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Basman C, Jamal S, Yoon SH, Dudiy Y, Anderson M, Landers D, Kaple R. Transcatheter tricuspid valve intervention in the presence of a cardiac implantable electronic device; state of the art review. Catheter Cardiovasc Interv 2024. [PMID: 39169689 DOI: 10.1002/ccd.31183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024]
Abstract
A large proportion of patients referred for transcatheter tricuspid valve intervention (TTVI) will have the presence of a cardiac implantable electronic device (CIED). In such patients, surgical correction of tricuspid regurgitation (TR) is associated with high rates of morbidity and mortality. Transvenous lead extraction (TLE) could potentially ameliorate CIED-induced TR; however, it carries inherent risks and frequently does not result in TR improvement. As multiple TTVI devices are in trial to gain regulatory approval, understanding which therapy is most appropriate among patients with a CIED is essential. This review centers on the nonsurgical treatment, including TLE and transcatheter tricuspid valve repair and replacement options, aimed at enhancing outcomes in patients with TR who also have concurrent CIEDs.
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Affiliation(s)
- Craig Basman
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sameer Jamal
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sung-Han Yoon
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Yuriy Dudiy
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mark Anderson
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - David Landers
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ryan Kaple
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
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2
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Akcay M, Yuksel S. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads-A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1360. [PMID: 39202640 PMCID: PMC11356401 DOI: 10.3390/medicina60081360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: The number of cardiac pacemakers being used has increased in recent decades, and this increase has led to a rise in device-related complications, requiring percutaneous device extraction. Our aim was to present our single-center clinical experience in percutaneous lead extractions. Materials and Methods: We analyzed an observational retrospective cohort study of 93 patients for the transvenous removal of a total of 163 endocardial leads. We evaluated the device details, indications, lead characteristics, extraction methods, complications, reimplantation procedure, follow-up data, effectiveness, and safety. Results: Patients' mean age was 68.6 ± 11.6 years. Lead extraction indications were pocket infection in 33 (35.5%), lead dysfunction in 33 (35.5%), and system upgrade in 21 (23%) cases, and lead endocarditis in 6 (6%) cases. The duration from implantation to extraction time was a detected median of 43 (24-87) months. The most common retracted lead type was the RV defibrillator lead (62%), and the lead fixation type was active for one hundred (61%) patients. A new device was inserted in 74 (80%) patients, and the device type was most commonly a CRT-D (61%). Patients were followed up at a median of 17 (8-36) months, and 18 patients (19%) died at follow-up. Complete procedural success was obtained in 78 (84%) patients, and clinical procedural success was obtained in 83 (89%) patients. Procedural failure was detected in 15 (16%) patients. Major and minor complications were detected in 10 (11%) and 6 (6.5%) patients, respectively. The most common minor complication was pocket hematoma. Conclusions: Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications. The simple manual traction method has a high rate of procedural success, despite a high dwell time of the lead.
