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Iwakawa H, Suzuki T, Terata K, Watanabe H. Successful treatment of lead-related superior vena cava syndrome in combination with transvenous lead extraction and venous stenting. J Arrhythm 2023; 39:813-815. [PMID: 37799792 PMCID: PMC10549838 DOI: 10.1002/joa3.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
We experienced a case of lead-related SVC syndrome, which was successfully treated using unique transvenous lead extraction technique and endovascular stenting. This case also suggests that intravascular ultrasound facilitates decision-making on whether the interventionist should perform TLE alone or add stenting in case of a lead-related venous obstruction.
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Affiliation(s)
- Hidehiro Iwakawa
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Tomohito Suzuki
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Ken Terata
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Hiroyuki Watanabe
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
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Schenker N, Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Safety and Efficacy of Excimer Laser Powered Lead Extractions in Obese Patients: A GALLERY Subgroup Analysis. J Clin Med 2023; 12:4096. [PMID: 37373789 DOI: 10.3390/jcm12124096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood. METHODS AND RESULTS All patients (n = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5-24.9; 25-29.9; 30-34.9; ≥35 kg/m2). Patients with a BMI ≥ 35.0 kg/m2 had the highest prevalence of arterial hypertension (84.2%, p < 0.001), chronic kidney disease (36.8%, p = 0.020) and diabetes mellitus (51.1%, p < 0.001). The rates for procedural minor (p = 0.684) and major complications (p = 0.498), as well as procedural success (p = 0.437), procedure-related (p = 0.533) and all-cause mortality (p = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m2), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06-8.45; p = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31-8.10; p = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03-9.22; p = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08-0.93; p = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03-77.49; p < 0.001). CONCLUSIONS LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients.
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Affiliation(s)
- Niklas Schenker
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, 61231 Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, 47228 Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, 57072 Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, 22457 Hamburg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, 16321 Bernau, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
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Soontornmanokati N, Sirikhamkorn C, Methachittiphan N, Chintanavilas K, Apakuppakul S, Ngarmukos T, Apiyasawat S, Lohawijarn W, Chandanamattha P. Transvenous Lead Extraction (TLE) Procedure: Experience from a Tertiary Care Center in Thailand. Indian Pacing Electrophysiol J 2022; 22:123-128. [PMID: 35219811 PMCID: PMC9091722 DOI: 10.1016/j.ipej.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transvenous Lead Extraction (TLE) is a standard treatment for some late Cardiac Implantable Electronics Device (CIED) complications. The outcome of transvenous lead extraction procedure in Thailand is not robust. Methods A Single-center retrospective cohort of TLE procedures performed at Ramathibodi hospital between January 2008 and December 2020 was studied. Results There were 157 leads from 105 patients who underwent lead removal procedure during the specified period. Data analysis was performed from 79 TLE patients due to incomplete data and lead explant procedure of the excluded subjects. Mean patients’ age was 57.7 ± 18.7 years, with 70.9% male. There were 82 pacemaker leads, 35 ICD leads, and 5 CS leads (mean number of leads were 1.54 ± 0.66 per patient), with mean implanted duration of 87.8 ± 68.2 months. Main indication for TLE was infection-related, which accounted for 67.1% of the cases. Overall clinical success rate was 97.5%. Mean operative time was 163.8 ± 69.5 min. Major complications occurred in 4 patients (5.1%) with one in-hospital mortality from severe sepsis. Conclusion TLE using laser sheath and rotating mechanical sheath for transvenous lead extraction is effective and safe, even outside high-volume center.
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Affiliation(s)
- Natcha Soontornmanokati
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Chulaporn Sirikhamkorn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Nilubon Methachittiphan
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Kumpol Chintanavilas
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sanatcha Apakuppakul
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Tachapong Ngarmukos
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirin Apiyasawat
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wachara Lohawijarn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Pakorn Chandanamattha
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Shah B, Saidullah S, Aamer Niaz M, Zaman F, Parveen Z, Ghazanfar A, Mumtaz H. Strategies for the Long-Term Preservation of Site for Future Implantation of Cardiac Implantable Electronic Devices (CIEDs): Two Decades of Experience. Cureus 2022; 14:e22259. [PMID: 35350505 PMCID: PMC8933269 DOI: 10.7759/cureus.22259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/05/2022] Open
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Bencardino G, Ruscio E, Scacciavillani R. Powered sheaths for lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1769-1780. [PMID: 34486141 DOI: 10.1111/pace.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 11/27/2022]
Abstract
Transvenous lead extraction (TLE) has seen a rapid expansion in the past 20 years. The procedure has changed from early techniques involving simple manual traction that frequently proved themselves ineffective for chronically implanted leads, and carried significant periprocedural risks including death, to the availability of a wide range of more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. The reduction in morbidity and mortality associated with these new extraction techniques has widened indications to TLE from prevalent use in life-threatening situations, such as infection and sepsis, to a more widespread use even in noninfectious situations such as malfunctioning leads. Powered sheaths have been a remarkable step forward in this improvement in TLE procedures and recent registries at high-volume centers report high success rates with exceedingly low complication rates. This review is aimed at describing technical features of powered sheaths as well as reported performance during TLE procedures.
