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Murphy SP, Lew J, Yucel E, Singh J, Mela T. Cardiac implantable electronic device-induced tricuspid regurgitation: Implications and management. J Cardiovasc Electrophysiol 2024; 35:1017-1025. [PMID: 38501386 DOI: 10.1111/jce.16251] [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: 11/20/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead-induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing-induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre-existing TR have not been consistent predictors of CIED-induced TR. While two-dimensional echocardiography is helpful in assessing the severity of TR, three-dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three-dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED-induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important.
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Affiliation(s)
- Sean P Murphy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanney Lew
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evin Yucel
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jagmeet Singh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theofanie Mela
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Demoulas Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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2
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Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M, Cavalcante JL, de Potter T, Doenst T, Friedrichs K, Hausleiter J, Karam N, Kodali S, Latib A, Marijon E, Mittal S, Nickenig G, Rinaldi A, Rudzinski PN, Russo M, Starck C, von Bardeleben RS, Wunderlich N, Zamorano JL, Hahn RT, Maisano F, Leclercq C. Tricuspid valve disease and cardiac implantable electronic devices. Eur Heart J 2024; 45:346-365. [PMID: 38096587 PMCID: PMC10834167 DOI: 10.1093/eurheartj/ehad783] [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: 07/08/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Level 7C, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Departement, University Hospital of Geneva, Geneva, Switzerland
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Osama Soliman
- Discipline of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive, and University of Galway, Galway H91 YR71, Ireland
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Manuel Barreiro
- Cardiology Department, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - João L Cavalcante
- Cardiac MR and Structural CT lab, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rine Westphalia, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik I, Ludwig-Maximilians-University, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Paris Cité, Paris, France
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, NewYork, NY, USA
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Suneet Mittal
- Department of Cardiology, The Valley Health System, the Synder Comprehensive Center for Atrial Fibrillation, Ridgewood, NJ, USA
| | - Georg Nickenig
- Herzzentrum Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Aldo Rinaldi
- Department of Cardiology, Guy’s & St Thomas’ NHS Trust, London, UK
| | - Piotr Nikodem Rudzinski
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Universitätsmedizin Mainz of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Nina Wunderlich
- Department of Cardiology/Angiology, Asklepios Klinik Langen, Langen, Germany
| | - José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU Rennes, lTSI-UMR1099, Rennes F-35000, France
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3
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Chango-Azanza DX, Munin M, Sanchez G, Raggio I, Pelayo ME, Garro H, Arevalo M, Carbajales J, Makhoul S, Ronderos R. Insights of tricuspid regurgitation mechanisms in patients with right ventricular apical pacing by three-dimensional echocardiography. Echocardiography 2023; 40:903-915. [PMID: 37485601 DOI: 10.1111/echo.15651] [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: 02/26/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE Device lead-induced tricuspid regurgitation (LITR) mechanisms are well-defined by 3D transthoracic echocardiography (3D-TTE). There is a lack of data on the Latin-American population. The objective of this study was to describe the prevalence of several mechanisms and insights in patients with permanent right ventricular (RV) implanted devices by 3D-TTE examination. METHODS We performed a cross-sectional analysis of 101 patients with permanent cardiac devices such as pacemakers or defibrillators. 3D-TTE was obtained on all patients in RV-focused apical views to perform a complete tricuspid valve (TV) evaluation: leaflets, subvalvular apparatus, precise lead location, and functional assessment to evaluate possible mechanisms of tricuspid regurgitation (TR). RESULTS In a total of 101 patients, the leads did not interfere with TV function in 53 p. (59%), while LITR was observed in 38 (41%) patients. Adherent, impinging, entangled, and mixed lead-induced mechanisms were observed. Time in years since device implantation was significantly higher in patients with LITR. CONCLUSIONS LITR was present in a high proportion of our population. LITR is the result of damage to the TV as well as its subvalvular apparatus due to the fibrotic and inflammatory response over time when leads are situated in unfavorable locations.
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Affiliation(s)
- Diego Xavier Chango-Azanza
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
- Department of Cardiology, Ramos Mejia Hospital, Buenos Aires, Argentina
- Master Ultrasound in Cardiology, National University of La Plata, La Plata, Argentina
| | - Martin Munin
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
| | - Gustavo Sanchez
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
| | - Ignacio Raggio
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
| | - Maria Eugenia Pelayo
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
| | - Hugo Garro
- Department of Cardiology, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Mario Arevalo
- Department of Cardiology, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Justo Carbajales
- Department of Cardiology, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Silvia Makhoul
- Department of Echocardiography, Juan Fernandez Hospital, Buenos Aires, Argentina
| | - Ricardo Ronderos
- Department of Cardiovascular Ultrasound, CEMIC (Center for Medical Education and Clinical Research "Norberto Quirno"), Buenos Aires, Argentina
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Núñez Fernández MJ, Padín Paz EM, Vázquez Temprano N, Nieto Rodríguez JA, Marchena Yglesias PJ, Imbalzano E, Montenegro AC, Fernández Jiménez B, Rivera A, Espitia O, Monreal M. Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts. Vasc Med 2023; 28:324-330. [PMID: 37272085 DOI: 10.1177/1358863x231175185] [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] [Indexed: 06/06/2023]
Abstract
BACKGROUND The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.
