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Zweibel SL. Switching to exclusive remote follow-up of CIEDs: Further proof of feasibility and safety. J Cardiovasc Electrophysiol 2024. [PMID: 38923130 DOI: 10.1111/jce.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Steven L Zweibel
- Hartford HealthCare, Heart & Vascular Institute, Hartford, Connecticut, USA
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Dougherty CM, Cordoza M, Wang D, Alsoyan AH, Stein PK, Burr RL. Aerobic Exercise Improves Heart Rate Variability After an Implantable Cardioverter Defibrillator (ICD). Biol Res Nurs 2024:10998004241261273. [PMID: 38881252 DOI: 10.1177/10998004241261273] [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: 06/18/2024]
Abstract
CLINICAL TRIAL REGISTRATION Clinicaltrials.gov: NCT00522340.
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Affiliation(s)
- Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Makayla Cordoza
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Di Wang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Afnan Hamad Alsoyan
- Critical Care Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Phyllis K Stein
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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Talaei F, Ang QX, Tan MC, Hassan M, Scott L, Cha YM, Lee JZ, Tamirisa K. Impact of infective versus sterile transvenous lead removal on 30-day outcomes in cardiac implantable electronic devices. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01775-1. [PMID: 38459202 DOI: 10.1007/s10840-024-01775-1] [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: 09/24/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection. METHODS From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied. RESULTS Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33-6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23-4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97-1.29) or vascular complications (OR = 1.12; 95% CI 0.73-1.72) between the two groups. CONCLUSION Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients.
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Affiliation(s)
- Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Internal Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Qi-Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Min-Choon Tan
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Mustafa Hassan
- Department of Cardiovascular Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kamala Tamirisa
- Texas Cardiac Arrhythmia Institute, Austin and Dallas, TX, USA.
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Bhalla JS, Majmundar M, Patel KN, Deshmukh AJ, Connolly HM, Chirac A, Egbe AC, Miranda WR, Madhavan M. Trends in cardiac implantable electronic device utilization in adults with congenital heart disease: a US nationwide analysis. J Interv Card Electrophysiol 2024; 67:319-328. [PMID: 37392273 DOI: 10.1007/s10840-023-01601-0] [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: 03/13/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) have increased risk of arrhythmias warranting implantation of cardiac implantable electronic devices (CIEDs), which may parallel the observed increase in survival of ACHD patients over the past few decades. We sought to characterize the trends and outcomes of CIED implantation in the inpatient ACHD population across US from 2005 to 2019. METHODS A retrospective analysis of the Nationwide Inpatient Sample (NIS) identified 1,599,519 unique inpatient ACHD admissions (stratified as simple (85.1%), moderate (11.5%), and complex (3.4%)) using the International Classification of Diseases 9/10-CM codes. Hospitalizations for CIED implantation (pacemaker, ICD, CRT-p/CRT-d) were identified and the trends analyzed using regression analysis (2-tailed p < 0.05 was considered significant). RESULTS A significant decrease in the hospitalizations for CIED implantation across the study period [3.3 (2.9-3.8)% in 2005 vs 2.4 (2.1-2.6)% in 2019, p < 0.001] was observed across all types of devices and CHD severities. Pacemaker implantation increased with each age decade, whereas ICD implantation rates decreased over 70 years of age. Complex ACHD patients receiving CIED were younger with a lower prevalence of age-related comorbidities, however, had a greater prevalence of atrial/ventricular tachyarrhythmias and complete heart block. The observed inpatient mortality rate was 1.2%. CONCLUSIONS In a nationwide analysis, we report a significant decline in CIED implantation between 2005 and 2019 in ACHD patients. This may either be due to a greater proportion of hospitalizations resulting from other complications of ACHD or reflect a declining need for CIED due to advances in medical/surgical therapies. Future prospective studies are needed to elucidate this trend further.
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Affiliation(s)
- Jaideep Singh Bhalla
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kunal N Patel
- Department of Cardiovascular Medicine, West Virginia University Hospital, Morgantown, WV, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Anca Chirac
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander C Egbe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Zanovello U, Fuss C, Arduino A, Bottauscio O. Efficient prediction of MRI gradient-induced heating for guiding safety testing of conductive implants. Magn Reson Med 2023; 90:2011-2018. [PMID: 37382200 DOI: 10.1002/mrm.29787] [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: 04/19/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To propose an efficient numerical method to predict the temperature increase of an implantable medical device induced by any linearly polarized homogeneous magnetic field, according to the ISO 10974 methodology for testing of gradient-induced device heating. THEORY AND METHODS The concepts of device-specific power and temperature tensors are introduced to mathematically describe the electromagnetic and thermal anisotropic behavior of the device, from which the device heating for an arbitrary exposure direction can be predicted. The proposed method is compared to a brute-force approach based on simulations, and validated by applying it to four reference orthopedic implants with a commercial simulation software. RESULTS The proposed method requires about 5% $$ \% $$ of the time required by the brute-force approach, and 30% $$ \% $$ of the memory occupancy. The temperature increase predicted by the proposed method over a range of incident magnetic field exposures deviated from brute-force direct simulations by less than± $$ \pm $$ 0.3% $$ \% $$ . CONCLUSION The proposed method allows efficient prediction of the heating of an implantable medical device induced by any linearly polarized homogeneous magnetic field using a small fraction of the simulations required by the brute-force approach. The results can be used to predict the worst-case orientation of the gradient field, for subsequent experimental characterization according to the ISO 10974 standard.