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Affiliation(s)
- Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Breeman KTN, du Long R, Beurskens NEG, van der Wal AC, Wilde AAM, Tjong FVY, Knops RE. Tissues attached to retrieved leadless pacemakers: Histopathological evaluation of tissue composition in relation to implantation time and complications. Heart Rhythm 2021; 18:2101-2109. [PMID: 34461305 DOI: 10.1016/j.hrthm.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Leadless pacemakers (LPs) have proven safe and effective, but device revisions remain necessary. Either replacing the LP or implanting a new adjacent LP is feasible. Replacement seems more appealing, but encapsulation and tissue adhesions may hamper the safety and efficacy of LP retrieval. OBJECTIVE We determined the incidence and cellular characteristics of tissue adherent to retrieved LPs and the potential implications for end-of-life strategy. METHODS All 15 consecutive successful Nanostim LP retrievals in a tertiary center were included. We assessed the histopathology of adherent tissue and obtained clinical characteristics. RESULTS Adherent tissue was present in 14 of 15 retrievals (93%; median implantation duration 36 months; range 0-96 months). The tissue consisted of fibrosis (n = 2), fibrosis and thrombus (n = 9), or thrombus only (n = 3). In short-term retrievals (<1 year), mostly fresh thrombi without fibrosis were seen. In later retrievals, the tissue consisted of fibrosis often with organizing or lytic thrombi. Fibrosis showed different stages of organization, notably early fibrocellular and later fibrosclerotic tissue. Inflammatory cells were seen (n = 4) without signs of infection. Tricuspid valve material was retrieved in 1 patient after 36 months, resulting in increased tricuspid regurgitation. CONCLUSION Our results suggest that fibrosis and thrombus adherent to LPs are common and encapsulate the LP as seen in transvenous pacemakers. LPs may adhere to the tricuspid valve or subvalvular apparatus affecting retrieval safety. The end-of-life strategy should be optimized by incorporating risk stratification for excessive fibrotic encapsulation and adhesions.
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Affiliation(s)
- Karel T N Breeman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Romy du Long
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niek E G Beurskens
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction. Cells 2021; 10:cells10071794. [PMID: 34359963 PMCID: PMC8304203 DOI: 10.3390/cells10071794] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Body implants and implantable medical devices have dramatically improved and prolonged the life of countless patients. However, our body repair mechanisms have evolved to isolate, reject, or destroy any object that is recognized as foreign to the organism and inevitably mounts a foreign body reaction (FBR). Depending on its severity and chronicity, the FBR can impair implant performance or create severe clinical complications that will require surgical removal and/or replacement of the faulty device. The number of review articles discussing the FBR seems to be proportional to the number of different implant materials and clinical applications and one wonders, what else is there to tell? We will here take the position of a fibrosis researcher (which, coincidentally, we are) to elaborate similarities and differences between the FBR, normal wound healing, and chronic healing conditions that result in the development of peri-implant fibrosis. After giving credit to macrophages in the inflammatory phase of the FBR, we will mainly focus on the activation of fibroblastic cells into matrix-producing and highly contractile myofibroblasts. While fibrosis has been discussed to be a consequence of the disturbed and chronic inflammatory milieu in the FBR, direct activation of myofibroblasts at the implant surface is less commonly considered. Thus, we will provide a perspective how physical properties of the implant surface control myofibroblast actions and accumulation of stiff scar tissue. Because formation of scar tissue at the surface and around implant materials is a major reason for device failure and extraction surgeries, providing implant surfaces with myofibroblast-suppressing features is a first step to enhance implant acceptance and functional lifetime. Alternative therapeutic targets are elements of the myofibroblast mechanotransduction and contractile machinery and we will end with a brief overview on such targets that are considered for the treatment of other organ fibroses.
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Archontakis S, Pirounaki M, Aznaouridis K, Karageorgopoulos D, Sideris K, Tolios P, Triantafyllou K, Gatzoulis K, Tousoulis D, Sideris S. Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications. J Cardiovasc Electrophysiol 2020; 32:491-499. [PMID: 33345428 DOI: 10.1111/jce.14841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection. METHODS AND RESULTS Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001). CONCLUSIONS Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.
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Affiliation(s)
| | - Maria Pirounaki
- Second Department of Medicine, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | | | | | - Panagiotis Tolios
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
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Keiler J, Schulze M, Dreger R, Springer A, Öner A, Wree A. Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients-A Post Mortem Study. Front Cardiovasc Med 2020; 7:602179. [PMID: 33330664 PMCID: PMC7734031 DOI: 10.3389/fcvm.2020.602179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1-2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Ronja Dreger
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Armin Springer
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
| | - Alper Öner
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Uslu A, Küp A, Kanar BG, Balaban I, Demir S, Gülşen K, Kepez A, Doğan C, Candan Ö, Akgün T, Altıntas B, Sadıc BO. Transvenous extraction of pacemaker leads via femoral approach using a gooseneck snare. Herz 2020; 46:82-88. [PMID: 33009623 DOI: 10.1007/s00059-020-04987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction (TLE) via simple manual traction (SMT) is the first-line therapy. When SMT is not successful, TLE from the femoral vein using a gooseneck snare (GS) with a radiofrequency ablation catheter (RFAC) may be an alternative option. The aim of our study was to evaluate the success rate of transvenous extraction of chronically implanted leads via the femoral approach using a GS with RFCA in cases of failure with SMT. METHODS The study included 94 consecutive patients who were referred for lead extraction due to pocket erosion and infection (71 patients) and to lead malfunction (23 patients). Initially, SMT was attempted for all patients. If SMT was not successful, patients underwent TLE using a GS with RFAC. RESULTS Leads were extracted successfully with SMT in 34 patients (54 leads), while 60 patients (83 leads) underwent TLE using a GS with RFAC. The mean indwelling time of the leads was longer in the femoral approach with GS (87.5 ± 37.9 vs. 31.3 ± 25.8 months; p < 0.001). The procedural success rate was 96.7% in the femoral approach with GS. A preceding implantation lead duration of >51 months predicted an unsuccessful SMT necessitating alternative TLE using a GS with RFAC with 86% sensitivity and 78% specificity (p < 0.001). CONCLUSION Transvenous lead extraction via the femoral approach using GS with RFAC may be an alternative approach to SMT with a high success rate, especially when the indwelling time of the leads is long.