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Affiliation(s)
- Manuel J Núñez Fernández
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Emilio M Padín Paz
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Nuria Vázquez Temprano
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - José A Nieto Rodríguez
- Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Castilla-La Mancha, Spain
| | - Pablo J Marchena Yglesias
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, A.O.U Policlinico 'G. Martino', Messina, Italy
| | - Ana Cristina Montenegro
- Department of Vascular Medicine, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Alberto Rivera
- Department of Internal Medicine, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Olivier Espitia
- Centre Hospitalier Universitaire de Nantes, Service de Médecine Interne, Nantes, Pays de la Loire, France
| | - Manuel Monreal
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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5
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Miguelena Hycka J, López Menéndez J, Martín García M, Muñoz Pérez R, Castro Pinto M, Torres Terreros CB, García Chumbiray PF, Rodriguez-Roda J. Electrodos no funcionantes ¿Extracción o abandono? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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6
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Gelves-Meza J, Lang RM, Valderrama-Achury MD, Zamorano JL, Vargas-Acevedo C, Medina HM, Salazar G. Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review. J Am Soc Echocardiogr 2022; 35:1107-1122. [PMID: 35964911 DOI: 10.1016/j.echo.2022.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation which in turn has an impact on morbidity and mortality. Echocardiography is necessary for grading of tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair/replacement in severe cases. This review aims to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation, the benefits of using 3D echocardiography with some technical considerations, and finally, propose a treatment algorithm.
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Affiliation(s)
- Julián Gelves-Meza
- Cardiologist, Echocardiography Laboratory, Fundación Cardioinfantil - Instituto de Cardiología. Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia.
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, Cardiac Imaging Center, the University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Catalina Vargas-Acevedo
- Pediatrician, Research Assistant, Institute of Congenital Heart Disease. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Hector Manuel Medina
- Cardiologist, Section Head, Cardiac Imaging. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Gabriel Salazar
- Cardiologist, Section Head, Echocardiography Laboratory. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
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7
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Wijesuriya N, Elliott MK, Mehta V, Behar JM, Niederer S, Wilkoff BL, Rinaldi CA. Transvenous lead extraction in conduction system pacing. Front Physiol 2022; 13:993604. [PMID: 36035491 PMCID: PMC9410714 DOI: 10.3389/fphys.2022.993604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Conduction System Pacing (CSP) delivered by His Bundle Pacing (HBP) or Left Bundle Pacing (LBP) are exciting novel interventions in the field of Cardiac Resynchronization Therapy (CRT). As the evidence base for CSP grows, the volume of implants worldwide is projected to rise significantly in the coming years. As such, physicians will be confronted with increasingly prevalent and vital issues arising in long-term follow up, including the management of infected, malfunctioning, or redundant CSP leads. Transvenous lead extraction (TLE) is the first-line option for removal of pacing leads when indicated in these circumstances. The evidence base for TLE in the context of CSP is still in its infancy. In this article, we first provide a brief overview of TLE. We then examine the data on the long-term performance of HBP leads. Next, we describe the features of the Medtronic Select Secure 3,830 lead, and how experience of TLE of this lead in the paediatric population has informed our practice. Finally, we review the current evidence for TLE in HBP and LBP, and discuss how future studies can address gaps in our current knowledge.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- *Correspondence: Nadeev Wijesuriya,
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bruce L Wilkoff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Deb Family Endowed Chair in Lead Management, Cleveland Clinic, Cleveland, OH, United States
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, United Kingdom
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8
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Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis. J Clin Med 2021; 11:jcm11010089. [PMID: 35011829 PMCID: PMC8745716 DOI: 10.3390/jcm11010089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. Methods: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008–2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. Results: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. Conclusions: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.
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9
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Duijzer D, de Winter MA, Nijkeuter M, Tuinenburg AE, Westerink J. Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:698336. [PMID: 34490367 PMCID: PMC8416492 DOI: 10.3389/fcvm.2021.698336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Aims: The presence of transvenous leads for cardiac device therapy may increase the risk of venous thromboembolisms. The epidemiology of these complications has not yet been determined systematically. Therefore, this study aims to determine (I) the incidence of symptomatic upper extremity deep vein thrombosis (UEDVT) and (II) the prevalence of asymptomatic upper extremity vein occlusion in patients with transvenous leads, both after the initial 2 months following lead implantation. Methods: PubMed, EMBASE, and Cochrane Library were searched until March 31, 2020 to identify studies reporting incidence of UEDVT and prevalence of asymptomatic vein occlusion after the initial 2 months after implantation in adult patients with transvenous leads. Incidence per 100 patient years of follow-up (PY) and proportions (%) were calculated to derive pooled estimates of incidence and prevalence. Results: Search and selection yielded 20 and 24 studies reporting on UEDVT and asymptomatic vein occlusion, respectively. The overall pooled incidence of UEDVT was 0.9 (95% CI 0.5–1.4) per 100PY after 2 months after lead implantation. High statistical heterogeneity was present among studies (I2 = 82.4%; P = < 0.001) and only three studies considered to be at low risk of bias. The overall pooled prevalence of asymptomatic upper extremity vein occlusion was 8.6% (95% CI 6.0–11.5) with high heterogeneity (I2 = 81.4%; P = <0.001). Meta-regression analysis showed more leads to be associated with a higher risk of UEDVT. Conclusion: Transvenous leads are an important risk factor for symptomatic UEDVT, which may occur up to multiple years after initial lead implantation. Existing data on UEDVT after lead implantation is mostly of poor quality, which emphasizes the need for high quality prospective research. Asymptomatic vein occlusion is present in a substantial proportion of patients and may complicate any future lead addition. Clinical Trial Registration: (URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178136, Identifier: PROSPERO 2020 CRD42020178136).
