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Griffiths S, Behar JM, Kramer DB, Debney MT, Monkhouse C, Lefas AY, Lowe M, Amin F, Cantor E, Boyalla V, Karim N, Till J, Markides V, Clague JR, Wong T. The long-term outcomes of cardiac implantable electronic devices implanted via the femoral route. Pacing Clin Electrophysiol 2022; 45:481-490. [PMID: 35043404 PMCID: PMC9305836 DOI: 10.1111/pace.14449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/17/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
Background Conventional superior access for cardiac implantable electronic devices (CIEDs) is not always possible and femoral CIEDs (F‐CIED) are an alternative option when leadless systems are not suitable. The long‐term outcomes and extraction experiences with F‐CIEDs, in particular complex F‐CIED (ICD/CRT devices), remain poorly understood. Methods Patients referred for F‐CIEDs implantation between 2002 and 2019 at two tertiary centers were included. Early complications were defined as ≤30 days following implant and late complications >30 days. Results Thirty‐one patients (66% male; age 56 ± 20 years; 35% [11] patients with congenital heart disease) were implanted with F‐CIEDs (10 ICD/CRT and 21 pacemakers). Early complications were observed in 6.5% of patients: two lead displacements. Late complications at 6.8 ± 4.4 years occurred in 29.0% of patients. This was higher with complex F‐CIED compared to simple F‐CIED (60.0% vs. 14.3%, p = .02). Late complications were predominantly generator site related (n = 8, 25.8%) including seven infections/erosions and one generator migration. Eight femoral generators and 14 leads (median duration in situ seven [range 6–11] years) were extracted without complication. Conclusions Procedural success with F‐CIEDs is high with clinically acceptable early complication rates. There is a notable risk of late complications, particularly involving the generator site of complex devices following repeat femoral procedures. Extraction of chronic F‐CIED in experienced centers is feasible and safe.
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Affiliation(s)
- Samuel Griffiths
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jonathan M Behar
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - Mike T Debney
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | | | - Alicia Y Lefas
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Martin Lowe
- Barts Heart Centre, West Smithfields, London, EC1A 7BE, UK
| | - Fouad Amin
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Emily Cantor
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Vennella Boyalla
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Nabeela Karim
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jan Till
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Vias Markides
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Jonathan R Clague
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - Tom Wong
- Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK
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Costa R, Silva KRD, Martinelli Filho M, Carrillo R. Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block. Arq Bras Cardiol 2017; 109:331-339. [PMID: 28876373 PMCID: PMC5644213 DOI: 10.5935/abc.20170126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/12/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). OBJECTIVE This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. METHODS Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. RESULTS All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. CONCLUSION Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.
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Affiliation(s)
- Roberto Costa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Katia Regina da Silva
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roger Carrillo
- Miller School of Medicine, University of Miami, Miami, USA
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García Guerrero JJ, Fernández de la Concha Castañeda J, Doblado Calatrava M, Redondo Méndez Á, Lázaro Medrano M, Merchán Herrera A. Transfemoral access when superior venous approach is not feasible equals overall success of permanent pacemaker implantation. Ten-year series. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:638-643. [DOI: 10.1111/pace.13082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 02/19/2017] [Accepted: 03/14/2017] [Indexed: 11/27/2022]
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Cecchin F, Halpern DG. Cardiac Arrhythmias in Adults with Congenital Heart Disease: Pacemakers, Implantable Cardiac Defibrillators, and Cardiac Resynchronization Therapy Devices. Card Electrophysiol Clin 2017; 9:319-328. [PMID: 28457245 DOI: 10.1016/j.ccep.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implanting cardiac rhythm medical devices in adults with congenital heart disease requires training in congenital heart disease. The techniques and indications for device implantation are specific to the anatomic diagnosis and state of disease progression. It often requires a team of physicians and is best performed at a specialized adult congenital heart center.
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Affiliation(s)
- Frank Cecchin
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - Daniel G Halpern
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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Seow SC, Lim TW, Singh D, Yeo WT, Kojodjojo P. Permanent pacing in patients without upper limb venous access: a review of current techniques. HEART ASIA 2014; 6:163-6. [PMID: 27326197 DOI: 10.1136/heartasia-2014-010546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/04/2022]
Abstract
Permanent transvenous cardiac pacing is usually accomplished through the upper limb veins. When these are occluded, several other vascular access options exist which include the internal jugular, external jugular, femoral and iliac veins as well as more proximal access of the subclavian veins. Anterograde and retrograde techniques to restore subclavian venous patency has been described. A review of these approaches is undertaken, with a discussion of their pros and cons. Familiarity with these techniques will enable the implanter to perform transvenous pacing when faced with limited vascular access.