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Affiliation(s)
- Umberto Zanovello
- Metrologia dei materiali innovativi e scienze della vita, Istituto Nazionale di Ricerca Metrologica, Torino, Italy
| | | | - Alessandro Arduino
- Metrologia dei materiali innovativi e scienze della vita, Istituto Nazionale di Ricerca Metrologica, Torino, Italy
| | - Oriano Bottauscio
- Metrologia dei materiali innovativi e scienze della vita, Istituto Nazionale di Ricerca Metrologica, Torino, Italy
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Pecha S, Chung DU, Burger H, Osswald B, Ghaffari N, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. Laser lead extraction in octo- and nonagenarians. A subgroup analysis from the GALLERY registry. J Cardiovasc Electrophysiol 2023; 34:1951-1960. [PMID: 37493496 DOI: 10.1111/jce.16018] [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: 02/17/2023] [Revised: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In an aging population with cardiac implantable electronic devices, an increasing number of octo- and even nonagenarians present for lead extraction procedures. Those patients are considered at increased risk for surgical procedures including lead extraction. Here, we investigated safety and efficacy of transvenous lead extraction in a large patient cohort of octo- and nonagenarians. METHODS AND RESULTS A subgroup analysis of all patients aged ≥80 years (n = 499) in the German Laser Lead Extraction Registry (GALLERY) was performed. Outcomes were compared to the nonoctogenarians from the registry. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. An analysis of patient- and device characteristics, as well as an assessment of predictors for adverse events via multivariate analyses was conducted. Mean patients age was 84.3 ± 3.7 years in the octogenarians group and 64.1 ± 12.4 years in the nonoctogenarians group. The median lead dwell time was 118.0 months (78; 167) and 92.0 months [60; 133], p < .001 in the octogenarians and nonoctogenarians group, respectively. Clinical procedural success rate was achieved in 97.6% of the cases in octogenarians and 97.9% in nonoctogenarians (p = .70). Overall complication rate was 4.4% in octogenarians and 4.3% in nonoctogenarians (0.91). In octogenarians procedure-related mortality was 0.8% and all-cause in-hospital mortality was 5.4%, while in nonoctogenarians, procedure related and all-cause in-hospital mortality were 0.5% and 3.1%, respectively. A body mass index (BMI) <20 kg/m2 , was the only statistically significant predictor for procedure-related complications in octogenarians, while systemic infection, BMI ≤20 kg/m2 , procedural complications and chronic kidney disease were predictors for in-hospital mortality. CONCLUSIONS Laser lead extraction in octo- and nonagenarians is safe and effective. BMI ≤20 kg/m2 was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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Modi V, Shah K, Ferraro B, Gasimli-Gamache L, Nanda S, Stevens S, Shirani J. Cardiac implantable electronic device implantation and device-related infection. Europace 2023; 25:euad208. [PMID: 37572046 PMCID: PMC10422690 DOI: 10.1093/europace/euad208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/01/2023] [Indexed: 08/14/2023] Open
Abstract
AIMS Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device-related infections (DRI) remain a significant complication of CIED and are associated with major adverse outcomes. We aimed to assess the trend in CIED implantations, and the burden and morbidity associated with DRI. METHODS AND RESULTS The 2011-2018 National Inpatient Sample database was searched for admissions for CIED implantation and DRI. A total of 1 604 173 admissions for CIED implantations and 71 007 (4.4%) admissions for DRI were reported. There was no significant change in annual admission rates for DRI (3.96-4.59%, P value for trend = 0.98). Those with DRI were more likely to be male (69.3 vs. 57%, P < 0.001) and have a Charlson comorbidity index score ≥3 (46.6 vs. 36.8%, P < 0.001). The prevalence of congestive heart failure (CHF) increased in those admitted with DRI over the observation period. Pulmonary embolism, deep vein thrombosis, and post-procedural hematoma were the most common complications in those with DRI (4.1, 3.6, and 2.90%, respectively). Annual in-hospital mortality for those with DRI ranged from 3.9 to 5.8% (mean 4.4%, P value for trend = 0.07). Multivariate analysis identified CHF [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.35-2.07], end-stage renal disease (OR = 1.90; 95% CI = 1.46-2.48), coagulopathy (OR = 2.94; 95% CI = 2.40-3.61), and malnutrition (OR = 2.50; 95% CI = 1.99-3.15) as the predictors of in-hospital mortality for patients admitted with DRI. CONCLUSION Device-related infection is relatively common and continues to be associated with high morbidity and mortality. The prevalence of DRI has not changed significantly despite technical and technological advances in cardiac devices and their implantation.