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Affiliation(s)
- Abdülkadir Uslu
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Batur Gönenç Kanar
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey.
| | - Ismail Balaban
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Kamil Gülşen
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Alper Kepez
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey
| | - Cem Doğan
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Özkan Candan
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Taylan Akgün
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Bernas Altıntas
- Cardiology Department, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Beste Ozben Sadıc
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey
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Negative-pressure wound therapy (NPWT) for the treatment of pacemaker pocket infection in patients unable or unwilling to undergo CIED extraction. J Interv Card Electrophysiol 2020; 61:245-251. [PMID: 32572720 DOI: 10.1007/s10840-020-00805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The occurrence of cardiac pacemaker pocket infection has markedly increased and has become a new problem facing cardiovascular internists. The aim of our study was to investigate the effectiveness and safety of treating cardiac pacemaker pocket infection using negative-pressure wound therapy (NPWT) in patients who are unwilling or unable to have their cardiac implantable electronic devices (CIEDs) removed. METHODS From March 2013 to April 2019, NPWT was applied to 26 patients with cardiac pacemaker pocket infection who were unwilling or unable to have their CIEDs removed. In the first stage, a negative-pressure drainage system was placed in the pacemaker pocket after debridement. Then, NPWT was used to seal the wound, and the negative pressure (300-400 mmHg) was sustained for 5-7 days. In the second stage, the pacemaker was relocated to the subpectoral layer, and the wound was closed. RESULTS In all but three of our 26 patients, the wound healed completely without complications and without evidence of residual infection. The average follow-up period was 26.92 ± 9.46 months. Only 3 diabetic patients whose tissue bacterial cultures revealed that methicillin-resistant Staphylococcus epidermidis developed uncontrolled infections. Eventually, the entire original pacemaker systems were removed, and new pacemakers were implanted in the contralateral chest wall. CONCLUSIONS When warranted by strictly selected indications, the method of NPWT without CIED extraction can be considered as a new and effective treatment for patients with pacemaker pocket infection who are unwilling or unable to have the device removed.
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12
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Svennberg E, Jacobs K, McVeigh E, Pretorius V, Birgersdotter-Green U. Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction. JACC Clin Electrophysiol 2019; 5:1439-1446. [PMID: 31857044 DOI: 10.1016/j.jacep.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to assess if pre-procedural computed tomography (CT) could identify high-risk operative features and predict increased procedural complexity. BACKGROUND Unpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads. METHODS Consecutive patients who had CTs performed ≤90 days before their planned lead extraction (LE) were included. CTs were reviewed blinded to outcome according to a preset checklist. The outcome was a combined endpoint of procedural complexity and major complications. RESULTS Between January 1, 2015 and July 1, 2018, 143 patients underwent CT and LE. Median age was 68 years (interquartile range [IQR]: 54.4 to 76.5), and 35% were female. Median age of extracted leads was 111 months, and 126 (43%) were >10 years. CT detected lead perforation ≥5 mm (n = 13), <5 mm (n = 55), severe lead adhesions (n = 65), leads touching vessel wall >1 cm (n = 102), lead fracture (n = 8), and severe ipsilateral venous stenosis/occlusion (n = 36). The procedure was complex in 63 cases. There were 2 deaths, and 6 major complications. Patients with severe lead adhesions had more complex procedures (n = 36 vs 29; p = 0.04), whereas none of the other findings on CT were significantly associated with worse outcome. In patients with leads that had an indwelling time <10 years (n = 72), severe lead adhesions on CT was associated with worse outcome in multivariable analysis (odds ratio: 6.4; 95% confidence interval: 1.4 to 30.2; p = 0.02). CONCLUSIONS Pre-procedural CT can be used to locate severe lead adhesions in patients planned for lead extraction. In patients with indwelling leads <10 years, pre-procedural CT aids in identifying patients prone to complex extractions.