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Affiliation(s)
- Murat Akcay
- Department of Cardiology, Ondokuz Mayıs University School of Medicine, Samsun 55139, Turkey;
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3
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Mehta VS, Ma Y, Wijesuriya N, DeVere F, Howell S, Elliott MK, Mannkakara NN, Hamakarim T, Wong T, O'Brien H, Niederer S, Razavi R, Rinaldi CA. Enhancing transvenous lead extraction risk prediction: Integrating imaging biomarkers into machine learning models. Heart Rhythm 2024; 21:919-928. [PMID: 38354872 DOI: 10.1016/j.hrthm.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Machine learning (ML) models have been proposed to predict risk related to transvenous lead extraction (TLE). OBJECTIVE The purpose of this study was to test whether integrating imaging data into an existing ML model increases its ability to predict major adverse events (MAEs; procedure-related major complications and procedure-related deaths) and lengthy procedures (≥100 minutes). METHODS We hypothesized certain features-(1) lead angulation, (2) coil percentage inside the superior vena cava (SVC), and (3) number of overlapping leads in the SVC-detected from a pre-TLE plain anteroposterior chest radiograph (CXR) would improve prediction of MAE and long procedural times. A deep-learning convolutional neural network was developed to automatically detect these CXR features. RESULTS A total of 1050 cases were included, with 24 MAEs (2.3%) . The neural network was able to detect (1) heart border with 100% accuracy; (2) coils with 98% accuracy; and (3) acute angle in the right ventricle and SVC with 91% and 70% accuracy, respectively. The following features significantly improved MAE prediction: (1) ≥50% coil within the SVC; (2) ≥2 overlapping leads in the SVC; and (3) acute lead angulation. Balanced accuracy (0.74-0.87), sensitivity (68%-83%), specificity (72%-91%), and area under the curve (AUC) (0.767-0.962) all improved with imaging biomarkers. Prediction of lengthy procedures also improved: balanced accuracy (0.76-0.86), sensitivity (75%-85%), specificity (63%-87%), and AUC (0.684-0.913). CONCLUSION Risk prediction tools integrating imaging biomarkers significantly increases the ability of ML models to predict risk of MAE and long procedural time related to TLE.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - YingLiang Ma
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | - Nadeev Wijesuriya
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Felicity DeVere
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sandra Howell
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark K Elliott
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nilanka N Mannkakara
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tatiana Hamakarim
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tom Wong
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Hugh O'Brien
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Reza Razavi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Heart Vascular & Thoracic Institute, Cleveland Clinic London, London, United Kingdom
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4
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Dhindsa DS, Mekary W, El-Chami MF. Pacing and Defibrillation Consideration in the Era of Transcatheter Tricuspid Valve Replacement. Curr Cardiol Rep 2024; 26:331-338. [PMID: 38492178 DOI: 10.1007/s11886-024-02032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE OF REVIEW Tricuspid regurgitation is a commonly encountered valvular pathology in patients with trans-tricuspid pacing or implantable cardioverter-defibrillator leads. Transcatheter tricuspid valve interventions are increasingly performed in patients at high surgical risk. Implantation of these valves can lead to the "jailing" of a trans-tricuspid lead. This practice carries both short- and long-term risks of lead failure and subsequent infection without the ability to perform traditional transvenous lead extraction. Herein, this manuscript reviews available therapeutic options for lead management in patients undergoing transcatheter tricuspid valve interventions. RECENT FINDINGS The decision to jail a lead may be appropriate in certain high-risk cases, though extraction may be a better option in most cases given the variety of options for re-implant, including leadless pacemakers, valve-sparing systems, epicardial leads, leads placed directly through prosthetic valves, and the completely subcutaneous implantable-defibrillator. A growing number of patients meet the requirement for CIED implantation in the United States. A significant proportion of these patients will have tricuspid valve dysfunction, either related to or independent of their transvenous lead. As with any percutaneous intervention that has shown efficacy, the role of TTVI is also likely to increase as this therapy advances beyond the investigational phase. As such, the role of the heart team in the management of these patients will be increasingly critical in the years to come, and in those patients that have pre-existing CIED leads, we advocate for the involvement of an electrophysiologist in the heart team.
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Affiliation(s)
- Devinder S Dhindsa
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA
| | - Wissam Mekary
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA.