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Affiliation(s)
- Vivek Modi
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Kashyap Shah
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Bruce Ferraro
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Leyla Gasimli-Gamache
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Sudip Nanda
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Steven Stevens
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke’s University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA
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Bock M, O’Connor M, Chouchane A, Schmidt P, Schaarschmidt C, Knoll K, Bahlke F, Englert F, Storz T, Kottmaier M, Trenkwalder T, Reents T, Bourier F, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis. J Clin Med 2023; 12:4900. [PMID: 37568301 PMCID: PMC10420171 DOI: 10.3390/jcm12154900] [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: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. METHODS We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. RESULTS The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). CONCLUSION Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.
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Affiliation(s)
- Matthias Bock
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Matthew O’Connor
- Auckland City Hospital, Department of Cardiology, Auckland 1023, New Zealand
| | - Amir Chouchane
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Philip Schmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Claudia Schaarschmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Katharina Knoll
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Fabian Bahlke
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Florian Englert
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Theresa Storz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marc Kottmaier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Tilko Reents
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Felix Bourier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marta Telishevska
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Sarah Lengauer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Gabriele Hessling
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Isabel Deisenhofer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Christof Kolb
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
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Šačić D, Petrović O, Zamaklar-Trifunović D, Ivanović B. Cardiac pacemaker-related endocarditis complicated with pulmonary embolism: Case report. Front Cardiovasc Med 2023; 10:1191194. [PMID: 37396580 PMCID: PMC10313500 DOI: 10.3389/fcvm.2023.1191194] [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: 03/21/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Cardiac device-related endocarditis as a device-therapy complication is a growing problem due to higher life expectancy and the increasing number of abandoned leads and subclinical symptoms. We reported a case of a 47-year-old woman with an implanted pacemaker who was admitted to the clinic for cardiology due to the right-sided device-related infective endocarditis of the pacemaker leads with vegetations, predominantly in the right atrium and right ventricle and complicated by pulmonary embolism. Several years after pacemaker implantation, she was diagnosed with systemic lupus erythematosus and started immunosuppressive therapy. The patient was treated with prolonged intravenous antibiotic therapy. The atrial and ventricular lead was extirpated, and the posterior leaflet of the tricuspid valve was shaved.
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Affiliation(s)
- Dalila Šačić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Danijela Zamaklar-Trifunović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branislava Ivanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Ghezzi ES, Sharman RLS, Selvanayagam JB, Psaltis PJ, Sanders P, Astley JM, Knayfati S, Batra V, Keage HAD. Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients. Europace 2023; 25:euad130. [PMID: 37311667 PMCID: PMC10264222 DOI: 10.1093/europace/euad130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. METHODS Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. RESULTS Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges' g = 0.07 (95%CI 0-0.14)]. CONCLUSION Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Rhianna L S Sharman
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5001, Australia
- Department of Medicine, School of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
| | - Peter J Psaltis
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Prashanthan Sanders
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Jack M Astley
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Sara Knayfati
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Vrinda Batra
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
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11
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Andresen H, Pagonas N, Eisert M, Patschan D, Nordbeck P, Buschmann I, Sasko B, Ritter O. Defibrillator exchange in the elderly. Heart Rhythm O2 2023; 4:382-390. [PMID: 37361620 PMCID: PMC10288028 DOI: 10.1016/j.hroo.2023.05.001] [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] [Indexed: 06/28/2023] Open
Abstract
Background Implantable cardioverter-defibrillator (ICD) therapy in elderly patients is controversial because survival benefits might be attenuated by nonarrhythmic causes of death. Objective The purpose of this study was to investigate the outcome of septuagenarians and octogenarians after ICD generator exchange (GE). Methods A total of 506 patients undergoing elective GE were analyzed to determine the incidence of ICD shocks and/or survival after GE. Patients were divided into a septuagenarian group (age 70-79 years) and an octogenarian group (age ≥80 years). The primary endpoint was death from any cause. Secondary endpoints were survival after appropriate ICD shock and death without experiencing ICD shocks after GE ("prior death"). Results The association of the ICD with all-cause mortality and arrhythmic death was determined for septuagenarians and octogenarians. Comparing both groups, similar left ventricular ejection fraction (35.6% ± 11.2% vs 32.4% ± 8.9%) and baseline prevalence of New York Heart Association functional class III or IV heart failure (17.1% vs 14.7%) were found. During the entire follow-up period of the study, 42.5% of patients in the septuagenarian group died compared to 79% in the octogenarian group (P <.01). Prior death was significantly more frequent in both age groups than were appropriate ICD shocks. Predictors of mortality were common in both groups and included advanced heart failure, peripheral arterial disease, and renal failure. Conclusion In clinical practice, decision-making for ICD GE among the elderly should be considered carefully for individual patients.