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Affiliation(s)
- Emma Svennberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet Stockholm, Sweden.
| | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, California
| | - Elliot McVeigh
- Department of Radiology, University of California San Diego, San Diego, California; Department of Bioengineering, University of California San Diego, La Jolla, California; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
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Efficacy and Safety of Transvenous Lead Extraction in the Device Laboratory and Operating Room Guided by a Novel Risk Stratification Scheme. JACC Clin Electrophysiol 2019; 5:174-182. [DOI: 10.1016/j.jacep.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 11/19/2022]
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14
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Chan CW, Chan LK, Lam T, Tsang KK, Chan KW. Comparative study about the tensile strength and yielding mechanism of pacing lead among major manufacturers. Pacing Clin Electrophysiol 2018; 41:828-833. [PMID: 29758585 DOI: 10.1111/pace.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND With extraction of cardiovascular implantable electronic devices (CIED) increasingly necessitated, various studies have contemplated to investigate clinical predictors for its success and complications. Intrinsic parameters of CIED leads have been studied less extensively and are the foci of this study. METHODS Three major pacemaker manufacturers accepted invitation. Leads then underwent tensile test in vitro with their composite tensile strength (TS) compared. Mechanism of yielding, under tensile stress, was also observed among them. RESULTS All pacing leads, participated in this study, surpassed requirement of European Standard EN 45502-2-1. Boston Scientific's FINELINE II STEROX 4456/52 cm (Boston Scientific Corp., St. Paul, MN, USA) and Medtronic's CAPSURE SENSE 4074/52 cm (Medtronic, Minneapolis, MN, USA) showed similar composite TS and both were stronger compared with St. Jude Medical's ISOFLEX OPTIM 1948/52 cm (P <0.001; St. Jude Medical, Sylmar, CA, USA). Despite a difference in the exact site, the Medtronic 4074 and St. Jude Medical 1948 yielded similarly in that their distal tip electrode remained connected with a flimsy inner coil to proximal portion of the lead after their composite TS was exceeded. Boston Scientific 4456's insulation tubing and coil wire broke almost simultaneously and separated completely from the tip electrode when it yielded. CONCLUSIONS FINELINE II STEROX 4456/52 cm and CAPSURE SENSE 4074/52 cm showed stronger composite tensile strength than ISOFLEX OPTIM 1948/52 cm. FINELINE II STEROX 4456 was found more prone to complete severance. Limitations and precautions to translate these differences directly into real-life scenario are discussed.
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Affiliation(s)
- Chi-Wo Chan
- Division of Cardiology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Lip-Kiong Chan
- Division of Cardiology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Tongny Lam
- Division of Cardiology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Kin-Keung Tsang
- Division of Cardiology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Kin-Wing Chan
- Division of Cardiology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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Merchant FM, Tejada T, Patel A, El-Khalil J, Desai Y, Keeling B, Lattouf OM, Leon AR, El-Chami MF. Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads. Heart Rhythm 2018; 15:855-859. [DOI: 10.1016/j.hrthm.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 10/18/2022]
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16
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Zucchelli G, Favilli E, Viani S, Barletta V, Di Cori A, Segreti L, Bongiorni MG. Leadless pacing in a patient with superior vena cava syndrome undergoing lead extraction and percutaneous angioplasty. J Cardiol Cases 2018; 17:212-214. [PMID: 30279895 DOI: 10.1016/j.jccase.2018.02.008] [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] [Received: 11/14/2017] [Revised: 02/11/2018] [Accepted: 02/17/2018] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava (SVC) syndrome is an uncommon but serious complication associated with chronic transvenous implanted leads. In the recent past, open-heart surgery combining lead extraction and epicardial implant was usually performed to reduce syndrome recurrences. We describe the case of a 78-year-old man successfully treated by percutaneous lead extraction associated with venous balloon angioplasty and reimplantation of leadless pacemaker. <Learning objective: Chronic vascular complications following lead implantation usually require surgical treatment, due to the need for subsequent epicardial implantation. Percutaneous lead extraction along with leadless pacing allowed effective non-surgical management of chronic complications of transvenous pacing.>.
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Affiliation(s)
- Giulio Zucchelli
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Elena Favilli
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Stefano Viani
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Valentina Barletta
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Andrea Di Cori
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Luca Segreti
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Maria Grazia Bongiorni
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
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17
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An unusual complication during reimplantation of implantable cardioverter defibrillator (ICD) after ICD leads extraction: Distal migration of anchoring sleeve. Anatol J Cardiol 2018; 19:156-157. [PMID: 29424744 PMCID: PMC5864819 DOI: 10.14744/anatoljcardiol.2017.8249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Bontempi L, Vassanelli F, Lipari A, Locantore E, Cassa MB, Salghetti F, Elmaghawry M, Vizzardi E, D'Aloia A, Mahmudov R, Cerini M, Curnis A. Extraction of a coronary sinus lead: always so easy? J Cardiovasc Med (Hagerstown) 2018; 18:807-810. [PMID: 25050526 DOI: 10.2459/jcm.0000000000000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Luca Bontempi
- aDivisione e Cattedra di Cardiologia, Spedali Civili e Università degli Studi di Brescia, Brescia, Italy bAswan Heart Centre, Aswan, Egypt cCentral Hospital of Oil Workers, Cardiovascular Disease Center, Baku, Azerbaijan
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19
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Joung B. Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Abstract
Cardiac implantable electronic device (CIED) infections are complex medical problems that are increasingly encountered. They are associated with significant morbidity and mortality with tremendous economic cost. The current review will emphasize the prevention, diagnosis, and treatment of this clinical entity using the relatively limited evidence that is currently available. Because there is a paucity of high quality evidence regarding prevention, diagnosis, and treatment of CIED infections, this review will attempt to summarize the best evidence as well as to suggest, when possible, paradigms for care. The topic of CIED infections is a dynamic one as the scope of CIED continues to widen. Furthermore, there are promising advancements in CIED technology which may help reduce its occurrence the future. Unfortunately, significant gaps in knowledge remain, and definitive recommendations regarding CIED infections and future studies should be directed at improving our ability to prevent infections.