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Affiliation(s)
- Swee-Chong Seow
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Toon-Wei Lim
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Devinder Singh
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Wee-Tiong Yeo
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Pipin Kojodjojo
- Cardiology Department , National University Heart Centre , Singapore , Singapore
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Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NAM, Gewitz M, Newburger JW, Schron EB, Taubert KA. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121:458-77. [PMID: 20048212 DOI: 10.1161/circulationaha.109.192665] [Citation(s) in RCA: 728] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening. This has prompted the study of all aspects of CIED infections. Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research.
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Allred JD, McElderry HT, Doppalapudi H, Yamada T, Kay GN. Biventricular ICD Implantation Using the Iliofemoral Approach: Providing CRT to Patients with Occluded Superior Venous Access. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1351-4. [PMID: 18811820 DOI: 10.1111/j.1540-8159.2008.01190.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- James D Allred
- Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
Adults with congenital heart disease constitute one of the fastest growing populations in cardiology. Pacing is an integral part of their therapy and may reduce their morbidity and mortality significantly. The current generation of pacemakers is more sophisticated and complex, and they are being utilized for indications other than conduction abnormalities, such as termination of tachycardia and improvement of heart failure. The complex anatomy and history of multiple previous surgeries in adults with congenital heart disease, however, pose many limitations and technical challenges related to the placement of a pacemaker. Unique and innovative approaches to endocardial lead placement and improved epicardial leads is making pacemaker implantation more feasible in these patients.
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Affiliation(s)
- Anjan S Batra
- Department of Pediatric Cardiology, University of California, Irvine, Children's Hospital of Orange County, Orange, CA 92868, USA.
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García Guerrero JJ, De La Concha Castañeda JF, Fernández Mora G, López Quero D, Redondo Méndez A, Dávila Dávila E, Merchán Herrera A. Permanent Transfemoral Pacemaker: A Single-Center Series Performed with an Easier and Safer Surgical Technique. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:675-9. [PMID: 16008803 DOI: 10.1111/j.1540-8159.2005.00145.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION When venous access via the upper venous tree is not possible, the usual approach is to proceed to epicardial lead placement. MATERIAL AND METHODS This report presents a consecutive series of 12 permanent pacemaker systems utilizing the right femoral vein for venous access implanted between May 2001 and October 2004. RESULTS A modification of the previously reported surgical technique was used with a mean implant time of 52 minutes. Five were dual-chamber systems and seven were VVIR. All the leads implanted were active fixation. There was a 0% dislodgment rate and a mean follow-up of 18 months. During this time, three patients required revision or treatment of a pocket complication. All systems remained in the pacing mode as originally programmed with stable low sensing and pacing thresholds. There was no clinical evidence for acute or chronic venous thrombosis and no evidence of asymptomatic venous obstruction in eight patients who underwent echo-duplex studies. CONCLUSION We believe that the permanent femoral implant utilizing the technical modifications described in this article, offers an alternative to epicardial lead placement when the usual upper venous tree access is not available.
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Affiliation(s)
- Juan J García Guerrero
- Department of Cardiology, Hospital Infanta Cristina, Ctra Portugal S/N, 06010 Badajoz, Spain.
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Abstract
PURPOSE OF REVIEW This review is intended to highlight major clinical advances over the past year related to (1). biventricular pacing as a treatment for dilated myopathy, (2). growing clinical experience with implantable cardioverter defibrillators in pediatrics, (3). technical advances in standard antibradycardia pacing, and (4). an appraisal of the newly updated ACC/AHA/NASPE guidelines for device implant in children and adolescents. RECENT FINDINGS Complex rhythm devices are being used more frequently in children. Biventricular pacing to improve ventricular contractility is a rapidly evolving technology that has now been applied to children and young adults with intraventricular conduction delay, such as bundle branch block after cardiac surgery. Implantable defibrillators are also being used for an expanding list of conditions, although lead dysfunction is seen as a fairly common complication in active young patients. Guidelines for device implantation have been developed, but the weight of evidence remains somewhat limited by the paucity of pediatric data in this field. SUMMARY Thanks to refinements in lead design and generator technology, coupled with rapidly expanding clinical indications, pacemakers and implantable defibrillators have become increasingly important components of cardiac therapy for young patients. Expanded multicenter clinical studies will be needed to develop more objective guidelines for use of this advanced technology.
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Affiliation(s)
- Edward P Walsh
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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