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Milman A, Wieder-Finesod A, Zahavi G, Meitus A, Kariv S, Shafir Y, Beinart R, Rahav G, Nof E. Complicated Pocket Infection in Patients Undergoing Lead Extraction: Characteristics and Outcomes. J Clin Med 2023; 12:4397. [PMID: 37445433 DOI: 10.3390/jcm12134397] [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: 05/16/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiac implantable electronic device (CIED) infection can present with pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. Here, we aim to characterize those presenting with both pocket and systemic infection. A retrospective analysis of CIED extraction procedures included 300 patients divided into isolated pocket (n = 104, 34.7%), complicated pocket (n = 54, 18%), and systemic infection (n = 142, 47.3%) groups. The systemic and complicated pocket groups frequently presented with leukocytosis and fever > 37.8, as opposed to the isolated pocket group. Staphylococcus aureus was the most common pathogen in the systemic and complicated pocket groups (43.7% and 31.5%, respectively), while Coagulase-negative staphylococci (CONS) predominated (31.7%) in the isolated pocket group (10.6%, p < 0.001). No differences were observed in procedural success or complications rates. Kaplan-Meier survival analysis found that at three years of follow-up, the rate of all-cause mortality was significantly higher among patients with systemic infection compared to both pocket groups (p < 0.001), with the curves diverging at thirty days. In this study, we characterize a new entity of complicated pocket infection. Despite the systemic pattern of infection, their prognosis is similar to isolated pocket infection. We suggest that this special category be presented separately in future publications of CIED infections.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Anat Wieder-Finesod
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 5262000, Israel
| | - Guy Zahavi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Anesthesiology and Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Amit Meitus
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Saar Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yuval Shafir
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Galia Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 5262000, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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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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3
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Courtney AM, Chandler JK, Anderson J, Shrestha A, Noheria A, Pimentel R, Dendi R, Ramirez R, Reddy YM, Sheldon SH. UltraSound Axillary Vein Access (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation. Pacing Clin Electrophysiol 2022; 45:1364-1371. [PMID: 36270271 DOI: 10.1111/pace.14611] [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: 04/15/2022] [Revised: 09/13/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. OBJECTIVE We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). METHODS Single-center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30-day complication rates. RESULTS The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2 ). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2-15.3 min vs. 5.2 IQR 3.4-8.6 min, p = .009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0-21.0 min to 8.6 IQR 4.5-10.8 min, p = .038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3-4.7 min vs. 5.2 IQR 3.4-8.6 min, p = .15). Venograms were less common with USAA than conventional access (2% vs. 33%, p < .0001). The 30-day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p = .44). CONCLUSION Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration.
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Affiliation(s)
- Alex M Courtney
- School of Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Jonathan K Chandler
- Department of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - John Anderson
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Shrestha
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rigoberto Ramirez
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Y Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Zheng W, Ze F, Yang D, Li D, Zhou X, Yuan C, Li X. Long-term outcomes of non-systematic device reimplantation following lead extraction in selected patients. MEDICINE INTERNATIONAL 2021; 1:11. [PMID: 36698430 PMCID: PMC9829079 DOI: 10.3892/mi.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023]
Abstract
Following the removal of cardiovascular implantable electronic devices (CIEDs), reassessment of the need for a new device is vital. Some patients may have exhibited an improvement in rhythm or cardiac function and may thus no longer meet the guideline requirements for reimplantation. However, the long-term outcomes of non-systematic device reimplantation remain unknown. In the present study, it was hypothesized that the implantation of pacing systems in selected patients following lead extraction is safe. In order to confirm this hypothesis, a total of 854 patients (aged between 28 and 82 years) who underwent the removal of a CIED were enrolled in the present study and they were all reassessed to determine whether a new device following lead extraction was necessary. In order to determine which patients would undergo non-systematic device reimplantation, the standard guidelines, the criteria and the wishes of the patient were all taken into consideration. Patients remained device-free unless an adverse clinical event occurred that required reimplantation. The primary study endpoint was the rate of sudden death or reimplantation. Between January, 2014 and December, 2019, 854 consecutive patients underwent pacing system extraction, of whom 210 patients (24.6%) underwent non-systematic device reimplantation following careful reassessment (the non-reimplantation group). Among the 210 patients, 162 (77.1%) were fitted with pacemakers, 26 (12.4%) underwent cardiac resynchronization therapy or cardiac resynchronization therapy-defibrillator and 22 (10.5%) were implanted with a cardioverter-defibrillator. During a mean follow-up period of 40.4 months, 86 patients reached the primary endpoint of the study, including 54 out of 210 patients (25.7%) who experienced an adverse clinical event that required reimplantation and 32 out of 210 patients (15.2%) who experienced sudden death. Reimplantation of a new device was not required in ~25% of the patients. On the whole, the present study demonstrates that following pacing system removal, non-systematic device reimplantation associated with close surveillance is safe for selected patients.