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Affiliation(s)
- Steven Leung
- Department of Medicine, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA
| | - Stephan Danik
- Department of Cardiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
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Bhatia M, Safavi-Naeini P, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management of Laser Lead Extraction for Cardiovascular Implantable Electronic Devices. Semin Cardiothorac Vasc Anesth 2017; 21:302-311. [DOI: 10.1177/1089253217728581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) play a significant role in the modern management of cardiovascular disease. CIEDs include implantable pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. These devices improve the quality of life of their recipients and help reduce the incidence of sudden cardiac death. Traditionally, CIEDs have been reliant on the use of transvenous endocardial leads to directly connect with the heart. Over time, these endovascular leads may become endothelialized rendering removal extremely difficult. As the indications for CIEDs expands and with the continuing evolution of these devices, the number of patients requiring explantation for device recall, malfunction, and infection continues to increase. In this manuscript, we review the most common CIEDs, the indications and process of lead removal/device explantation, potential complications associated with the procedure and the anesthetic management of these patients.
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Affiliation(s)
- Meena Bhatia
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Isawa T, Yamada T, Honda T, Yamaya K, Ootomo T. "Spaghetti twisting" technique: a novel method of catching pacemaker leads using a needle's eye snare. Clin Case Rep 2017; 5:1269-1273. [PMID: 28781840 PMCID: PMC5538061 DOI: 10.1002/ccr3.1050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/04/2017] [Accepted: 05/27/2017] [Indexed: 11/10/2022] Open
Abstract
The needle's eye snare has become an indispensable tool in contemporary pacemaker lead extraction techniques. Here, we present a modified method of using the needle's eye snare, named “spaghetti twisting” technique, to catch and secure pacemaker leads, which would help operators catch and secure leads much easily.
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Affiliation(s)
- Tsuyoshi Isawa
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Takashi Yamada
- Department of Cardiology Takaishi Fujii Cardiovascular Hospital Takaishi Japan
| | - Taku Honda
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Kazuhiro Yamaya
- Department of Cardiovascular Surgery Sendai Kousei Hospital Sendai Japan
| | - Tatsushi Ootomo
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
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24
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Isawa T, Yamada T, Honda T, Yamaya K, Ootomo T. A "tetra-axial" system in transfemoral lead extraction. Clin Case Rep 2017; 5:1000-1002. [PMID: 28588854 PMCID: PMC5458036 DOI: 10.1002/ccr3.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 11/11/2022] Open
Abstract
Pacemaker lead extractors must become familiar with transfemoral approaches for lead extraction as a bail‐out procedure for a failed superior approach. We presented a “tetra‐axial” system for transfemoral lead extraction. This system would be more widely applicable in cases with difficulties in extraction, resulting in more procedural success.
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Affiliation(s)
- Tsuyoshi Isawa
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Takashi Yamada
- Department of Cardiology Takaishi Fujii Cardiovascular Hospital Takaishi Japan
| | - Taku Honda
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Kazuhiro Yamaya
- Department of Cardiovascular Surgery Sendai Kousei Hospital Sendai Japan
| | - Tatsushi Ootomo
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
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25
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Epstein LM, Maytin M. Strategies for Transvenous Lead Extraction Procedures. J Innov Card Rhythm Manag 2017; 8:2702-2716. [PMID: 32494448 PMCID: PMC7252922 DOI: 10.19102/icrm.2017.080502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis. The past four decades, however, have witnessed significant advances in lead extraction technology, resulting in more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a marked decline in the incidence of procedure-related morbidity and mortality, with recent registries at high-volume centers reporting high success rates with exceedingly low complication rates. Future developments in lead extraction are likely to focus on new tools that will allow for us to provide comprehensive device management, develop alternative systems for extraction training, and focus on the design of new leads conceived to facilitate future extraction.
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Affiliation(s)
- Laurence M Epstein
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Melanie Maytin
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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Infecciones en dispositivos de estimulación cardiaca: diagnóstico y tratamiento en un centro de referencia. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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El-Chami MF, Sayegh MN, Patel A, El-Khalil J, Desai Y, Leon AR, Merchant FM. Outcomes of lead extraction in young adults. Heart Rhythm 2017; 14:537-540. [DOI: 10.1016/j.hrthm.2017.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 10/20/2022]
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Manolis AS, Melita H. Managing infected cardiovascular implantable electronic devices. ACTA ACUST UNITED AC 2016. [DOI: 10.1002/cce2.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - H. Melita
- Onassis Cardiac Surgery Center; Athens Greece
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Gutiérrez Carretero E, Arana Rueda E, Lomas Cabezas JM, Laviana Martínez F, Villa Gil-Ortega M, Acosta Martínez J, Pedrote Martínez A, de Alarcón González A. Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center. ACTA ACUST UNITED AC 2016; 70:355-362. [PMID: 27964841 DOI: 10.1016/j.rec.2016.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience. METHODS Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge. RESULTS Percutaneous traction (PCT) was the most frequent procedure (n=280) in local (n=166) and systemic infections (n=114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure). CONCLUSIONS Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse.