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5
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Dagher L, Tfaily MA, Vavuranakis M, Bhatia NK, Westerman SB, Shah AD, Lloyd MS, Leal M, De Lurgio DB, Merchant A, Panagopoulos A, Patel AM, Tompkins C, Leon AR, Merchant FM, El-Chami MF. Safety of same-day discharge after lead extraction procedures. Heart Rhythm 2023; 20:1669-1673. [PMID: 37591366 DOI: 10.1016/j.hrthm.2023.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after cardiovascular procedures is rapidly gaining ground. OBJECTIVE We sought to evaluate the safety of SDD after transvenous lead extraction (TLE). METHODS We performed a retrospective chart review of patients who underwent elective TLE between January 2020 and October 2021 at our institution. The primary outcome was SDD, and major procedural complications and readmissions within 30 days of the procedure were secondary outcomes. RESULTS In this analysis of 111 patients who underwent elective TLE, 80 patients (72%) were discharged on the same day (SDD group) while 31 patients (28%) stayed overnight (overnight group). Lead malfunction was the most common indication for TLE in both groups. Patients in the overnight group were more likely to have a lead dwell time of ≤10 years than those in the SDD group (38.7% vs 20% of all leads in each group; P = .042), have laser sheaths used for extraction and a higher number of leads extracted. No major complications were reported in both groups. In a multivariate analysis, lower body mass index and the use of laser sheath during TLE were predictors of overnight stay. Patients who underwent a procedure using advanced extraction techniques were 3.5 times more likely to stay overnight (95% confidence interval 1.27-9.78; P = .016). CONCLUSION In appropriately selected patients undergoing elective lead extraction, SDD is feasible and safe. Higher body mass index, fewer extracted leads, shorter lead dwell times (<10 years), and less frequent use of laser-powered extraction sheaths were associated with an increased likelihood of SDD.
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Affiliation(s)
- Lilas Dagher
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamad Ali Tfaily
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Vavuranakis
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Neal Kumar Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Miguel Leal
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - David B De Lurgio
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Alam Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anastasios Panagopoulos
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anshul M Patel
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Tompkins
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
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Rinaldi CA, Diemberger I, Biffi M, Gao YR, Sizto E, Jin N, Epstein LM, Defaye P. Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients. Europace 2023; 25:euad298. [PMID: 37757839 PMCID: PMC10655058 DOI: 10.1093/europace/euad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS While numerous studies have demonstrated favourable safety and efficacy of the excimer laser sheath for transvenous lead extraction (TLE) in smaller cohorts, comprehensive large-scale investigations with contemporary data remain scarce. This study aims to evaluate the safety and performance of laser-assisted TLE through a meta-analysis of contemporary data. METHODS AND RESULTS A systematic literature search was conducted to identify articles that assessed the safety and performance of the spectranetics laser sheath (SLS) II and GlideLight Excimer laser sheaths in TLE procedures between 1 April 2016 and 31 March 2021. Safety outcomes included procedure-related death and major/minor complications. Performance outcomes included procedural and clinical success rates. A random-effects, inverse-variance-weighting meta-analysis was performed to obtain the weighted average of the evaluated outcomes. In total, 17 articles were identified and evaluated, including 1729 patients with 2887 leads. Each patient, on average, had 2.3 ± 0.3 leads with a dwell time of 7.9 ± 3.0 years. The TLE procedural successes rate was 96.8% [1440/1505; 95% CI: (94.9-98.2%)] per patient and 96.3% [1447/1501; 95% CI: (94.8-97.4%)] per lead, and the clinical success rate per patient was 98.3% [989/1010, 95% CI: (97.4-99.0%)]. The procedure-related death rate was 0.08% [7/1729, 95% CI: (0.00%, 0.34%)], with major and minor complication rates of 1.9% [41/1729; 95% CI: (1.2-2.8%)] and 1.9% [58/1729; 95% CI: (0.8-3.6%)], respectively. CONCLUSION This meta-analysis demonstrated that excimer laser sheath-assisted TLE has high success and low procedural mortality rates. It provides clinicians with a reliable and valuable resource for extracting indwelling cardiac leads which require advanced extraction techniques.