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Affiliation(s)
- Henrike Andresen
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Marius Eisert
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Daniel Patschan
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Ivo Buschmann
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Benjamin Sasko
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Department of Internal Medicine IV–Cardiology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
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12
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Hofer D, Kuster N, Bebié MC, Sasse T, Steffel J, Breitenstein A. Success and Complication Rates of Transvenous Lead Extraction in a Developing High-Volume Extraction Center: The Zurich Experience. J Clin Med 2023; 12:jcm12062260. [PMID: 36983262 PMCID: PMC10051593 DOI: 10.3390/jcm12062260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Transvenous lead extractions are increasingly performed for malfunction or infection of cardiac implantable electronic devices, but they harvest a potential for complications and suboptimal success. Apart from multicenter registries and reports from highly experienced single centers, the outcome in individual newly developing high-volume centers starting a lead extraction program is less well established. We aimed to evaluate the clinical and radiological success and complication rate at our center, having started a lead extraction program less than a decade ago. Methods: We retrospectively analyzed patients who underwent transvenous lead extraction at the University Hospital Zurich from 2013 to 2021 regarding success as well as complications and compared our results to previously reported outcome rates. Results: A total of 346 patients underwent 350 transvenous lead extractions from January 2013 to December 2021. Combined radiological success was achieved in 97.7% and clinical success in 96.0% of interventions. Procedure-related major complications occurred in 13 patients (3.7%). Death within 30 days after transvenous lead extractions occurred in 13 patients (3.7%), with a procedure-related mortality of 1.4% (five patients). Summary: Transvenous lead extractions in newly developing high-volume centers can be performed with high clinical and radiological success rates, but procedure-related major complications may affect a relevant number of patients. Compared to large single or multicenter registries of experienced centers, the success rate may be lower and the complication rate higher in centers newly starting with lead extraction, which may have important implications for patient selection, procedural planning, proctoring, and safety measures.
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13
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Tauber J, Tingley JP, Barmettler A. Implantable Electronic Cardiovascular Device Complications Related to Electrocautery During Ophthalmology Surgery: A Systematic Review. Ophthalmic Plast Reconstr Surg 2023; 39:108-116. [PMID: 36136730 DOI: 10.1097/iop.0000000000002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Implantable electronic cardiovascular device such as cardiac pacemakers and implantable defibrillators are common life-saving devices. Device-related complications can arise when undergoing surgical interventions with electrosurgical tools due to electromagnetic interference, based on electrocautery type, implantable electronic cardiovascular device type, electrocautery location, and a number of other factors. The risk of device-related complications due to electrocautery in oculoplastic surgery has not been established. This systematic literature review assesses prevalence, risk factors, and outcomes of electrocautery-related device complications in oculoplastic surgery. METHODS Systematic literature review followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines and used the search terms "pacemaker," "implantable cardioverter defibrillator," "electrocautery," "cautery," and "electrosurgery" through June 2022. Inclusion criteria were full-text articles, discussing ocular, oculoplastic, or other facial surgery. Exclusion criteria were non-English language or surgery focused on other parts of the body. Full-text manuscripts of identified articles were reviewed and relevant data were extracted. RESULTS Twelve studies met inclusion criteria. Two studies were level I and II evidence, while 10 studies were level III or IV. There were no reports of electromagnetic interference with bipolar cautery use. With monopolar cautery use, cases of electromagnetic interference were reported, but without related significant morbidity or mortality. Safety recommendations to minimize electrical flow through the implantable electronic cardiovascular device are described. CONCLUSIONS There were no reports of implantable electronic cardiovascular device-related complications from bipolar or thermocautery use in ophthalmic or oculoplastic surgeries. Monopolar have been associated with electromagnetic interference, but additional preoperative and perioperative measures can be taken to mitigate this risk.
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Affiliation(s)
- Jenna Tauber
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, U.S.A
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14
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Jafry AH, Raza SM, Bajwa A, Hassan A, Akhtar KH, Salat H, Abdo T. Pulmonary hemorrhage after cardiac resynchronization therapy device implantation - A systematic review. Am J Med Sci 2022; 364:796-802. [PMID: 35798057 DOI: 10.1016/j.amjms.2022.06.018] [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: 08/10/2021] [Revised: 03/09/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
Cardiac implantable electronic devices are being increasingly used for a variety of cardiovascular diseases. We describe a rare case of massive hemoptysis after device implantation. The patient was managed conservatively with reversal of anticoagulation and inhaled tranexamic acid and had a successful recovery. A systematic review accompanies the case presentation. The modality and difficulty of access appear to play a significant role in precipitating bleeding, believed to be the result of direct injury to the pulmonary parenchyma and vasculature. The condition is often self-limiting; however, anticoagulation reversal, intubation, endobronchial intervention, and transarterial embolization may be indicated in more severe pulmonary hemorrhage.