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Affiliation(s)
| | - Eduardo Arana Rueda
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Manuel Villa Gil-Ortega
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Jesús Acosta Martínez
- Servicio de Anestesia y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alonso Pedrote Martínez
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arístides de Alarcón González
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Grupo de Investigación en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, Sevilla, Spain.
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Abstract
The population of patients with cardiac implantable electronic devices (CIEDs) continues to grow due to increasing indications in an aging population and breakthroughs in both the medical and the surgical care of patients with heart disease. As a result, there has been a growing need for device and lead extractions due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections, and lead advisory alerts.
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Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:348-354. [PMID: 27980549 PMCID: PMC5133324 DOI: 10.5114/aic.2016.63636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Spontaneous lead dislodgement into the pulmonary circulation is a rare complication of permanent pacing with unproven harmfulness and an indication of controversial class for transvenous lead extraction (TLE). AIM To assess TLE safety in patients with leads dislodged into the pulmonary artery. MATERIAL AND METHODS A retrospective analysis of a 9-year-old database of transvenous lead extraction procedures comprising 1767 TLEs was carried out, including a group of 19 (1.1%) patients with leads dislodged into the pulmonary artery (LDPA). RESULTS Under univariate analysis the factors that increased the likelihood of the presence of an electrode in the pulmonary artery were mean lead dwelling time (increase of risk by 9% per year), total number of leads in the heart before TLE (increase of risk by 66% for one lead) and the number of abandoned leads (increase of risk by 119%). The presence of LDPA was associated with frequent occurrence of intracardiac lead abrasion (increase by 316%) and isolated lead-related infective endocarditis (LRIE) (increase by 500%). There were no statistically significant differences in clinical (p = 0.3), procedural (p = 0.94) or radiological (p = 0.31) success rates in compared (LDPA and non-LDPA) groups. Long-term mortality after TLE was comparable in both groups. CONCLUSIONS As the effectiveness and safety of TLE in patients with LDPA are comparable to those in standard TLE procedures, in our opinion, such patients should be considered TLE candidates.
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Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2016. [DOI: 10.20286/ijcp-010201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sawhney V, Breitenstein A, Sporton S, Dhinoja M. Percutaneous lead extraction and venous recanalisation using spectranetics tight rail: A single centre experience. Indian Pacing Electrophysiol J 2016. [PMCID: PMC5197445 DOI: 10.1016/j.ipej.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Despite advances in lead extraction tools, percutaneous lead extraction remains a complex procedure associated with significant morbidity and mortality. Moreover, no standards or directives exist to guide physicians in the choice of their extraction tool or approach and all operators tend to have their own preferred method. The reporting of outcomes with existing and newly emerging extraction technology is therefore encouraged. Methods and results Four lead extraction procedures using the new spectranetics tight rail rotating dilator sheath are described here. All patients (n = 3) had chronically implanted leads (mean duration = 11.7 years) and the pre-procedure venogram showed occluded left subclavian and brachiocephalic veins with extensive collateralisation. All leads were extracted successfully using this newly designed rotating dilator sheath and vascular access was also retained by venous recanalisation using this kit. One patient required a second extraction procedure at four weeks due to diaphragmatic twitch without macroscopic coronary sinus (CS) lead displacement. This was replaced with a transseptal LV lead. There were no other procedure related complications and all patients remained well with good lead parameters at three months follow-up. Conclusion The use of this new tight rail extraction tool appears safe and effective in chronically implanted leads. Moreover, it helps to preserve the vascular access by recanalisation of long tortuous occlusions. Its use across various centres and larger number of patients will be required to confirm our results.
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Starck CT, Falk V. Lead extraction technology and techniques: a surgeon's perspective. Multimed Man Cardiothorac Surg 2016; 2016:mmw009. [PMID: 27354462 DOI: 10.1093/mmcts/mmw009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/09/2016] [Indexed: 11/12/2022]
Abstract
Transvenous lead extraction procedures have gained substantial clinical importance during the past decade. With current tools and techniques, high success rates in combination with low complication rates can be achieved by experienced centres. Even in experienced hands, life-threatening complications can occur, and every physician performing such procedures must be prepared for this scenario. This necessitates immediately available access to extracorporeal circulation, and if the operator is a cardiologist, cardiac surgical standby is mandatory.
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Affiliation(s)
- Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
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Aung H, Espinosa RE, Powell BD, McLeod CJ. Entrapment of a Pacing Lead within a Chiari Network: Utility of Intracardiac Echo and a Laser Sheath. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:620-2. [PMID: 26873294 DOI: 10.1111/pace.12828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022]
Abstract
Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal.