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Affiliation(s)
- Wencheng Zheng
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China,Fourth Department of Cardiovascular, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China,Correspondence to: Dr Feng Ze, Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, 11 Xizhimen South Street, Xicheng, Beijing 100044, P.R. China
| | - Dandan Yang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Ding Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Xu Zhou
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Cuizhen Yuan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Xuebin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
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5
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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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Morita J, Yamaji K, Nagashima M, Kondo Y, Sadohara Y, Hirokami J, Kuji R, Korai K, Fukunaga M, Hiroshima K, Ando K, Goya M. Predictors of lead break during transvenous lead extraction. J Arrhythm 2021; 37:645-652. [PMID: 34141017 PMCID: PMC8207345 DOI: 10.1002/joa3.12524] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. METHODS We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. RESULTS A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07-1.17; P < .001), passive leads (OR 2.29 95% CI 1.09-4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72-6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03-5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade. CONCLUSIONS Lead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.
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Affiliation(s)
- Junji Morita
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kyohei Yamaji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | | | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Yohei Sadohara
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Jun Hirokami
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Rei Kuji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kengo Korai
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Masato Fukunaga
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | | | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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7
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Chandler JK, Apte N, Ranka S, Mohammed M, Noheria A, Emert M, Pimentel R, Dendi R, Reddy M, Sheldon SH. Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation. J Cardiovasc Electrophysiol 2021; 32:458-465. [PMID: 33337570 DOI: 10.1111/jce.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized. METHODS AND RESULTS This is a retrospective, age and sex-matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m2 , 15% right-sided, 43% implantable cardioverter-defibrillator, 15% upgrades). UGAVA was successful in 178/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38 ± 6 vs. 28 ± 6 kg/m2 , p < .0001). Median time from local anesthetic to completion of UGAVA was 7 min (interquartile range [IQR]: 4-10) and median procedure time 61 min (IQR: 50-92). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6 min; IQR: 2-5 vs. 4-9; p < .001). Thirty-day complications were similar in UGAVA versus conventional (n = 7 vs. 26, 4 vs. 7%; p = .13, p = .41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (n = 0 vs. 3, 0 vs. 1%; p = .22). CONCLUSIONS UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.
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Affiliation(s)
- Jonathan K Chandler
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Nachiket Apte
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Martin Emert
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Nof E, Bongiorni MG, Auricchio A, Butter C, Dagres N, Deharo JC, Rinaldi CA, Maggioni AP, Kutarski A, Kennergren C, Laroche C, Milman A, Beinart R, Bogdan S, Mortsell D, Calvi V, Desiron Q, Mansourati J, Blomstrom Lundqvist C, Glikson M. Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal: an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry. Europace 2020; 21:1876-1889. [PMID: 31625553 DOI: 10.1093/europace/euz269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/13/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved. METHODS AND RESULTS ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046]. CONCLUSION A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
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Affiliation(s)
- Eyal Nof
- Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Bernau, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Aldo P Maggioni
- ANMCO Research Center, Florence, Italy.,EURObservational Research Programme, European Society of Cardiology, Biot, Sophia-Antipolis, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Charles Kennergren
- Sahlgrenska University Hospital, Cardiothoracic Surgery, Sahlgrenska/SU, Goteborg, Sweden
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Biot, Sophia-Antipolis, France
| | - Anat Milman
- Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stefan Bogdan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - David Mortsell
- Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Valeria Calvi
- Policlinico G. Rodolico, AZ.OU Policlinico-V. Emanuele, Catania, Italy
| | | | | | | | - Michael Glikson
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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9
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Claridge S, Johnson J, Sadnan G, Behar JM, Porter B, Sieniewicz B, Jackson T, Webb J, Gould J, Sohal M, Hamid S, Patel N, Gill J, Rinaldi CA. Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:155-160. [DOI: 10.1111/pace.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/23/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Simon Claridge
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jonathan Johnson
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Gazi Sadnan
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jonathan M. Behar
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Bradley Porter
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Benjamin Sieniewicz
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Tom Jackson
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jessica Webb
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Justin Gould
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Manav Sohal
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Shoaib Hamid
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Nik Patel
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Jaswinder Gill