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Affiliation(s)
- Ali Haider Jafry
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
| | - Syeda Maheen Raza
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Awais Bajwa
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ahmad Hassan
- Department of Medicine-Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Khawaja Hassan Akhtar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Huzaifah Salat
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Health Care System, Oklahoma City Oklahoma, USA
| | - Tony Abdo
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Health Care System, Oklahoma City Oklahoma, USA
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15
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Sommers N, Berger M, Rubenstein JC, Roth J, Pan A, Thompson C, Widlansky ME. Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices. Eur Rev Aging Phys Act 2022; 19:26. [PMID: 36324065 PMCID: PMC9628136 DOI: 10.1186/s11556-022-00305-0] [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: 01/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns. METHODS Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods. RESULTS Activity significantly decreased during the pandemic period compared to one year prior by an average of 0.53 ± 1.18h/day (P < 0.001) for PPM patients and 0.51 ± 1.2h/day (P < 0.001) for ICD patients. Stratification of subjects by active time (< 2 versus ≥ 2h/day) showed patients with < 2h, particularly those with ICDs, had modestly greater activity reductions with the pandemic onset. Logistical regression analyses suggest a trend toward a greater reduction in active time at the onset of the pandemic and an increased risk of hospital or emergency department (ED) admission for PPM patients, but not ICD patients. CONCLUSION The onset of the pandemic in the United States was associated with a significant drop in PPM and ICD patient active hours that was modestly more pronounced in less active patients and cannot be explained by one year of aging or seasonal variation. If sustained, these populations may experience excess cardiovascular morbidity.
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Affiliation(s)
- Nicholas Sommers
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Marcie Berger
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Jason C. Rubenstein
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - James Roth
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Amy Pan
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Colton Thompson
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Michael E. Widlansky
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA ,grid.30760.320000 0001 2111 8460Division of Cardiovascular Medicine,, Medical College of Wisconsin, Milwaukee, WI USA
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16
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Khaloo P, Uzomah UA, Shaqdan A, Ledesma PA, Galvin J, Ptaszek LM, Ruskin JN. Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017. J Am Heart Assoc 2022; 11:e025600. [PMID: 36000421 PMCID: PMC9496407 DOI: 10.1161/jaha.122.025600] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Most published reports describing outcomes of patients with cardiovascular implantable electronic device–related infective endocarditis (CIED‐IE) are single‐center studies with small patient sample sizes. The goal of this study was to utilize population‐based data to assess trends in CIED‐IE hospitalization and to compare outcomes between patients hospitalized with CIED‐IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE). Methods and Results A query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED‐IE, and 26 111 (4%) had PVE. There was a 509% increase in CIED‐IE hospitalizations in the United States from 2003 to 2017 (P trend<0.001). In‐hospital mortality and length of stay associated with CIED‐IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 (P trend=0.032 and 0.018, respectively). The in‐hospital mortality rate was lower in patients hospitalized with CIED‐IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED‐IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED‐IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE). Conclusions Despite the fact that the number of comorbidities per patient with CIED‐IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED‐IE than for patients with NVE and PVE. Patients with CIED‐IE had the longest lengths of stay and highest hospital costs.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | | | - Ayman Shaqdan
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Pablo A Ledesma
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jennifer Galvin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
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17
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Xiao Z, He J, Yang D, An Y, Li X. Bridge pacemaker with an externalized active fixation lead for pacemaker-dependent patients with device infection. Pacing Clin Electrophysiol 2022; 45:761-767. [PMID: 35357706 DOI: 10.1111/pace.14493] [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: 12/22/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of Cardiac Implantable Electronic Device (CIED) infection has been increasing in recent years. For pacemaker-dependent patients, a temporary pacemaker is needed before a new device can be implanted. The aim of this study is to evaluate the safety and efficacy of using a temporary pacing device with an externalized active fixation lead (bridge pacemaker) before a new device can be implanted in pacemaker-dependent patients with device infection. METHODS All patients who were admitted to our cardiac center with