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Affiliation(s)
- Htin Aung
- Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Raul E Espinosa
- Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Brian D Powell
- Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Christopher J McLeod
- Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Kocabaş U, Duygu H, Eren NK, Akyıldız Zİ, Özyıldırım S, Tülüce SY, Kırış T, Nazlı C. Transvenous extraction of pacemaker and implantable cardioverter defibrillator leads using Evolution® mechanical dilator sheath: a single center confirmatory experience. SPRINGERPLUS 2016; 5:356. [PMID: 27066369 PMCID: PMC4803708 DOI: 10.1186/s40064-016-1987-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/09/2016] [Indexed: 11/15/2022]
Abstract
Objective In recent years there has been an increase in clinical situations requiring lead extraction procedures of implanted cardiac devices. In our clinic, extraction procedures are performed with Evolution® mechanical lead extraction system. In this manuscript we aimed to evaluate our lead extraction procedures. Methods We retrospectively evaluated lead extraction procedures carried out on 41 patients [30 male, 11 female patient; mean age 61.5 ± 18.5 median 67 (23–85)] between 2008 and 2015 using Evolution® system. Procedural success, major and minor complications are determined according to previously published guidelines. Results Mean duration of the lead implantation was 88.4 ± 62.5 months (6–240). Implanted device was a pacemaker in 27 (65.8 %) and ICD in 14 (34.2 %) of patients. Total 67 leads were extracted from the patients, 22 (32.8 %) were atrial, 30 (44.2 %) were ventricular, 14 (21.5 %) were dual coil defibrillator and 1 (1.5 %) was coronary sinus lead. Indications for lead removal were pacemaker decubitis and infection in 29 (70.8 %), lead dysfunction in 11 (26.8 %) and subclavian vein thrombosis in 1 (2.4 %) patient. Success rate with Evolution® system without using snare was 85.3 %. Clinical success rate was 97.5 % procedural success rate was 95.1 % and failure occured in one patient. Major complications occured in 2 (4.8 %) patients, 1 (2.4 %) was procedure related mortality. Minor complications were seen in 5 (12.2 %) of patients. Conclusions In our single center study it is shown that extraction of pacemaker and defibrillator leads of relatively long implantation duration and in an older age patient group may be successfully carried out using the Evolution® system. However due to potentially serious complications it is adviced to be done by experienced operators in centers with cardiovascular surgery backup.
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Affiliation(s)
- Uğur Kocabaş
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Hamza Duygu
- Cardiology Department, Medical Faculty, Near East University, Nicosia, Cyprus
| | - Nihan Kahya Eren
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Zehra İlke Akyıldız
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | | | - Selcen Yakar Tülüce
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Tuncay Kırış
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Cem Nazlı
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
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Kumar D, Banerjee S, Naik J, Gupta K, Roy RR, Kumar A. A novel use of EP catheter in extraction of trapped intracardiac devices: Two case reports. Indian Heart J 2016; 67 Suppl 3:S92-6. [PMID: 26995446 PMCID: PMC4799006 DOI: 10.1016/j.ihj.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 12/01/2022] Open
Abstract
The decision to retrieve chronically implanted abandoned leads and trapped intracardiac devices percutaneously has been difficult and highly controversial. We present two case reports in which electrophysiological ablation catheter was used to retrieve infected abandoned pacemaker lead and trapped permacatheter (permacath) in right ventricle. We could avert major cardiovascular surgeries in both the patients by simply modifying the traditionally used techniques for extraction of intracardiac devices.
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Affiliation(s)
- Dilip Kumar
- Consultant Interventional Cardiologist and Electrophysiologist, Medica Superspecialty Hospital, Kolkata, India.
| | - Sunip Banerjee
- Director, Medica Institute of Cardiac Sciences, Medica Superspecialty Hospital, Kolkata, India
| | - Jaynarayan Naik
- Senior Consultant Interventional Cardiologist, Medica Superspecialty Hospital, Kolkata, India
| | - Kinnari Gupta
- Registrar, Medica Institute of Cardiac Sciences, Medica Superspecialty Hospital, Kolkata, India
| | - Rana Rathor Roy
- Consultant Interventional Cardiologist, Medica Superspecialty Hospital, Kolkata, India
| | - Arvind Kumar
- Consultant Interventional Cardiologist, Medica Superspecialty Hospital, Kolkata, India
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Güngör H, Zencir C, Tekten T. Percutaneous extraction of implantable cardioverter defibrillator electrode with mechanical dilator sheath. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bucher EF, Kim A, Givan J, Maloney ME. Dermatologic surgery on the chest wall in patients with a cardiac surgery history: a review of material that may be encountered intraoperatively, including potential complications and suggestions for proceeding safely. Int J Womens Dermatol 2016; 2:13-17. [PMID: 28491995 PMCID: PMC5412096 DOI: 10.1016/j.ijwd.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly prevalent in the population. As such, dermatologists may have a greater likelihood of encountering previously implanted or abandoned surgical material in the course of dermatologic surgery on the chest wall. A basic understanding of the wire types and the tunneling paths utilized in such procedures is important in accurately anticipating the presence of these wires to effectively manage any chance encounters. Objective We present a review on temporary epicardial pacing wires, temporary transvenous pacing wires, pacemaker leads, and surgical steel sutures in the context of dermatologic surgery. Methods A literature review was performed on frequently used wire material in patients with a history of cardiac surgery as well as related dermatologic complications from these materials. Results & Conclusion Dermatologic surgeons should particularly be aware that temporary epicardial pacing wires and pacemaker leads are not uncommonly abandoned in the chest wall of many patients. All patients with a cardiac surgery history should be questioned about possible retained wires. If wire material is encountered intraoperatively, immediately stop the procedure and do not attempt further manipulation of the wire until suggested steps are taken to ascertain the wire type.
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Affiliation(s)
| | - Andrew Kim
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | | | - Mary E. Maloney
- Department of Medicine, Division of Dermatology, UMass Memorial Healthcare, Worcester, MA
- Corresponding author.