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Affiliation(s)
- Daniël Duijzer
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maria A de Winter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathilde Nijkeuter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
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10
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Tatum R, Maynes EJ, Wood CT, Deb AK, Austin MA, O'Malley TJ, Choi JH, Massey HT, Morris RJ, Pavri BB, Tchantchaleishvili V. Tricuspid regurgitation associated with implantable electrical device insertion: A systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1297-1302. [PMID: 34081789 DOI: 10.1111/pace.14287] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) lead placement may worsen or result in tricuspid regurgitation (TR). While the association between lead placement and the incidence of TR has been established, current understanding of this problem remains incomplete. This systematic review and meta-analysis sought to pool the existing evidence to better understand the occurrence and severity of TR associated with cardiac implantable electrical device (CIED) insertion. METHODS An electronic search was performed to identify all relevant studies published from 2000 to 2018. Overall, 15 studies were selected for the analysis comprising 4019 patients with data reported on TR development following ICD or PPM lead placement. Demographic information, perioperative clinical variables, and clinical outcome measures, including pre and postoperative echocardiographic TR grade changes, were extracted and pooled for systematic review. RESULTS Mean patient age was 69 years [95% CI: 64.62-73.59], and 63% [95% CI: 57-68] were male. Devices implanted included ICD in 57% [95%CI: 43-70] and PPM in 41% [95%CI: 31-52]. The most common indications for pacemaker implantation were sick sinus syndrome in 22% [95% CI: 22-37] and AV block in 21% [95%CI:12-34. The commonest indications for ICD implantation were primary and secondary prevention of sudden cardiac death. Atrial fibrillation was present in 37% [95%CI: 28-46] and congestive heart failure in 15% [95%CI: 2-57]. Baseline distribution of TR grades were as follows: grade 0/1 TR in 89% [95%CI: 82-93], grade 2 TR in 8% [95%CI: 5-13], grade 3 TR in 2% [95%CI: 0-7] and grade 4 TR in 2% [95%CI: 1-4]. Post-procedure, grade 0/ 1 TR decreased to 68% [95% CI: 51-81] (p < 0.01), grade 2 TR increased to 21% [15-28] (p < 0.01), grade 3 TR increased to 13% [95%CI: 5-32] (p = 0.02), and grade 4 TR increased to 7% [95%CI: 5-9] (p < 0.01). CONCLUSION ICD and PPM lead placement is associated with increased TR post-procedure. Further studies are warranted to evaluate changes in TR grade in the long term.
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Affiliation(s)
- Rob Tatum
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Chelsey T Wood
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Avijit K Deb
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Melissa A Austin
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Jae Hwan Choi
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Rohinton J Morris
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Behzad B Pavri
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
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11
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Margonato D, Ancona F, Ingallina G, Melillo F, Stella S, Biondi F, Boccellino A, Godino C, Margonato A, Agricola E. Tricuspid Regurgitation in Left Ventricular Systolic Dysfunction: Marker or Target? Front Cardiovasc Med 2021; 8:702589. [PMID: 34262955 PMCID: PMC8273168 DOI: 10.3389/fcvm.2021.702589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022] Open
Abstract
Far from being historically considered a primary healthcare problem, tricuspid regurgitation (TR) has recently gained much attention from the scientific community. In fact, in the last years, robust evidence has emerged regarding the epidemiological impact of TR, whose prevalence seems to be similar to that of other valvulopathies, such as aortic stenosis, with an estimated up to 4% of people >75 years affected by at least moderate TR in the United States, and up to 23% among patients suffering from heart failure with reduced ejection fraction. This recurrent coexistence of left ventricular systolic dysfunction (LVSD) and TR is not surprising, considered the multiple etiologies of tricuspid valve disease. TR can complicate heart failure mostly as a functional disease, because of pulmonary hypertension (PH), subsequent to elevated left ventricular end-diastolic pressure, leading to right ventricular dilatation, and valve tethering. Moreover, the so-called "functional isolated" TR can occur, in the absence of PH, as a result of right atrial dilatation associated with atrial fibrillation, a common finding in patients with LVSD. Finally, TR can result as a iatrogenic consequence of transvalvular lead insertion, another frequent scenario in this cohort of patients. Nonetheless, despite the significant coincidence of these two conditions, their mutual relation, and the independent prognostic role of TR is still a matter of debate. Whether significant TR is just a marker for advanced left-heart disease, or a crucial potential therapeutical target, remains unclear. Aim of the authors in this review is to present an update concerning the epidemiological features and the clinical burden of TR in the context of LVSD, its prognostic value, and the potential benefit for early tricuspid intervention in patients affected by contemporary TR and LVSD.
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Affiliation(s)
- Davide Margonato
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.,Cardiology Department, University of Pavia, Pavia, Italy
| | - Francesco Ancona
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Federico Biondi
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Boccellino
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Department of Clinical Cardiology, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Department of Clinical Cardiology, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Laboratory, Istituto di Ricerca a Cura e Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
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12
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Segreti L, Giannotti Santoro M, Di Cori A, Fiorentini F, Zucchelli G, Bernini G, De Lucia R, Viani S, Paperini L, Barletta V, Soldati E, Bongiorni MG. Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads. Europace 2021; 22:1401-1408. [PMID: 32681177 DOI: 10.1093/europace/euaa134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. METHODS AND RESULTS Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07-11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01-1.02; P < 0.001) were associated with a higher risk of clinical failure. CONCLUSION Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.