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Affiliation(s)
- Christopher Aldo Rinaldi
- Cardiovascular Department, Guy's & St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Yu-Rong Gao
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Enoch Sizto
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Nancy Jin
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | | | - Pascal Defaye
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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8
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Abdelazeem A, Ahmed A, Curnis A, Arabia G, Cerini M, Aboelhassan M, Salghetti F, Milidoni A, Nawar M, Magdy G. Transvenous lead extraction, factors affecting procedural difficulty. Acta Cardiol 2023; 78:992-999. [PMID: 37318077 DOI: 10.1080/00015385.2023.2222986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A complex transvenous lead extraction (TLE) procedure could be associated with lower success and higher complication rates in inexperienced hands. In this study, we aim to assess the factors that determine procedural difficulty in TLE. METHODS We retrospectively studied 200 consecutive patients undergoing TLE in a single referral centre from June 2020 to December 2021. Lead extraction difficulty was assessed by the success of simple manual traction with or without a locking stylet, the need for advanced extraction tools and the number of tools required to extract the lead. Logistic and linear regression analyses were used to determine the factors independently affecting these 3 parameters. RESULTS 363 leads were extracted from 200 patients (79% males, mean age 66.85 years). The indication for TLE was device-related infection in 51.5%. Multivariate analysis revealed the lead indwelling time to be the only factor affecting the 3 parameters of difficulty. Passive fixation leads and dual coil leads increased procedural difficulty by affecting 2 parameters each. Factors that affected one parameter included infected leads, coronary sinus leads, older age of the patient and a history of valvular heart disease, all associated with a simpler procedure. Right ventricular leads were associated with a more complex one. CONCLUSION The most important factor that increased TLE procedural difficulty was a longer lead indwelling time, followed by passive fixation and dual-coil leads. Other contributing factors were the presence of infection, coronary sinus leads, older patients, a history of valvular heart disease and right ventricular leads.
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Affiliation(s)
- Ahmed Abdelazeem
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ashraf Ahmed
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Antonio Curnis
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Gianmarco Arabia
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Manuel Cerini
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Mohamed Aboelhassan
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Francesca Salghetti
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mostafa Nawar
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gehan Magdy
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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9
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Mehta VS, Wijesuriya N, DeVere F, Howell S, Elliott MK, Mannakarra N, Hamakarim T, Niederer S, Razavi R, Rinaldi CA. Long-term survival following transvenous lead extraction: unpicking differences according to sex. Europace 2023; 25:euad214. [PMID: 37466333 PMCID: PMC10410196 DOI: 10.1093/europace/euad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. METHODS AND RESULTS Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23-2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99-5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03-3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06-1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95-0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. CONCLUSION Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Nadeev Wijesuriya
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Felicity DeVere
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Sandra Howell
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Mark K Elliott
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Nilanka Mannakarra
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Tatiana Hamakarim
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Reza Razavi
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
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10
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Kutarski A, Miszczak-Knecht M, Brzezinska M, Birbach M, Lipiński W, Polewczyk AM, Jacheć W, Polewczyk A, Tułecki Ł, Tomków K, Stefańczyk P, Nowosielecka D, Bieganowska K. Transvenous Lead Extraction in Pediatric Patients - Is It the Same Procedure in Children as in Adults? Circ J 2023; 87:990-999. [PMID: 36517020 DOI: 10.1253/circj.cj-22-0542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
BACKGROUND Cardiac implantable electronic devices (CIED) are very rare in the pediatric population. In children with CIED, transvenous lead extraction (TLE) is often necessary. The course and effects of TLE in children are different than in adults. Thus, this study determined the differences and specific characteristics of TLE in children vs. adults. METHODS AND RESULTS A post hoc analysis of TLE data in 63 children (age ≤18 years) and 2,659 adults (age ≥40 years) was performed. The 2 groups were compared with respect to risk factors, procedure complexity, and effectiveness. In children, the predominant pacing mode was a single chamber ventricular system and lead dysfunction was the main indication for lead extraction. The mean implant duration before TLE was longer in children (P=0.03), but the dwell time of the oldest extracted lead did not differ significantly between adults and children. The duration (P=0.006) and mean extraction time per lead (P<0.001) were longer in children, with more technical difficulties during TLE in the pediatric group (P<0.001). Major complications were more common, albeit not significantly, in children. Complete radiographic and procedural success were significantly lower in children (P<0.001). CONCLUSIONS TLE in children is frequently more complex, time consuming, and arduous, and procedural success is more often lower. This is related to the formation of strong fibrous tissue surrounding the leads in pediatric patients.