CIED infection and in need of bridge pacemaker implantation from April 2013 to August 2020 were prospectively enrolled in this observational study. The medical records of all patients were collected and evaluated. All procedure-related complications were also collected. Long-term outcomes, including reinfection and death within one year after hospital discharge, were collected through telephone follow-ups. RESULTS During the study period, 1,050 patients underwent CIED extraction, of which 312 pacemaker-dependent patients underwent bridge pacemaker implantation. The mean age of the extracted leads was 44±38.7 months. The bridge pacemakers were in use for a mean duration of six days. Nine patients developed procedure-related complications including pericardial tamponade, pneumothorax, peripheral venous thrombosis, and pulmonary embolism. Three patients developed complications that were related to their bridge pacemakers, including lead dislodgement, over-sensing and elevated pacing threshold. During the 1-year follow-up, it was found that four patients had developed CIED reinfection and three patients had died due to cardiac-related reasons. CONCLUSIONS A bridge pacemaker with an externalized active fixation lead is safe and efficacious for pacemaker-dependent patients with device infection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zengli Xiao
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Jinshan He
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Dandan Yang
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Youzhong An
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Xuebin Li
- Cardiovascular department, Peking University People's Hospital, Beijing, China
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18
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A perturbation approach for ultrafast calculation of RF field enhancements near medical implants in MRI. Sci Rep 2022; 12:4224. [PMID: 35273313 PMCID: PMC8913743 DOI: 10.1038/s41598-022-08004-7] [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: 09/03/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
Patients with medical implants often are deprived of magnetic resonance imaging examination because of safety risks. One specific risk is the enhancement of the radiofrequency fields around the medical implant potentially resulting in significant tissue heating and damage. The assessment of this enhancement is a computationally demanding task, with simulations taking hours or days to converge. Conventionally the source of the radiofrequency fields, patient anatomy, and the medical implant are simulated concurrently. To alleviate the computational burden, we reformulate a fast simulation method that views the medical implant as a small perturbation of the simulation domain without the medical implant and calculates the radiofrequency fields associated with this perturbation. Previously, this method required an extensive offline stage where the result is intractable for large simulation domains. Currently, this offline stage is no longer required and the method is completely online. The proposed method results in comparable radiofrequency fields but is orders of magnitude faster compared to standard simulation technique; the finite-difference time-domain, the finite-sums, and the finite element methods. This acceleration could enable patient-specific and potentially online radiofrequency safety assessment.
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19
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Lee KS, Oh O, Miller J, Hammash M, Thompson DR, Ski CF, Cameron J, Hwang SY, Moser DK. Patients' openness to discussing implantable cardioverter defibrillator deactivation at end of life: a cross-sectional study. Eur J Cardiovasc Nurs 2022; 21:687-693. [PMID: 35018427 DOI: 10.1093/eurjcn/zvab130] [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: 07/01/2021] [Revised: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/14/2022]
Abstract
AIMS It is recommended that patients and clinicians discuss end-of-life deactivation of their implantable cardioverter defibrillator (ICD) prior to device implantation and throughout the illness trajectory to facilitate shared decision-making. However, such discussions rarely occur, and little is known about patients' openness to this discussion. The purpose of this study was to explore factors associated with patients' openness to discussing end-of-life ICD deactivation with clinicians. METHODS AND RESULTS This cross-sectional study recruited 293 patients with an ICD from outpatient clinics in the USA, Australia, and South Korea. Patients were classified into an open or resistant group based on their desire to discuss device deactivation at end of life with clinicians. Multivariable logistic regression was used to explore factors related to patients' openness to this discussion.About half of the participants (57.7%) were open to discussing such issues with their clinicians. Factors related to patients' openness to discussing device deactivation at end of life were living with someone, not having severe comorbid conditions (cancer and/or chronic kidney disease), greater ICD knowledge, and more experience discussing end-of-life issues with clinicians (odds ratio: 0.479, 0.382, 1.172, 1.332, respectively). CONCLUSION Approximately half of the ICD recipients were reluctant to discuss device deactivation at end of life with clinicians. Unmodifiable factors were their living arrangement and severe comorbidity. ICD knowledge and prior experience discussing end-of-life issues were potentially modifiable factors in the future. These factors should be addressed when assessing patients' readiness for a shared discussion about device deactivation at end of life.