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Hussein AA, Wilkoff BL. Extracción de electrodos transvenosos de dispositivos electrónicos implantables cardiacos: ¿quién, cuándo, cómo y dónde? Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hussein AA, Wilkoff BL. Transvenous Lead Extraction of Cardiac Implantable Electronic Devices: Who, When, How and Where? ACTA ACUST UNITED AC 2015; 69:3-6. [PMID: 26597165 DOI: 10.1016/j.rec.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Ayman A Hussein
- Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Department of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Bruce L Wilkoff
- Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Department of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, United States.
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Starck CT, Steffel J, Caliskan E, Holubec T, Schoenrath F, Maisano F, Falk V. Clinical performance of a new bidirectional rotational mechanical lead extraction sheath. Europace 2015; 18:253-6. [DOI: 10.1093/europace/euv126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/01/2015] [Indexed: 11/14/2022] Open
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Ann HW, Ahn JY, Jeon YD, Jung IY, Jeong SJ, Joung B, Lee M, Ku NS, Han SH, Kim JM, Choi JY. Incidence of and risk factors for infectious complications in patients with cardiac device implantation. Int J Infect Dis 2015; 36:9-14. [PMID: 25980618 DOI: 10.1016/j.ijid.2015.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The use of cardiac implantable electronic device (CIED; pacemakers, implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) implantation, one essential treatment for cardiac arrhythmias, is increasing. Infectious complications related to implants are the main reason for device removal and patient morbidity. We sought to identify the incidence of infectious complications among patients with cardiac device implantation and analyze the risk factors for infectious complications. METHODS A retrospective analysis was conducted of 1307 patients (61.5±14.2 years-old, 49.6% male) with cardiac device implantation from January 1990 to April 2013. We analyzed the incidence of infectious complications during the follow-up period. To investigate risk factors associated with infectious complications, we conducted a 1:2 matched case-control study of patients with infectious complications and controls without infectious complications who had the same implantation period and physician. RESULTS Among 1307 patients, 12 had a confirmed device-related infection: 7 with a pocket infection and 5 with infective endocarditis. Over a total of 9091.9 device-years, the incidence of infectious complications was 1.3/1000 device-years, based on the 12 patients with an infection. ICD (5.1/1000 device-year) had a higher incidence of infectious complications than other cardiac devices, and no infectious complications were observed among patients with CRT implantation. Mean duration from the time of implantation to infection was 2.02±1.65 years. In a multivariate analysis, the number of prior procedures including wound revision or scar revision was an independent risk factor for infectious complications (OR=10.88, 95% CI 1.11->999, p=0.040). CONCLUSIONS Infection was a rare complication of cardiac device implantation, but repeated procedures were associated with infectious complications.
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Affiliation(s)
- Hea Won Ann
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Yong Duk Jeon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - MoonHyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
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Yakish SJ, Narula A, Foley R, Kohut A, Kutalek S. Superior vena cava echocardiography as a screening tool to predict cardiovascular implantable electronic device lead fibrosis. J Cardiovasc Ultrasound 2015; 23:27-31. [PMID: 25883753 PMCID: PMC4398781 DOI: 10.4250/jcu.2015.23.1.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased. METHODS This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed. RESULTS 62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value < 0.05). The CIED group was subdivided into 2 groups based on device implant duration (< 2 years vs. ≥ 2 years). Of the CIED implanted for ≥ 2 years, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction. CONCLUSION Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.
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Affiliation(s)
- S Jeffrey Yakish
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Arvin Narula
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert Foley
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Andrew Kohut
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Steven Kutalek
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA
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Bongiorni MG, Di Cori A, Segreti L, Zucchelli G, Viani S, Paperini L, De Lucia R, Levorato D, Boem A, Soldati E. Transvenous extraction profile of Riata leads: Procedural outcomes and technical complexity of mechanical removal. Heart Rhythm 2015; 12:580-587. [DOI: 10.1016/j.hrthm.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 11/25/2022]
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46
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Multicentre comparison Of shock efficacy using single-vs. Dual-coil lead systems and Anodal vs. cathodaL polarITY defibrillation in patients undergoing transvenous cardioverter-defibrillator implantation. The MODALITY study. J Interv Card Electrophysiol 2015; 43:45-54. [DOI: 10.1007/s10840-015-9980-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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47
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Segreti L, Di Cori A, Soldati E, Zucchelli G, Viani S, Paperini L, De Lucia R, Coluccia G, Valsecchi S, Bongiorni MG. Major predictors of fibrous adherences in transvenous implantable cardioverter-defibrillator lead extraction. Heart Rhythm 2014; 11:2196-201. [DOI: 10.1016/j.hrthm.2014.08.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/30/2022]
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Starck CT, Stepuk A, Holubec T, Steffel J, Stark JW, Falk V. Compression coil provides increased lead control in extraction procedures. Europace 2014; 17:499-503. [DOI: 10.1093/europace/euu272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Asmarats L, Maristany J, Pons J, Buendía S, Gómez-Jaume A, Saus C, Macaya F, Pascual M, Bethencourt A, Van Malderen S, Szili-Torok T, Lever N, Webster M. How should I treat a patient with an entrapped infected permanent pacemaker lead? EUROINTERVENTION 2014; 10:403-5. [PMID: 25042269 DOI: 10.4244/eijv10i3a67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Luis Asmarats
- Department of Cardiology, Son Espases Hospital, Palma de Mallorca, Spain
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