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Affiliation(s)
| | | | | | - Mariusz Birbach
- Department of Cardiac Surgery, The Children's Memorial Health Institute
| | - Wojciech Lipiński
- Department of Cardiac Surgery, The Children's Memorial Health Institute
| | | | - Wojciech Jacheć
- Second Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Jan Kochanowski University, Institute of Medical Sciences
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital
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11
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Giudice M, Catuzzo B, Berlier N, Lau EW, Bonnemeier H, Assadian O, Baldauf B, Borov S, Scacciatella P. Use of Taurolidine in a Patient With a Cardiac Implantable Electronic Device Protrusion. JACC Case Rep 2023; 14:101835. [PMID: 37152697 PMCID: PMC10157148 DOI: 10.1016/j.jaccas.2023.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 05/09/2023]
Abstract
We report the successful salvage of cardiac implantable electronic device pulse generator protrusion sealed by the surrounding skin in a frail patient presenting 5 months after the last surgical revision. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Marcello Giudice
- Department for Cardiology and Electrophysiology, U. Parini Hospital, Aosta, Italy
| | - Bruna Catuzzo
- Department for Cardiology and Electrophysiology, U. Parini Hospital, Aosta, Italy
| | - Nicola Berlier
- Department for Cardiology and Electrophysiology, U. Parini Hospital, Aosta, Italy
| | | | - Hendrik Bonnemeier
- Helios Klinikum Cuxhaven, Cuxhaven, Germany
- Helios Klinikum Wesermarsch, Nordenham, Germany
- Christian-Albrechts University, Kiel, Germany
| | - Ojan Assadian
- Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Benito Baldauf
- Christian-Albrechts University, Kiel, Germany
- Address for correspondence: Dr Benito Baldauf, Medical faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany.
| | - Stefan Borov
- Christian-Albrechts University, Kiel, Germany
- Lakumed Kliniken, Landshut, Germany
| | - Paolo Scacciatella
- Department for Cardiology and Electrophysiology, U. Parini Hospital, Aosta, Italy
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12
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Tułecki Ł, Jacheć W, Polewczyk A, Czajkowski M, Targońska S, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. Assessment of the impact of organisational model of transvenous lead extraction on the effectiveness and safety of procedure: an observational study. BMJ Open 2022; 12:e062952. [PMID: 36581437 PMCID: PMC9806044 DOI: 10.1136/bmjopen-2022-062952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the impact of the organisational model of transvenous lead extraction (TLE) on effectiveness and safety of procedures. DESIGN Post hoc analysis of patient data entered prospectively into a computer database. SETTING Data of all patients undergoing TLE in three centres in Poland between 2006 and 2021 were analysed. PARTICIPANTS 3462 patients including: 985 patients undergoing TLE in a hybrid room (HR), with cardiac surgeon (CS) as co-operator, under general anaesthesia (GA), with arterial line (AL) and with transoesophageal echocardiography (TEE) monitoring (group 1), 68 patients-TLE in HR with CS, under GA, without TEE (group 2), 406 patients-TLE in operating theatre (OT) using 'arm-C' X-ray machine with CS under GA and with TEE (group 3), 154 patients-TLE in OT with CS under GA, without TEE (group 4), 113 patients-TLE in OT with anaesthesia team, using the 'arm-C' X-ray machine, without CS (group 5), 122 patients-TLE in electrophysiology lab (EPL), with CS under intravenous analgesia without TEE and AL (group 6), 1614 patients-TLE in EPL, without CS, under intravenous analgesia without TEE and AL (group 7). KEY OUTCOME MEASURE Effectiveness and safety of TLE depending on organisational model. RESULTS The rate of major complications (MC) was higher in OT/HR than in EPL (2.66% vs 1.38%), but all MCs were treated successfully and there was no MC-related death. The use of TEE during TLE increased probability of complete procedural succemss achieving about 1.5 times (OR=1.482; p<0.034) and were connected with reduction of minor complications occurrence (OR=0.751; p=0.046). CONCLUSIONS The most important condition to avoid death due to MC is close co-operation with cardiac surgery team, which permits for urgent rescue cardiac surgery. Continuous TEE monitoring plays predominant role in immediate decision on rescue sternotomy and improves the effectiveness of procedure.