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Affiliation(s)
- Kyoung Suk Lee
- College of Nursing, Seoul National University, 103 Daehak-ro, Jong-ro, Seoul 03080, South Korea
| | - Oonjee Oh
- College of Nursing, Seoul National University, 103 Daehak-ro, Jong-ro, Seoul 03080, South Korea
| | - Jennifer Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast 97 Lisburn Rd, Belfast BT9 7BL, UK
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, 19 Neptune Quay, Ipswich IP4 1QJ, UK
| | - Jan Cameron
- School of Clinical Sciences at Monash Health, Monash University, 27-31 Wright Street, Clayton VIC 3168, Australia
| | - Seon Young Hwang
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
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20
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Lee JZ, Majmundar M, Kumar A, Thakkar S, Patel HP, Sorajja D, Valverde AM, Kalra A, Cha YM, Mulpuru SK, Asirvatham SJ, Desimone CV, Deshmukh AJ. Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices. Heart Rhythm 2021; 19:768-775. [PMID: 34968739 DOI: 10.1016/j.hrthm.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality and morbidity. OBJECTIVE This study sought to evaluate the impact of early versus delayed transvenous lead removal (TLR) on in-hospital mortality and outcomes in patients with CIED infection. METHODS Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2016, to December 31, 2018. The timing of the TLR procedure was determined based on hospitalization days after initial admission for CIED infection. The impact of early (≤ 7 days) versus delayed (> 7 days) TLR on mortality and major adverse events was studied. RESULTS Of 12,999 patients who underwent TLR for CIED infections, 8,834 patients underwent early TLR versus 4,165 patients who underwent delayed TLR. Delayed TLR was associated with a significant increase in in-hospital mortality (8.3% vs. 3.5%, adjusted odds ratio:1.70; 95% confidence interval, 1.43-2.03; P value<0.001). Subgroup analysis of patients with CIED infection and systemic infection showed that delayed TLR in patients with systemic infection was associated with a higher rate of in-hospital mortality compared with early TLR (10.4% vs. 7.5%, adjusted odds ratio:1.24; 95% confidence interval, 1.04-1.49; P value<0.019). Delayed TLR was also associated with significantly higher adjusted odds of major adverse events and post-procedural length of stay. CONCLUSIONS These data suggest that delayed transvenous lead removal in patients with CIED infections is associated with increased in-hospital mortality and major adverse events, especially in patients with systemic infection.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, NY; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH
| | | | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL
| | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Arturo M Valverde
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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21
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Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2021; 15:891-911. [PMID: 34922877 DOI: 10.1016/j.jcmg.2021.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and the Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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22
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Almonte M, Huston T, Yee SL, Karimaei R, Hort A, Rawlins M, Seet J, Nizich Z, McLellan D, Stobie P, Czarniak P, Chalmers L. Adherence to antimicrobial prophylaxis guidelines in cardiac implantable electronic device procedures in two Australian teaching hospitals. AUST HEALTH REV 2021; 45:761-770. [PMID: 34470697 DOI: 10.1071/ah21046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Objective This study investigated antibiotic prophylaxis (AP) guideline adherence and the cardiac implantable electronic device (CIED) infection rate in two major Australian public teaching hospitals. Methods In a retrospective observational study, the medical records of patients who underwent CIED procedures between January and December 2017 were reviewed (Hospital A, n = 400 procedures; Hospital B, n = 198 procedures). Adherence to AP guidelines was assessed regarding drug, dose, timing, route and frequency. Infection was identified using follow-up documentation. Results AP was administered in 582 of 598 procedures (97.3%). Full guideline adherence was observed in 33.9% of procedures (203/598) and differed significantly between Hospitals A and B (47.3% vs 7.1%, respectively; P < 0.001). Common reasons for non-adherence were the timing of administration (42.3% vs 60.6% non-adherent in Hospitals A and B, respectively; P < 0.001) and repeat dosing (19.3% vs 78.8% non-adherent in Hospitals A and B, respectively; P < 0.001). Twenty infections were identified over 626.6 patient-years of follow-up (mean (±s.d.) follow-up 1.0 ± 0.3 years). The infection rate was 3.19 per 100 patient-years (P = 0.99 between hospitals). Two devices were removed due to infection; no patients died from CIED infection. Conclusions Although the rate of serious CIED infection was low, there was evidence of highly variable and suboptimal antibiotic use, and potential overuse of AP. What is known about the topic? Previous Australian studies have revealed high rates of inappropriate surgical AP. CIED infections are potentially life threatening, but can be avoided through effective use of AP. However, prolonged durations of AP in this setting may also result in complications, including Clostridioides difficile infection. What does this paper add? This study, the first to our knowledge to focus specifically on adherence to Australian guidelines for AP in CIED procedures, highlighted several common issues between AP in this setting and surgical and procedural AP more broadly. 'Early' and 'late' dose administration and extended post-procedural AP were common. Only 34% of prescriptions fully adhered to the guidelines; practices varied significantly between the two hospitals. What are the implications for practitioners? There is a clear need for institution-specific antimicrobial stewardship strategies to optimise AP in CIED procedures, aligned with the Antimicrobial Stewardship Clinical Care Standard. Patients are being placed at potentially avoidable risk of both complications of extended durations of AP and CIED infection, although the rate of serious CIED infection was low. A standardised approach to surveillance of CIED infections and prospective multisite audits of AP in CIED procedures using a validated tool, such as the Surgical National Antimicrobial Prescribing Survey, are recommended to better inform evidence-based practice. Potential strategies to optimise guideline adherence include prescribing support in patients with immediate penicillin hypersensitivity or methicillin-resistant Staphylococcus aureus colonisation, optimising the in-patient location of drug administration to promote timely dosing, limiting inappropriate post-procedural prophylaxis and routine S. aureus screening and decolonisation.
