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Holzhauser L, Imamura T, Nayak HM, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Patel A, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation-An Underrecognized Problem. J Card Fail 2018; 24:101-108. [PMID: 29325797 PMCID: PMC5945281 DOI: 10.1016/j.cardfail.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. METHODS We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). RESULTS A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. CONCLUSION RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
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Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hemal M Nayak
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nitasha Sarswat
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sara Kalantari
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Onsager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
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Böhm A, Bányai F, Komáromy K, Pintér A, Préda I. Cerebral embolism due to a retained pacemaker lead: a case report. Pacing Clin Electrophysiol 1998; 21:629-30. [PMID: 9558700 DOI: 10.1111/j.1540-8159.1998.tb00111.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are only a few reported cases of a pacemaker lead migrating inadvertently into the left atrium or ventricle. An unusual complication of unremoved, unwanted pacemaker lead is presented. The free tip of the lead caused cerebral embolism after perforating the interatrial septum.
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Affiliation(s)
- A Böhm
- Cardiovascular Center, Imre Haynal University of Health Sciences, Budapest, Hungary
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Byrd CL, Schwartz SJ, Hedin N, Beach M. Intravascular techniques for extraction of permanent pacemaker leads. J Thorac Cardiovasc Surg 1991. [DOI: 10.1016/s0022-5223(19)36615-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nawa S, Kurozumi K, Shimizu A, Nakayama Y, Teramoto S, Dohi T, Henmi C. An unusual complication of a myocardial electrode--apatite mantle on the platinum-iridium spurs. Heart Vessels 1986; 2:242-5. [PMID: 3571108 DOI: 10.1007/bf02059976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of a high excitation threshold that occurred 2 years 5 months after the initial implantation of pacemaker electrodes is described in a girl 4 years 3 months of age. This complication was considered to be due to calcification of the platinum-iridium electrode spurs. The calcified material was shown to be a kind of apatite using the X-ray powder diffraction method. This complication is rare, but it must be kept in mind since battery longevity has markedly improved in recent years.
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Hubbell DS, Tyler GR, Zoble RG. Polyurethane sheath disintegration causing impaction of pacer lead and shock during attempted removal. Pacing Clin Electrophysiol 1986; 9:527-30. [PMID: 2426672 DOI: 10.1111/j.1540-8159.1986.tb06610.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Steady traction to remove a lead whose polyurethane sheath had disintegrated caused displacement of the heart and caused hypotension; the bared lead uncoiled and impacted in the wall of the subclavian vein. The tension on the intrathoracic lead was relieved via immediate anterior thoracotomy and compartmentalization of the superior vena cava.
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Abstract
The aim of this prospective study was to investigate the incidence of pulmonary embolism after pacemaker implantation, and to assess the benefits, if any, of postoperative prophylactic heparin therapy. Twenty of 40 patients were given low-dose heparin therapy; the remaining 20 patients were the control group and were not treated. Assignment to one of these groups was made alternately, in chronological order according to the time of implantation. Only tined leads with silicone insulation were used. All patients were mobilized on their first postoperative day. Pulmonary scintigraphy was performed before implantation, two weeks after implantation and again 12 months later. A pulmonary embolism was defined as evidence of new perfusion defects after implantation. There were no such defects in the group treated with heparin; the control group (20 patients) had three cases of perfusion defects within a 14-day postoperative period. Twelve months later, no further perfusion defects were observed in any patient. Thus, our study revealed a 15% incidence of asymptomatic pulmonary embolism following pacemaker implantation in patients not given prophylactic heparin therapy.
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Bastianon V, Menichelli A, Colloridi V, Caputo V, Tres J, Del Principe D. Ventricular thrombosis during permanent endocardial pacing in a pediatric patient with hemorrheological disorders. Pacing Clin Electrophysiol 1985; 8:164-9. [PMID: 2580275 DOI: 10.1111/j.1540-8159.1985.tb05745.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thrombosis in the right atrium or ventricle is a rare complication of permanent endocardial pacing in adults. To the best of our knowledge, this complication has not been previously reported at all in the pediatric age group. We report on a case of a 7-year-old boy who had large left ventricular thrombi that occurred during permanent endocardial electrical stimulation. Subsequent pulmonary emboli complicated congestive heart failure in this patient. As a diagnostic approach, echocardiography and pulmonary perfusion scintigraphy were used. We comment on possible causes of this serious complication and suggest hemorrheological and platelet activation studies in patients with permanent endocardial pacing.
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Byrd CL, Schwartz SJ, Sivina M, Yahr WZ, Greenberg JJ. Technique for the surgical extraction of permanent pacing leads and electrodes. J Thorac Cardiovasc Surg 1985. [DOI: 10.1016/s0022-5223(19)38860-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Probst P, Mühlberger V, Lederbauer M, Pachinger O, Kaliman J, Steinbach K. Electrophysiologic findings in carotid sinus massage. Pacing Clin Electrophysiol 1983; 6:689-96. [PMID: 6192401 DOI: 10.1111/j.1540-8159.1983.tb05327.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Thirty patients with carotid sinus syndrome were electrophysiologically studied. In 14 patients carotid sinus massage was performed during atrial and ventricular stimulation, and the conduction times were measured. The AH-time was prolonged by more than 120 ms in 6 patients (20%); the HV-time was prolonged in 6 patients by more than 55 ms (20%); 5 patients had bundle branch block (16.7%); The sinus node recovery time was prolonged in 7 out of 27 patients (26%). Ten patients (33%) did not have additional electrophysiologic abnormalities. There was a predominance of carotid sinus syndrome on the right side. During carotid sinus massage there was a significant increase of the AH-time, but there were no significant changes of the HV-time or the width of the QRS-complexes. Twenty-one patients developed an atrial asystole and 9 patients an atrial bradycardia and an additional AV-block. There was a longer AH-time and a longer prolongation of the AH-time in the patients who developed an AV-block. Twelve out of 14 patients (85.7%) developed an AV-block during carotid sinus massage and atrial pacing. During ventricular pacing 5 of 14 patients (35.7%) revealed a complete retrograde block before carotid sinus massage and 5 of the remaining 9 patients developed a total retrograde block during carotid sinus massage. Consequently, in 71.4% of the patients with carotid sinus syndrome complete retrograde conduction block and atrial asystole can be expected during attacks of ventricular asystole and simultaneous ventricular pacing. In conclusion, there is a high incidence of additional disturbances of the sinus node function and AV-conduction in patients with carotid sinus syndrome. AAI pacemakers are contraindicated due to the common development of additional AV-block during carotid sinus massage. Physiologic pacing might contribute to better hemodynamics, particularly in patients with the mixed type of carotid sinus syndrome.
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