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Affiliation(s)
- Łukasz Tułecki
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Wojciech Jacheć
- Cardiology, Faculty of Medical Science, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Physiology, Patophysiology and Clinical Immunology, Jan Kochanowski University of Kielce Collegium Medicum, Kielce, Poland
- Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | | | | | - Konrad Tomków
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Kamil Karpeta
- Cardiac Surgery, Masovian Specialistic Hospital, Radom, Poland
| | - Dorota Nowosielecka
- Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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13
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Kutarski A, Jacheć W, Tułecki Ł, Czajkowski M, Nowosielecka D, Stefańczyk P, Tomków K, Polewczyk A. Disparities in transvenous lead extraction in young adults. Sci Rep 2022; 12:9601. [PMID: 35689031 PMCID: PMC9187694 DOI: 10.1038/s41598-022-13769-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
Adults with cardiac implantable electronic devices (CIEDs) implanted at an early age constitute a specific group of patients undergoing transvenous lead extraction (TLE). The aim of this study is to assess safety and effectiveness of TLE in young adults. A comparative analysis of two groups of patients undergoing transvenous lead extraction was performed: 126 adults who were 19–29 years old at their first CIED implantation (early adulthood) and 2659 adults who were > 40 years of age at first CIED implantation and < 80 years of age at the time of TLE (middle-age/older adulthood). CIED-dependent risk factors were more common in young adults, especially longer implant duration (169.7 vs. 94.0 months). Moreover younger age of patients at first implantation, regardless of the dwell lead time, is a factor contributing to the greater development of connective tissue proliferation on the leads (OR 2.587; p < 0.001) and adhesions of the leads with the heart structures (OR 3.322; p < 0.001), which translates into worse TLE results in this group of patients. The complexity of procedures and major complications were more common in younger group (7.1 vs. 2.0%; p < 0.001), including hemopericardium (4.8 vs 1.3; p = 0.006) and TLE-induced tricuspid valve damage (3.2 vs.0.3%; p < 0.001). Among middle-aged/older adults, there were 7 periprocedural deaths: 6 related to the TLE procedure and one associated with indications for lead removal. No fatal complications of TLE were reported in young adults despite the above-mentioned differences (periprocedural mortality rate was comparable in study groups 0.3% vs 0.0%; p = 0.739). Predictors of TLE-associated major complications and procedure complexity were more likely in young adults compared with patients aged > 40 to < 80 years. In younger aged patients prolonged extraction duration and higher procedure complexity were combined with a greater need for second line tools. Both major and minor complications were more frequent in young adults, with hemopericardium and tricuspid valve damage being predominant.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Marek Czajkowski
- Department. of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland. .,Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Grunwaldzka Str. 45, 25-726, Kielce, Poland.
