957158 DOI: 10.4022/jafib.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD). In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. To date, no control data have been published on transvenous lead extraction in the setting of VT ablation. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.
Collapse
Affiliation(s)
- Luca Segreti
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Coluccia
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
4
|
Diemberger I, Mazzotti A, Giulia MB, Biffi M, Cristian M, Massaro G, Matteo M, Martignani C, Letizia ZM, Ziacchi M, Reggiani B, Reggiani ML, Battistini P, Boriani G. From lead management to implanted patient management: systematic review and meta-analysis of the last 15 years of experience in lead extraction. Expert Rev Med Devices 2014; 10:551-73. [PMID: 23895081 DOI: 10.1586/17434440.2013.811837] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous lead extraction is considered a safe and effective procedure, although published results derive primarily from cohort studies. The authors performed a systematic review and meta-analysis of the last 15 years' experience in this field, to give an objective evaluation of the efficacy and safety of this procedure. Moreover, the subsequent metaregression analysis enabled the identification of the main factors influencing these results: patient age, presence of leads in situ for more than 1 year, presence of device infection and use of laser sheath. These findings are significant in order to improve our extraction approach, data reporting and future research.
Collapse
Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Zhou X, Jiang H, Ma J, Bakhai A, Li J, Zhang Y, Li Y, Wang D, Zhang Y, Xu G, Zhang J, Tang B. Comparison of standard and modified transvenous techniques for complex pacemaker lead extractions in the context of cardiac implantable electronic device-related infections: a 10-year experience. Europace 2013; 15:1629-35. [PMID: 23887094 DOI: 10.1093/europace/eut077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Complete lead extraction of cardiac implantable electronic devices (CIED) for device-related infections remains a complex procedure for chronically implantated leads. We present data from a single-centre registry of consecutive patients with extractions over 10 years. METHOD AND RESULTS Patients were identified from the centre's electronic database with CIED-related infections who underwent lead extraction using either the standard technique and equipment or a modified innovative transvenous lead technique extraction using an ablation catheter. Of 151 patients with CIED-related infections, not responding to simple manual traction to effect lead extraction, average age 65 ± 8 years (range 45-82), 64% being male, 75 underwent standard (S) extraction, and 76 underwent modified (M) extraction. Procedural, lead extraction, and fluoroscopy exposure times with S and M methods, respectively, were 65 ± 14 vs. 52 ± 6 min (P < 0.01), 56 ± 12 vs. 36 ± 8 min (P < 0.001), and 48 ± 12 vs. 31 ± 7 min (P < 0.001). Retrieval rates were numerically lower with the standard technique at 92 vs. 96% but did not achieve significance, with respective complication rates of 6.7 and 5.3%. CONCLUSION In our single-centre study, a modified extraction technique to retrieve leads for infections of CIEDs using a steerable ablation catheter has improved procedural parameters over the standard technique, without compromising clinical lead extraction success rates. This may be a promising approach for a future, prospective trial.
Collapse
Affiliation(s)
- XianHui Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urmuqi, Xinjiang 830011, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Rodriguez Y, Garisto JD, Carrillo RG. A Novel Retrograde Laser Extraction Technique Using a Transatrial Approach. Circ Arrhythm Electrophysiol 2011; 4:501-5. [DOI: 10.1161/circep.111.963462] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasser Rodriguez
- From the Department of Cardiothoracic Surgery, University of Miami Hospital, Miller School of Medicine, Miami, FL
| | - Juan D. Garisto
- From the Department of Cardiothoracic Surgery, University of Miami Hospital, Miller School of Medicine, Miami, FL
| | - Roger G. Carrillo
- From the Department of Cardiothoracic Surgery, University of Miami Hospital, Miller School of Medicine, Miami, FL
| |
Collapse
|
7
|
Wong RH, Chai J, Ng CS, Wan IY, Wan S, Underwood MJ. Transvenous pacing lead-induced superior vena cava syndrome: What do we know? SURGICAL PRACTICE 2009. [DOI: 10.1111/j.1744-1633.2009.00462.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Trappe HJ. Akuttherapie bei bradykarden Rhythmusstörungen oder Schrittmachernotfällen. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH, Epstein LM, Friedman RA, Kennergren CEH, Mitkowski P, Schaerf RHM, Wazni OM. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009; 6:1085-104. [PMID: 19560098 DOI: 10.1016/j.hrthm.2009.05.020] [Citation(s) in RCA: 770] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Indexed: 12/20/2022]
|
10
|
Bongiorni MG, Soldati E, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Solarino G, Balbarini A, Marzilli M, Mariani M. Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads. Eur Heart J 2008; 29:2886-93. [PMID: 18948356 PMCID: PMC2638651 DOI: 10.1093/eurheartj/ehn461] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique. METHODS AND RESULTS We developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%). CONCLUSION Mechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.