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Affiliation(s)
- Luca Segreti
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | | | - Andrea Di Cori
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulia Bernini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano Viani
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Luca Paperini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ezio Soldati
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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13
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Sinkar K, Bachani N, Bagchi A, Jadwani J, Panicker GK, Bansal R, Mahajan A, Lokhandwala Y. Is the right ventricular function affected by permanent pacemaker? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:929-935. [PMID: 33826174 DOI: 10.1111/pace.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
AIMS The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, but the effect on RV function per se has not been evaluated systematically. We aimed to assess the effect of dual chamber pacemaker on RV function. METHODS AND RESULTS All consecutive patients undergoing dual chamber pacemaker from January 2018 to March 2019 for AV block with a structurally normal heart were included. They underwent pre-procedure detailed echocardiography (including three-dimensional [3D] RV ejection fraction [RVEF]), a screening echocardiogram 2 days after pacemaker implantation and again a detailed echocardiogram at 6-month follow-up. We compared the baseline echocardiographic RV parameters with those 6 months after the pacemaker implantation. A total of 60 patients underwent successful pacemaker implantation. At 6 months, most of the patients were pacemaker dependent with pacing percentage of 98.9% ± 2.4%; there was a significant increase in TR and a mean drop in RVEF by 2.8 ± 5%, with 23 (38.3%) having at least a 5% decrease in RVEF. The drop in RVEF positively correlated with TR vena contracta at 6 months but did not correlate with pulmonary artery systolic pressure at 6 months. CONCLUSION Our study shows the presence of demonstrable RV dysfunction as early as 6 months in a majority of patients who have undergone pacemaker implantation.
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Affiliation(s)
- Kunal Sinkar
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Neeta Bachani
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Avishek Bagchi
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Jaipal Jadwani
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Gopi Krishna Panicker
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India.,Indian Institute of Management, Ahmedabad, Gujarat, India
| | - Raghav Bansal
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Ankit Mahajan
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Yash Lokhandwala
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
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14
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Niazi GZK, Masood A, Ahmed N, Qadir I, Akhtar A, Saleemi MS, Ahmed I. Permanent pacemaker implantation associated tricuspid regurgitation. Asian Cardiovasc Thorac Ann 2020; 29:191-194. [PMID: 33115258 DOI: 10.1177/0218492320971114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of tricuspid regurgitation in patients with dual-chamber permanent pacemaker implantation. METHODS This study included 153 patients undergoing permanent pacemaker implantation. All eligible candidates had baseline transthoracic echocardiography to rule out preexisting tricuspid regurgitation. Echocardiography across the tricuspid valve was repeated one month after permanent pacemaker implantation, and the frequency of significant tricuspid regurgitation was determined. The associations of potential effect modifiers (age, sex, height, body mass index categories, diabetes, and hypertension) with tricuspid regurgitation were assessed individually using simple and multivariable logistic regression models. RESULTS After dual-chamber permanent pacemaker implantation, significant tricuspid regurgitation was present in 22 (15.8%) patients. Tricuspid regurgitation was significantly associated with body mass index >30 kg·m-2 (odds ratio = 32.84, 95% confidence interval: 1.26-853.82, p = 0.04). CONCLUSION Significant tricuspid regurgitation was present in substantial number of patients after dual-chamber pacemaker implantation and was independently associated with body mass index >30 kg·m-2.
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Affiliation(s)
| | - Arslan Masood
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | - Nisar Ahmed
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | - Irfan Qadir
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | - Ammar Akhtar
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | | | - Ijaz Ahmed
- Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
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15
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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16
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Alqarawi W, Coppens J, Aldawood W, Ramirez FD, Redpath CJ, Nair GM, Nery PB, Davis DR, Abu Shama R, Aydin A, Klein A, Golian M, Schaller RD, Green MS, Birnie DH, Sadek MM. A Strategy of Lead Abandonment in a Large Cohort of Patients With Sprint Fidelis Leads. JACC Clin Electrophysiol 2019; 5:1059-1067. [DOI: 10.1016/j.jacep.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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17
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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18
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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Salazar G, Gelves J. Insuficiencia tricuspídea: técnicas ecocardiográficas para evaluar la valvulopatía olvidada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Sidhu BS, Gould J, Sieniewicz B, Porter B, Rinaldi CA. The role of transvenous lead extraction in the management of redundant or malfunctioning pacemaker and defibrillator leads post ELECTRa. Europace 2019; 20:1733-1740. [PMID: 29452360 DOI: 10.1093/europace/euy018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
Cardiac implantable electronic devices implantation rates have increased over the past decade due to broader indications and an ageing population. Similarly, device and lead complications have also risen. The management of pacemaker/defibrillator leads that are no longer required (redundant) or malfunctioning, can be contentious. There is a need to balance the risk of transvenous lead extraction (TLE) against those of lead abandonment. The recently published European Lead Extraction ConTRolled Registry (ELECTRa) study provides contemporary outcomes for TLE across Europe with important implications for the management of redundant and/or malfunctioning leads. This review article discusses the potential complications for each interventional approach when managing redundant or malfunctioning pacemaker leads.