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14
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Racine HP, Jacques F, Philippon F. The effect of centre volume and procedure location on major complications and mortality from transvenous lead extraction: an ESC EHRA EORP European Lead Extraction ConTRolled ELECTRa registry subanalysis. Europace 2021; 23:1149. [PMID: 33718946 DOI: 10.1093/europace/euab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hugo-Pierre Racine
- Electrophysiology Division, Lead Extraction Program, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725 Chemin Ste-Foy, Quebec G1V 4G5, Canada
| | - Frédéric Jacques
- Cardiac surgery Division, Lead Extraction Program, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725 Chemin Ste-Foy, Quebec G1V 4G5, Canada
| | - François Philippon
- Electrophysiology Division, Lead Extraction Program, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725 Chemin Ste-Foy, Quebec G1V 4G5, Canada
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15
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Sidhu BS, Sieniewicz B, Gould J, Elliott MK, Mehta VS, Betts TR, James S, Turley AJ, Butter C, Seifert M, Boersma LVA, Riahi S, Neuzil P, Biffi M, Diemberger I, Vergara P, Arnold M, Keane DT, Defaye P, Deharo JC, Chow A, Schilling R, Behar JM, Leclercq C, Auricchio A, Niederer SA, Rinaldi CA. Leadless left ventricular endocardial pacing for CRT upgrades in previously failed and high-risk patients in comparison with coronary sinus CRT upgrades. Europace 2021; 23:1577-1585. [PMID: 34322707 PMCID: PMC8502498 DOI: 10.1093/europace/euab156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) upgrades may be less likely to improve following intervention. Leadless left ventricular (LV) endocardial pacing has been used for patients with previously failed CRT or high-risk upgrades. We compared procedural and long-term outcomes in patients undergoing coronary sinus (CS) CRT upgrades with high-risk and previously failed CRT upgrades undergoing LV endocardial upgrades. METHOD AND RESULTS Prospective consecutive CS upgrades between 2015 and 2019 were compared with those undergoing WiSE-CRT implantation. Cardiac resynchronization therapy response at 6 months was defined as improvement in clinical composite score (CCS) and a reduction in LV end-systolic volume (LVESV) ≥15%. A total of 225 patients were analysed; 121 CS and 104 endocardial upgrades. Patients receiving WiSE-CRT tended to have more comorbidities and were more likely to have previous cardiac surgery (30.9% vs. 16.5%; P = 0.012), hypertension (59.2% vs. 34.7%; P < 0.001), chronic obstructive airways disease (19.4% vs. 9.9%; P = 0.046), and chronic kidney disease (46.4% vs. 21.5%; P < 0.01) but similar LV ejection fraction (30.0 ± 8.3% vs. 29.5 ± 8.6%; P = 0.678). WiSE-CRT upgrades were successful in 97.1% with procedure-related mortality in 1.9%. Coronary sinus upgrades were successful in 97.5% of cases with a 2.5% rate of CS dissection and 5.6% lead malfunction/displacement. At 6 months, 91 WiSE-CRT upgrades and 107 CS upgrades had similar improvements in CCS (76.3% vs. 68.5%; P = 0.210) and reduction in LVESV ≥15% (54.2% vs. 56.3%; P = 0.835). CONCLUSION Despite prior failed upgrades and high-risk patients with more comorbidities, WiSE-CRT upgrades had high rates of procedural success and similar improvements in CCS and LV remodelling with CS upgrades.
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Affiliation(s)
- Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simon James
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Andrew J Turley
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Christian Butter
- Immanuel Heart Center Bernau & Brandenburg Medical School Theodor Fontane, Germany
| | - Martin Seifert
- Immanuel Heart Center Bernau & Brandenburg Medical School Theodor Fontane, Germany
| | - Lucas V A Boersma
- St. Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands/AUMC, Amsterdam, Netherlands
| | - Sam Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | | | - Mauro Biffi
- IRCCS Policlinico S'Or 25 sola-Malpighi, Bologna, Italy
| | | | | | - Martin Arnold
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany
| | | | | | | | - Anthony Chow
- St. Bartholomew's Hospital, London, United Kingdom
| | | | | | | | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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16
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Diaz JC, Romero J, Costa R, Cuesta A, Biase LD, Alviz I, Velasco A, Gabr M, Duque M, Marin JE, Aristizabal J, Velasquez J, Niño CD, Mazzetti H. Current practice in transvenous lead extraction in Latin America: Latin American Heart Rhythm Association survey. J Cardiovasc Electrophysiol 2021; 32:2715-2721. [PMID: 34288220 DOI: 10.1111/jce.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead-related complications. Currently, objective data on TLE in Latin America is lacking. OBJECTIVE To describe the current practice standards in Latin American centers performing TLE. METHODS An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. RESULTS A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty-nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. CONCLUSION This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.