Collapse
Affiliation(s)
- Maria Grazia Bongiorni
- Arrhythmology Unit of CardioVascular Division, CardioThoracic Department, University Hospital, Via Paradisa 2, 56100 Pisa, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
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]
|
12
|
Affiliation(s)
- Charles J Love
- Division of Cardiology, The Ohio State University, Columbus, Ohio 43210-1228, USA.
| |
Collapse
|
13
|
Cooper JM, Sauer WH, Garcia FC, Krautkramer MJ, Verdino RJ. Covering sleeves can shield the high-voltage coils from lead chatter in an integrated bipolar ICD lead. ACTA ACUST UNITED AC 2007; 9:137-42. [PMID: 17272336 DOI: 10.1093/europace/eul180] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Integrated bipolar implantable cardioverter-defibrillator (ICD) leads use the distal high-voltage coil as both the ventricular sensing anode and the distal shocking electrode. Mechanical interactions between the distal ICD coil and other intracardiac leads have been reported to result in electrical oversensing and inappropriate ICD therapies. We sought to determine whether covering sleeves over the high-voltage coils of an integrated bipolar ICD lead could prevent sensed artefact from mechanical lead interactions. METHODS AND RESULTS Endotak Reliance 0157 and Endotak Reliance-G 0185 leads, the latter with expanded polytetrafluoroethylene (ePTFE) sleeves covering the high-voltage coils, were connected to ICD generators and the leads were submerged in saline. Device programmers were used to communicate with the ICD generators, providing real-time electrogram recording throughout testing. A series of mechanical interactions were performed with the ICD leads, including sliding and striking each distal coil against metal and non-metal components of other ICD and pacemaker leads. All direct metal-metal interactions resulted in sensed electrical artefact, including interactions between the bare ICD coil and another bare ICD coil or metal pacemaker ring. Identical mechanical interactions where metal-metal contact was prevented due to an interposed ePTFE covering sleeve were electrically silent with no sensed artefact. CONCLUSIONS A covering sleeve over the distal high-voltage coil of an integrated bipolar ICD lead can mechanically shield the lead from metal-metal interactions, which might otherwise result in sensed artefact and inappropriate ICD therapies or withholding of pacing output. This finding has implications for lead selection when a new ICD lead is to be implanted adjacent to abandoned intracardiac leads or lead fragments.
Collapse
Affiliation(s)
- Joshua M Cooper
- University of Pennsylvania Health System, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | | | | | | | |
Collapse
|
14
|
Saad EB, Saliba WI, Schweikert RA, Al-Khadra AS, Abdul-Karim A, Niebauer MJ, Wilkoff BL. Nonthoracotomy Implantable Defibrillator Lead Extraction:. Results and Comparison with Extraction of Pacemaker Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2003; 26:1944-50. [PMID: 14516333 DOI: 10.1046/j.1460-9592.2003.00300.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extraction of pacemaker leads has been demonstrated to be successful and safe in experienced hands using current tools. Whether application of such techniques and tools yield similar results among patients undergoing extraction of nonthoracotomy implantable defibrillator leads is unknown. This report describes a retrospective analysis of indications, techniques used, and outcome of patients who had a single ventricular nonthoracotomy implantable defibrillator lead extracted at The Cleveland Clinic Foundation. Results were compared to a matched population of patients undergoing extraction of ventricular pacemaker leads from a national registry and to the experience with pacemaker lead extraction at The Cleveland Clinic Foundation. Successful complete extraction of ventricular nonthoracotomy implantable defibrillator leads, in the absence of major complications, was achieved in 96.9% of attempts to extract leads from 161 patients. Clinical success was achieved in 98.1% of patients. Failure occurred in three patients. Two patients had major complications, including one death. The most common indication for extraction was infection (46.6%), followed by lead failure (34.2%). Procedure (140.8 vs 171.2 minutes, P<0.01) and fluoroscopy (9.9 vs 11.0 minutes, P<0.01) times compared favorably with those obtained from the pacemaker lead extraction database. Use of LASER did not influence the safety of the procedure or fluoroscopy times. Extraction of ventricular nonthoracotomy implantable defibrillator leads using currently available tools is a complex but effective procedure. In experienced hands, excellent success rates should be achieved with a low incidence of complications.