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Affiliation(s)
- Baldeep S Sidhu
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Justin Gould
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Benjamin Sieniewicz
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Bradley Porter
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Christopher A Rinaldi
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
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22
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol 2019; 42:1006-1017. [DOI: 10.1111/pace.13715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Jacheć
- 2nd Department of CardiologyMedical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze Zabrze Poland
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences KielceThe Jan Kochanowski University Kielce Poland
- Swietokrzyskie Cardiology Center Kielce Poland
| | - Luca Segreti
- Department of CardiologyUniversity Hospital of Pisa Pisa Italy
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23
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Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:622-636. [DOI: 10.1016/j.jcmg.2018.09.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022]
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24
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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25
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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26
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Ebrille E, Chang JD, Zimetbaum PJ. Tricuspid Valve Dysfunction Caused by Right Ventricular Leads. Card Electrophysiol Clin 2018; 10:447-452. [PMID: 30172281 DOI: 10.1016/j.ccep.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tricuspid regurgitation is increasingly recognized as a clinically significant valvular condition. The role of multiple pacemaker and implantable cardiac defibrillator leads in distortion of the valve structure and the risk of trauma to the valve and subvalvular apparatus with lead extraction contribute to the development of tricuspid regurgitation (TR). There is a clinical imperative to better understand the optimal way to diagnose lead-related TR, risk factors for the development of TR, and optimal strategies to mitigate this problem.
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Affiliation(s)
- Elisa Ebrille
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - James D Chang
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - Peter J Zimetbaum
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA.
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27
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Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
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Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Saran N, Said SM, Schaff HV, Maltais S, Stulak JM, Greason KL, Daly RC, Pochettino A, King KS, Dearani JA. Outcome of tricuspid valve surgery in the presence of permanent pacemaker. J Thorac Cardiovasc Surg 2018; 155:1498-1508.e3. [DOI: 10.1016/j.jtcvs.2017.11.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/21/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
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Pacemaker-induced tricuspid regurgitation is uncommon immediately post-implantation. J Interv Card Electrophysiol 2017; 49:281-287. [DOI: 10.1007/s10840-017-0266-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
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Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol 2017; 69:2331-2341. [DOI: 10.1016/j.jacc.2017.02.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
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Keyser A, Brodoefel H, Schmid C. Long-Range Real Migration of Implantable Cardioverter Defibrillator Lead. Thorac Cardiovasc Surg Rep 2016; 5:62-64. [PMID: 28018829 PMCID: PMC5177438 DOI: 10.1055/s-0035-1566266] [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: 07/31/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
The need for pacemaker and implantable cardioverter defibrillator (ICD) lead revisions and extractions is steadily increasing. Despite the lack of representative studies, the risk of lead extraction is frequently considered to be lower than leaving nonfunctional leads in situ. We report the case of a patient who was referred to our institution for exchange of a malfunctioning ICD lead. The diagnostic work-up revealed a long-segment transmural migration of the ICD lead at the site of the subclavian and innominate vein. Due to the unpredictable risk of vein perforation, we abandoned the extraction procedure.
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Affiliation(s)
- Andreas Keyser
- Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Harald Brodoefel
- Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Hussein AA, Tarakji KG, Martin DO, Gadre A, Fraser T, Kim A, Brunner MP, Barakat AF, Saliba WI, Kanj M, Baranowski B, Cantillon D, Niebauer M, Callahan T, Dresing T, Lindsay BD, Gordon S, Wilkoff BL, Wazni OM. Cardiac Implantable Electronic Device Infections: Added Complexity and Suboptimal Outcomes With Previously Abandoned Leads. JACC Clin Electrophysiol 2016; 3:1-9. [PMID: 29759687 DOI: 10.1016/j.jacep.2016.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to assess the impact of previously abandoned leads on the clinical management of cardiac device infections, notably transvenous lead extraction and subsequent clinical course. BACKGROUND The population of patients with cardiac implantable electronic devices continues to grow with a disproportionate increase in device infections, which are invariably life threatening. A potentially complicating issue is the widely practiced strategy of device lead abandonment at the time of system revision, change, or upgrade, which is affecting an increasing number of patients. METHODS The study assessed the impact of previously abandoned leads in a prospectively maintained registry of consecutive patients undergoing percutaneous extraction of infected cardiac devices at the Cleveland Clinic between August 1996 and September 2012. The primary clinical endpoint was complete procedural and clinical success defined as the successful removal of the device and all lead material from the vascular space, in the absence of a major complication. RESULTS Of 1,386 patients with infected cardiac devices, 323 (23.3%) had previously abandoned leads. Failure to achieve the primary endpoint occurred more frequently in patients with abandoned leads (13.0% vs. 3.7%; p < 0.0001). This was primarily due to retention of lead material (11.5% vs. 2.9%; p < 0.0001), which was associated with poor clinical outcomes including higher rates of 1-month mortality (7.4% vs. 3.5% in those without lead remnants). Lead extraction procedures in patients with previously abandoned leads were longer (p < 0.0001), with longer fluoroscopy times (p < 0.0001), and more likely to require specialized extraction tools (94.4% vs. 81.8%; p < 0.0001) or adjunctive rescue femoral workstations (14.9% vs. 2.9%; p < 0.0001). Procedural complications occurred more frequently in patients with previously abandoned leads (11.5% vs. 5.6%; p = 0.0003), which was true for both major (3.7% vs. 1.4%; p = 0.009) and minor complications (7.7% vs. 4.4%; p = 0.02). CONCLUSIONS Previously abandoned leads complicate the management of cardiac device infections, leading to worse clinical outcomes.