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
| | - Christopher A. Rinaldi
- Department of Cardiology; Guy's and St Thomas’ Hospital Trust; London SE1 7EH UK
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London SE1 7EH UK
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Maytin M, Epstein LM. When You Have Nowhere to Look, You Look Where You Can. Circulation 2015; 132:2357-9. [PMID: 26534955 DOI: 10.1161/circulationaha.115.019563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Duque M, Díaz JC, Marín JE, Aristizábal JM, Velásquez JE, Duque L, Uribe W. Experiencia inicial con el retiro de electrodos de estimulación cardiaca mediante una técnica de extracción percutánea mecánica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Removal of an intracardiac lost port-A catheter utilizing a simple low-cost method. Int J Cardiol 2014; 176:1309-11. [DOI: 10.1016/j.ijcard.2014.07.156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/27/2014] [Indexed: 01/22/2023]
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13
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Bontempi L, Vassanelli F, Cerini M, D’Aloia A, Vizzardi E, Gargaro A, Chiusso F, Mamedouv R, Lipari A, Curnis A. Predicting the difficulty of a lead extraction procedure. J Cardiovasc Med (Hagerstown) 2014; 15:668-73. [DOI: 10.2459/jcm.0000000000000023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Calvagna GM, Patanè S. Transvenous pacemaker lead extraction in infective endocarditis. Int J Cardiol 2014; 176:511-3. [PMID: 25085380 DOI: 10.1016/j.ijcard.2014.07.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/05/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy
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15
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Di Monaco A, Pelargonio G, Narducci ML, Manzoli L, Boccia S, Flacco ME, Capasso L, Barone L, Perna F, Bencardino G, Rio T, Leo M, Di Biase L, Santangeli P, Natale A, Rebuzzi AG, Crea F. Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis. Europace 2014; 16:1496-507. [PMID: 24965015 DOI: 10.1093/europace/euu137] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. AIM Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. METHODS Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. RESULTS When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. CONCLUSIONS In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Stefania Boccia
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lucy Barone
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Teresa Rio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Milena Leo
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | - Pasquale Santangeli
- Department of Cardiology, University of Foggia, Foggia, Italy Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Antonio Giuseppe Rebuzzi
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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16
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Brinker J. Extraction of chronically implanted cardiovascular electronic device leads. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:325. [PMID: 24916463 DOI: 10.1007/s11936-014-0325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT Cardiovascular implantable electronic devices (CIED) are a remarkable success story. These systems are widely used to prevent symptomatic bradycardia, treat malignant tachyarrhythmia, and to restore a more physiologic contraction to a failing left ventricle. Implantation of a CIED usually involves a lifelong commitment to this therapy, which, unfortunately, is not free from complication requiring removal and/or replacement of all or part of the system. The major obstacle to removal of a CIED is the fibrous attachments that develop between a lead and co-existent leads, veins, and the heart. This process increases over time such that, by one year, removal by traction alone may be problematic and, if aggressive, result in complication. Physicians, surgeons, and engineers have refined techniques of percutaneous lead extraction and developed tools, which have facilitated the process, increased success, and lowered the incidence of complication. Extraction may be performed for a variety of indications some of which are unanimously agreed upon while others remain controversial. Proponents of a broadened application of extraction have proffered the concept of 'lead management,' which includes the removal of all leads that are not clinically relevant to the patient. The benefit of this approach would be to limit the risk of future complication, such as venous occlusion or thromboembolism, and to obviate the increase in difficulty of extraction (due to longer implant duration) that might accompany removal should that be required in the future. Intuitively appealing as this approach might be, there is little evidence supporting it, and the extraordinarily large number of patients currently implanted with recalled ICD leads is indicative of the potential impact this practice may have. This review will discuss extraction, its indications, and outcomes.
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Affiliation(s)
- Jeffrey Brinker
- Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, 7125Q, Baltimore, MD, 21287, USA,
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Forces applied during transvenous implantable cardioverter defibrillator lead removal. BIOMED RESEARCH INTERNATIONAL 2014; 2014:183483. [PMID: 24967337 PMCID: PMC4055293 DOI: 10.1155/2014/183483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/09/2014] [Accepted: 04/29/2014] [Indexed: 12/04/2022]
Abstract
Methods. 17 physicians, experienced in transvenous lead removal, performed a lead extraction manoeuvre of an ICD lead on a torso phantom. They were advised to stop traction only when further traction would be considered as harmful to the patient or when—based on their experience—a change in the extraction strategy was indicated. Traction forces were recorded with a digital precision gauge. Results. Median traction forces on the endocardium were 10.9 N (range from 3.0 N to 24.7 N and interquartile range from 7.9 to 15.3). Forces applied to the proximal end were estimated to be 10% higher than those measured at the tip of the lead due to a friction loss. Conclusion. A traction force of around 11 N is typically exerted during standard transvenous extraction of ICD leads. A traction threshold for a safe procedure derived from a pool of experienced extractionists may be helpful for the development of required adequate simulator trainings.
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