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Affiliation(s)
| | - Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alejandro Cuesta
- Facultad de Medicina, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Luigi D Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Jorge E Marin
- Hospital Universitario San Vicente Fundación, Rionegro, Colombia
| | | | | | | | - Hector Mazzetti
- Sanatorio de La Trinidad de San Isidro, Buenos Aires, Argentina
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17
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Niederer SA, Sacks MS, Girolami M, Willcox K. Scaling digital twins from the artisanal to the industrial. NATURE COMPUTATIONAL SCIENCE 2021; 1:313-320. [PMID: 38217216 DOI: 10.1038/s43588-021-00072-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/20/2021] [Indexed: 01/15/2024]
Abstract
Mathematical modeling and simulation are moving from being powerful development and analysis tools towards having increased roles in operational monitoring, control and decision support, in which models of specific entities are continually updated in the form of a digital twin. However, current digital twins are largely the result of bespoke technical solutions that are difficult to scale. We discuss two exemplar applications that motivate challenges and opportunities for scaling digital twins, and that underscore potential barriers to wider adoption of this technology.
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Affiliation(s)
- Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Michael S Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Mark Girolami
- Department of Engineering, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - Karen Willcox
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, USA
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18
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Sidhu BS, Ayis S, Gould J, Elliott MK, Mehta V, Kennergren C, Butter C, Deharo JC, Kutarski A, Maggioni AP, Auricchio A, Kuck KH, Blomström-Lundqvist C, Bongiorni MG, Rinaldi CA. Risk stratification of patients undergoing transvenous lead extraction with the ELECTRa Registry Outcome Score (EROS): an ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry analysis. Europace 2021; 23:1462-1471. [PMID: 33615342 DOI: 10.1093/europace/euab037] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Transvenous lead extraction is associated with a significant risk of complications and identifying patients at highest risk pre-procedurally will enable interventions to be planned accordingly. We developed the ELECTRa Registry Outcome Score (EROS) and applied it to the ELECTRa registry to determine if it could appropriately risk-stratify patients. METHODS AND RESULTS EROS was devised to risk-stratify patients into low risk (EROS 1), intermediate risk (EROS 2), and high risk (EROS 3). This was applied to the ESC EORP European Lead Extraction ConTRolled ELECTRa registry; 57.5% EROS 1, 31.8% EROS 2, and 10.7% EROS 3. Patients with EROS 3 or 2 were significantly more likely to require powered sheaths and a femoral approach to complete procedures. Patients with EROS 3 were more likely to suffer procedure-related major complications including deaths (5.1 vs. 1.3%; P < 0.0001), both intra-procedural (3.5 vs. 0.8%; P = 0.0001) and post-procedural (1.6 vs. 0.5%; P = 0.0192). They were more likely to suffer post-procedural deaths (0.8 vs. 0.2%; P 0.0449), cardiac avulsion or tear (3.8 vs. 0.5%; P < 0.0001), and cardiovascular lesions requiring pericardiocentesis, chest tube, or surgical repair (4.6 vs. 1.0%; P < 0.0001). EROS 3 was associated with procedure-related major complications including deaths [odds ratio (OR) 3.333, 95% confidence interval (CI) 1.879-5.914; P < 0.0001] and all-cause in-hospital major complications including deaths (OR 2.339, 95% CI 1.439-3.803; P = 0.0006). CONCLUSION EROS successfully identified patients who were at increased risk of significant procedural complications that require urgent surgical intervention.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, 41345 Goteborg, Sweden
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, 16321 Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego Street Nr 8, 20-090 Lublin, Poland
| | - Aldo P Maggioni
- European Society of Cardiology, EORP, 2035 route des Colles, Biot, Sophia Antipolis, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstraße 5, D-20099 Hamburg, Germany
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
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