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Affiliation(s)
- Ayman A Hussein
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - David O Martin
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Abhishek Gadre
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Fraser
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Alice Kim
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Brunner
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Amr F Barakat
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mark Niebauer
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Steven Gordon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
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Delling FN, Hassan ZK, Piatkowski G, Tsao CW, Rajabali A, Markson LJ, Zimetbaum PJ, Manning WJ, Chang JD, Mukamal KJ. Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads. Am J Cardiol 2016; 117:988-92. [PMID: 26833208 DOI: 10.1016/j.amjcard.2015.12.038] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022]
Abstract
Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies, or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥3+) among all echocardiograms performed from 2005 to 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular systolic/diastolic function, and pulmonary artery hypertension. We screened 93,592 echocardiograms (1,245 with PPM) in 58,556 individual patients (634 with PPM). The prevalence of STR was higher in patients after PPM placement (mean age 79 ± 3 years; 54% men) compared with those without a PPM (adjusted odds ratio 2.32; 95% confidence interval [CI] 1.54 to 3.49; p <0.0001). Among patients with a PPM lead, the presence of STR was associated with increased mortality (adjusted hazard ratio 1.40; 95% CI 1.04 to 2.11, p = 0.027, vs no STR). Compared with having neither a PPM lead nor STR, adjusted hazard ratios for death were 2.13 (95% CI 1.93 to 2.34) for STR but no PPM, 1.04 (0.89 to 1.22) for PPM without STR, and 1.55 (1.13 to 2.14) for PPM with STR. In conclusion, in a sample comprising >58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for left ventricular systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality.
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Affiliation(s)
- Francesca N Delling
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Zena K Hassan
- Cardiology Division, Department of Medicine, Washington Hospital Center and Georgetown University Medical Center, Washington, District of Columbia
| | - Gail Piatkowski
- Department of Decision Support, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Connie W Tsao
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alefiyah Rajabali
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence J Markson
- Department of Information Systems, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter J Zimetbaum
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James D Chang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Dokainish H, Elbarasi E, Masiero S, Van de Heyning C, Brambatti M, Ghazal S, Al-Maashani S, Capucci A, Buikema L, Leong D, Shivalkar B, Saenen J, Miljoen H, Morillo C, Divarakarmenon S, Amit G, Ribas S, Brautigam A, Baiocco E, Maolo A, Romandini A, Maffei S, Connolly S, Healey J. Prospective study of tricuspid valve regurgitation associated with permanent leads in patients undergoing cardiac rhythm device implantation: Background, rationale, and design. Glob Cardiol Sci Pract 2015; 2015:41. [PMID: 26779517 PMCID: PMC4633575 DOI: 10.5339/gcsp.2015.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/30/2015] [Indexed: 11/03/2022] Open
Abstract
Given the increasing numbers of cardiac device implantations worldwide, it is important to determine whether permanent endocardial leads across the tricuspid valve can promote tricuspid regurgitation (TR). Virtually all current data is retrospective, and indicates a signal of TR being increased after permanent lead implantation. However, the precise incidence of moderate or greater TR post-procedure, the exact mechanisms (mechanical, traumatic, functional), and the hemodynamic burden and clinical effects of this putative increase in TR, remain uncertain. We have therefore designed a multicenter, international, prospective study of 300 consecutive patients (recruitment completed, baseline data presented) who will undergo echocardiography and clinical assessment prior to, and at 1-year post device insertion. This prospective study will help determine whether cardiac device-associated TR is real, what are its potential mechanisms, and whether it has an important clinical impact on cardiac device patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Amit
- McMaster University, Hamilton, ON, Canada
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LEE REGINAC, FRIEDMAN SCOTTE, KONO ALANT, GREENBERG MARKL, PALAC ROBERTT. Tricuspid Regurgitation Following Implantation of Endocardial Leads: Incidence and Predictors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1267-74. [DOI: 10.1111/pace.12701] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/18/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022]
Affiliation(s)
- REGINA C. LEE
- Department of Cardiology; Georgetown Medical Center; Washington DC
| | - SCOTT E. FRIEDMAN
- Department of Cardiology; White River Junction VA; White River Vermont
- Department of Cardiology; Dartmouth Hitchcock Medical Center; Lebanon New Hampshire
| | - ALAN T. KONO
- Department of Cardiology; Dartmouth Hitchcock Medical Center; Lebanon New Hampshire
| | - MARK L. GREENBERG
- Department of Cardiology; White River Junction VA; White River Vermont
| | - ROBERT T. PALAC
- Department of Cardiology; Georgetown Medical Center; Washington DC
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37
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Trucco E, Mont L. Extraction of sterile leads is the preferred approach rather than implanting a new lead: the con perspective. Card Electrophysiol Clin 2015; 7:427-431. [PMID: 26304522 DOI: 10.1016/j.ccep.2015.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.
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Affiliation(s)
- Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain.
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Insuficiencia cardiaca derecha tras el implante de un marcapasos. Med Clin (Barc) 2015; 144:550-2. [DOI: 10.1016/j.medcli.2015.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
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Segreti L, Di Cori A, Zucchelli G, Soldati E, Coluccia G, Viani S, Paperini L, Bongiorni MG. A Questionable Indication For ICD Extraction After Successful VT Ablation. J Atr Fibrillation 2015; 7:1172. [PMID: 27957158 DOI: 10.4022/jafib.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD). In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. To date, no control data have been published on transvenous lead extraction in the setting of VT ablation. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.