Collapse
Affiliation(s)
- Eduardo B Saad
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Swanton BJ, Keane D, Vlahakes GJ, Streckenbach SC. Intraoperative transesophageal echocardiography in the early detection of acute tamponade after laser extraction of a defibrillator lead. Anesth Analg 2003; 97:654-656. [PMID: 12933378 DOI: 10.1213/01.ane.0000074234.13373.e7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Laser-assisted intracardiac lead extraction is associated with a 1%-2% incidence of pericardial tamponade. Because of this risk, many of these procedures are being performed in an operating room with a cardiac surgeon immediately available. Transesophageal echocardiography is a useful intraoperative monitor during these procedures.
Collapse
Affiliation(s)
- Brian J Swanton
- *Department of Anesthesia and Intensive Care, †Cardiology Division, and ‡Department of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | | |
Collapse
|
16
|
Cooper JM, Stephenson EA, Berul CI, Walsh EP, Epstein LM. Implantable cardioverter defibrillator lead complications and laser extraction in children and young adults with congenital heart disease: implications for implantation and management. J Cardiovasc Electrophysiol 2003; 14:344-9. [PMID: 12741703 DOI: 10.1046/j.1540-8167.2003.02500.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Implantable cardioverter defibrillators (ICDs) are being implanted for primary and secondary prevention of sudden death in children and young adults with congenital heart disease. Over time, ICD leads adhere to venous endothelium and endocardium. Lead removal, when necessary, often requires disruption of this fibrous tissue. METHODS AND RESULTS We retrospectively reviewed and analyzed our experience with ICD lead extraction in children and young adults with congenital heart disease. From April 1999 through January 2002, 14 patients underwent 15 lead extraction procedures to remove 21 leads (17 ICD leads and 4 pacing or sensing leads). Seven patients had surgically corrected structural heart disease (5 transposition of the great arteries with atrial switch repair and 2 corrected tetralogy of Fallot). Mean patient age at extraction was 17.9 +/- 5.7 years (range 9-32), and mean duration of lead implantation was 42.0 +/- 18.9 months (range 15-75). Fourteen of 15 procedures were performed for lead fracture or failure. A laser sheath was used for 20 of 21 lead extractions. Twenty of 21 leads (95%) were completely extracted. There were three instances of blood loss requiring transfusion. There were no major complications or deaths. CONCLUSION Young congenital heart disease patients with an ICD are at risk for growth-related lead distortion. The use of a laser sheath is safe and effective for ICD lead extraction in congenital heart disease patients, despite coil adherence and altered anatomy. It may be advisable to avoid dual-coil leads in patients with the potential for future growth.
Collapse
Affiliation(s)
- Joshua M Cooper
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | | | | | | | | |
Collapse
|
17
|
Talreja DR, Asirvatham S, Hayes DL. The use of radiofrequency catheter ablation to extract a chronic permanent pacemaker lead after failed laser extraction. J Interv Card Electrophysiol 2002; 6:187-90. [PMID: 11992031 DOI: 10.1023/a:1015327919866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Even with the latest advances in pacemaker lead extraction techniques, successful lead extraction via percutaneous techniques still cannot be achieved in up to 2% of procedures at qualified centers reiterating the need for further development in this area. We present an example of a novel technique using radiofrequency (RF) energy delivered with a steerable ablation catheter to facilitate lead removal using an 8-french guiding sheath (SRO, Daig corporation) and a bidirectional steerable 4 mm tip ablation catheter (EPT). With a short series of RF ablations, the pacemaker lead tip was successfully freed without complications.
Collapse
|
18
|
Brown LA, Baddley JW, Sanchez JE, Bachmann LH. Implantable cardioverter-defibrillator endocarditis secondary to Candida albicans. Am J Med Sci 2001; 322:160-2. [PMID: 11570782 DOI: 10.1097/00000441-200109000-00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) represents an important advance in the treatment of ventricular arrhythmias, but infection has remained a serious complication of device implantation. Fungal infections associated with these devices are uncommon, with only 4 cases previously reported. We describe a case of ICD-associated endocarditis caused by Candida albicans that was successfully treated with complete device explantation and prolonged antifungal therapy, and we review the features of ICD-related fungal infections.
Collapse
Affiliation(s)
- L A Brown
- Department of Medicine, University of Alabama at Birmingham, 35294-0006, USA
| | | | | | | |
Collapse
|