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Affiliation(s)
- Luca Segreti
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Coluccia
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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Abstract
Defibrillator lead advisories stir a lot of emotions, both with patients and physicians, and this may influence lead management. We reviewed the literature for a more evidence-based approach to this issue. From the complications of two of the current advisory leads, the Medtronic Sprint Fidelis and St. Jude Riata leads, and the consequences of possible interventions, we can conclude that a restrained approach to premature replacement is appropriate. It may be opportune to replace the leads during a scheduled generator replacement in case of a higher electrical failure rate, in order to prevent future premature interventions. We found no support to extract non-functional advisory leads. In contrast, extraction is often more demanding than anticipated, and the risk substantially exceeds that of simply abandoning the leads.
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Noheria A, Ponamgi SP, Desimone CV, Vaidya VR, Aakre CA, Ebrille E, Hu T, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace 2015; 18:246-52. [PMID: 25767086 DOI: 10.1093/europace/euv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
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Affiliation(s)
- Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Christopher V Desimone
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Sadreddini M, Haroun MJ, Buikema L, Morillo C, Ribas S, Divakaramenon S, Connolly SJ, Nieuwlaat R, Lonn EM, Healey JS, Dokainish H. Tricuspid valve regurgitation following temporary or permanent endocardial lead insertion, and the impact of cardiac resynchronization therapy. Open Cardiovasc Med J 2014; 8:113-20. [PMID: 25674163 PMCID: PMC4321203 DOI: 10.2174/1874192401408010113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 11/25/2022] Open
Abstract
Background: While some studies indicate that permanent pacemaker implantation is associated with development of tricuspid regurgitation (TR), other studies indicate no association.Little is known about the impact of temporary lead insertion during ablation procedures, or whether therapy (CRT) prevents TR post-device implantation. Hypothesis: We hypothesized that permanent, but nottemporary endocardial leads, are associated with development of TR, and that CRT would prevent (physiologic) TR. Methods: We performed a retrospective study of consecutive patients who underwent first device or radiofrequency catheter ablation over a 12-month period at a single, tertiary academic center who underwent pre- and post-procedure echocardiography. Results: In the 89 patients in the device group, the degree of TR significantly increased ≥ 1 grade post-permanent lead implantation: 9 had less TR, 46 were unchanged, and 34 had more TR(p=0.005). TR increased in the 62 patients who underwent device implantation without CRT (p=0.005), but did not increase in the 27 patients with CRT (p=0.47). In the 66 patients in the ablation group, there was no significant change in TR post-ablation: 8 had less TR, 48 were unchanged, and 10 had more TR (p=0.31). Conclusion: Permanent endocardial lead implantation was associated with an increase in TR; however, patients who underwent device implantation with CRT did not have an increase in TR.Temporary lead insertion during ablation was not associated with changes in the degree of TR. A large, prospective study is needed to accurately define the incidence and exact mechanisms of permanent endocardial lead-related TR.
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Affiliation(s)
- Masoud Sadreddini
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle J Haroun
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisanne Buikema
- Department of Medicine, University of Groningen, The Netherlands
| | - Carlos Morillo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sebastian Ribas
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Stuart J Connolly
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Eva M Lonn
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hisham Dokainish
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Li X, Ze F, Wang L, Li D, Duan J, Guo F, Yuan C, Li Y, Guo J. Prevalence of venous occlusion in patients referred for lead extraction: implications for tool selection. Europace 2014; 16:1795-9. [PMID: 24948591 DOI: 10.1093/europace/euu124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Data concerning the incidence of venous obstruction in patients referred for lead extraction is limited. Thus, we aimed to assess the incidence of venous obstruction in patients referred for lead extraction and the implications for tool selection. METHODS AND RESULTS Contrast venography of the access vein was obtained in 202 patients (147 men; mean age, 62.4 ± 14.5 years) scheduled for lead extraction. The indication for lead extraction included infection (n = 145, 72%) and other causes (n = 57, 28%). Two patients with device infection had superior vena caval occlusion. Access vein occlusion occurred in 6 (11%) patients without infection vs. 46 (32%) patients with infection [P = 0.002; odds ratio (OR) 3.94; 95% confidence interval (CI) 1.58-9.87]. No significant differences between occluded and non-occluded patients were seen for age, sex, device type, number of leads, time from implant of the initial lead, or anticoagulation therapy (all P>0.05). Procedural duration and fluoroscopy exposure time were significantly lower in the open group than in the occluded group (P < 0.05). Patients with venous occlusion required more advanced tools for lead extraction, such as dilator sheaths, evolution sheaths, and needle's eye snares (P = 0.019). CONCLUSION Both systemic and local infections are associated with increased risk of access vein occlusion. We found no support for the hypothesis that venous occlusion increases with the number of leads present. Lead extraction was more difficult in patients with venous occlusion, requiring advanced tools and more time.
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Affiliation(s)
- Xuebin Li
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Long Wang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Ding Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Jiangbo Duan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Fei Guo
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China
| | - Cuizhen Yuan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Yuguang Li
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China
| | - Jihong Guo
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
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Ratschiller T, Guenther T, Knappich C, Guenzinger R, Kehl V, Voss B, Lange R. Do transvalvular pacemaker leads influence functional outcome after tricuspid ring annuloplasty? Eur J Cardiothorac Surg 2014; 48:363-9. [DOI: 10.1093/ejcts/ezu449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/28/2014] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas Ratschiller
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Thomas Guenther
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Christoph Knappich
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ralf Guenzinger
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
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AL-BAWARDY RASHA, KRISHNASWAMY AMAR, RAJESWARAN JEEVANANTHAM, BHARGAVA MANDEEP, WAZNI OUSSAMA, WILKOFF BRUCE, TUZCU EMINMURAT, MARTIN DAVID, THOMAS JAMES, BLACKSTONE EUGENE, KAPADIA SAMIR. Tricuspid Regurgitation and Implantable Devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:259-66. [DOI: 10.1111/pace.12530] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- RASHA AL-BAWARDY
- Department of Cardiovascular Medicine; Montefiore Medical Center/Albert Einstein College of Medicine; Bronx New York
| | - AMAR KRISHNASWAMY
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - JEEVANANTHAM RAJESWARAN
- Quantitative Health Sciences/Division of Clinical Investigations; Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland Ohio
| | - MANDEEP BHARGAVA
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - OUSSAMA WAZNI
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - BRUCE WILKOFF
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - EMIN MURAT TUZCU
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - DAVID MARTIN
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - JAMES THOMAS
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
| | - EUGENE BLACKSTONE
- Department of Thoracic and Cardiovascular Surgery; Cleveland Clinic Foundation; Cleveland Ohio
| | - SAMIR KAPADIA
- Department of Cardiovascular Medicine; Cleveland Clinic Foundation; Cleveland Ohio
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Vaidya VR, DeSimone CV, Asirvatham SJ, Chandra VM, Noheria A, Hodge DO, Slusser JP, Rabinstein AA, Friedman PA. Implanted endocardial lead characteristics and risk of stroke or transient ischemic attack. J Interv Card Electrophysiol 2014; 41:31-8. [PMID: 24771226 DOI: 10.1007/s10840-014-9900-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patent foramen ovale (PFO) has been recently implicated as a strong predictor of stroke or transient ischemic attack (TIA) in patients with implanted pacemaker or defibrillation leads. Leads in the right heart can form thrombi that embolize to the pulmonary circulation and raise pulmonary pressure. This increases right-to-left shunting through PFO or intrapulmonary shunts and can result in paradoxical embolism. We sought to determine whether certain lead characteristics confer a higher thrombogenic risk resulting in stroke/TIAs in patients either with or without a PFO. METHODS We retrospectively analyzed 5,646 patients (mean age 67.3 ± 16.3 years, 64 % male) who had endocardial device leads implanted in 2000-2010. We performed univariate and multivariate-adjusted proportional hazards models to determine association of lead characteristics with stroke/TIA during follow-up. RESULTS On univariate analysis, passively fixated tined leads were associated with more stroke/TIAs (HR 1.77, 95 % CI 1.27, 2.47; p<0.001), whereas presence of defibrillation coil was associated with fewer stroke/TIAs (HR 0.59, 95 % CI 0.42-0.84; p=0.003). Number of leads per patient, presence of atrial lead, maximum lead size, tip shape, and type of insulating material were not associated with stoke/TIA. On multivariate analyses adjusting for age, sex, diagnosis of PFO, and prior history of stroke/TIA, the presence of tined leads was associated with stroke/TIA (HR 1.41, 95 % CI 1.00-1.97; p=0.049). Defibrillation coils were no longer associated with lower stroke/TIA on multivariate analysis. CONCLUSIONS Most physical characteristics of contemporary leads do not impact rate of stroke/TIA among patients receiving implantable devices. The presence of a PFO is a major risk factor for stroke/TIA in patients with endovascular leads.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Diemberger I, Biffi M, Martignani C, Boriani G. From lead management to implanted patient management: indications to lead extraction in pacemaker and cardioverter–defibrillator systems. Expert Rev Med Devices 2014; 8:235-55. [PMID: 21381913 DOI: 10.1586/erd.10.80] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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48
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Al-Bawardy R, Krishnaswamy A, Bhargava M, Dunn J, Wazni O, Tuzcu EM, Stewart W, Kapadia SR. Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249-54. [PMID: 23529935 DOI: 10.1002/clc.22104] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/06/2013] [Indexed: 11/06/2022] Open
Abstract
Implantable cardiac devices, including defibrillators and pacemakers, may be the cause of tricuspid regurgitation (TR) or may worsen existing TR. This review of the literature suggests that TR usually occurs over time after lead implantation. Diagnosis by clinical exam and 2-dimensional echocardiography may be augmented by 3-dimensional echocardiography and/or computed tomography. The mechanism may be mechanical perforation or laceration of leaflets, scarring and restriction of leaflets, or asynchronized activation of the right ventricle. Pacemaker-related TR might cause severe right-sided heart failure, but data regarding associated mortality are lacking. This comprehensive review summarizes the data regarding incidence, mechanism, and treatment of lead-related TR.
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Affiliation(s)
- Rasha Al-Bawardy
- Department Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Effects of tricuspid valve regurgitation on clinical and echocardiographic outcome in patients with cardiac resynchronization therapy. Europace 2012; 15:266-72. [DOI: 10.1093/europace/eus286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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MANDAL SAROJ, PANDE ARINDAM, MANDAL DEBOSMITA, KUMAR ASUTOSH, SARKAR ACHYUT, KAHALI DHIMAN, MAZUMDAR BISWAKESH, PANJA MANOTOSH. Permanent Pacemaker-Related Upper Extremity Deep Vein Thrombosis: A Series of 20 Cases. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1194-8. [DOI: 10.1111/j.1540-8159.2012.03467.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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