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Affiliation(s)
- Monique Almonte
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Northlands Pharmacy, Balcatta, WA, Australia
| | - Taylor Huston
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: TerryWhite Chemmart Leeming, Leeming, WA, Australia
| | - Sok Ling Yee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Pharmacy Alliance, Albany, WA, Australia
| | - Roya Karimaei
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Pharmacy 777 Lynwood, Lynwood, WA, Australia
| | - Adam Hort
- Pharmacy Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia. ;
| | - Matthew Rawlins
- Pharmacy Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia. ;
| | - Jason Seet
- Pharmacy Department, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA, Australia. ;
| | - Zachiah Nizich
- Pharmacy Department, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA, Australia. ;
| | - Duncan McLellan
- Infectious Diseases Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia.
| | - Paul Stobie
- Department of Cardiovascular Medicine, North Metropolitan Health Service, Nedlands, WA, Australia.
| | - Petra Czarniak
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Curtin Medical School, Curtin University, Bentley, WA, Australia.
| | - Leanne Chalmers
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Curtin Medical School, Curtin University, Bentley, WA, Australia. ; and Corresponding author.
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23
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Kim UH, Kim MY, Park EA, Lee W, Lim WH, Kim HL, Oh S, Jin KN. Deep Learning-Based Algorithm for the Detection and Characterization of MRI Safety of Cardiac Implantable Electronic Devices on Chest Radiographs. Korean J Radiol 2021; 22:1918-1928. [PMID: 34431249 PMCID: PMC8546129 DOI: 10.3348/kjr.2021.0201] [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: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 02/02/2023] Open
Abstract
Objective With the recent development of various MRI-conditional cardiac implantable electronic devices (CIEDs), the accurate identification and characterization of CIEDs have become critical when performing MRI in patients with CIEDs. We aimed to develop and evaluate a deep learning-based algorithm (DLA) that performs the detection and characterization of parameters, including MRI safety, of CIEDs on chest radiograph (CR) in a single step and compare its performance with other related algorithms that were recently developed. Materials and Methods We developed a DLA (X-ray CIED identification [XCID]) using 9912 CRs of 958 patients with 968 CIEDs comprising 26 model groups from 4 manufacturers obtained between 2014 and 2019 from one hospital. The performance of XCID was tested with an external dataset consisting of 2122 CRs obtained from a different hospital and compared with the performance of two other related algorithms recently reported, including PacemakerID (PID) and Pacemaker identification with neural networks (PPMnn). Results The overall accuracies of XCID for the manufacturer classification, model group identification, and MRI safety characterization using the internal test dataset were 99.7% (992/995), 97.2% (967/995), and 98.9% (984/995), respectively. These were 95.8% (2033/2122), 85.4% (1813/2122), and 92.2% (1956/2122), respectively, with the external test dataset. In the comparative study, the accuracy for the manufacturer classification was 95.0% (152/160) for XCID and 91.3% for PPMnn (146/160), which was significantly higher than that for PID (80.0%,128/160; p < 0.001 for both). XCID demonstrated a higher accuracy (88.1%; 141/160) than PPMnn (80.0%; 128/160) in identifying model groups (p < 0.001). Conclusion The remarkable and consistent performance of XCID suggests its applicability for detection, manufacturer and model identification, as well as MRI safety characterization of CIED on CRs. Further studies are warranted to guarantee the safe use of XCID in clinical practice.
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Affiliation(s)
- Ue-Hwan Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Moon Young Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Nam Jin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.
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24
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Liberato ACS, Raitt MH, Zarraga IGE, MacMurdy KS, Dougherty CM. Health-Related Quality of Life in the Spironolactone to Reduce ICD Therapy (SPIRIT) Trial. Clin Nurs Res 2021; 31:588-597. [PMID: 34362264 DOI: 10.1177/10547738211036817] [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
To describe health related quality of life (HRQOL) and symptoms in the SPIRIT trial and determine effects of implantable cardioverter defibrillator (ICD) shocks on HRQOL over 24 months. Ninety participants aged 66 ± 10 years, 96% men, 75% with NYHA class II, with an ICD were randomized to spironolactone 25 mg (N = 44) or placebo (N = 46). HRQOL was measured every 6 months for 24 months using: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling compared changes in HRQOL over-time and ANCOVA compared HRQOL between those getting an ICD shock or not. Over 24-months, there were no differences in HRQOL between the spironolactone versus placebo groups. Those with at least one ICD shock reported significantly lower HRQOL and more symptoms at 6- and 24-months. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms.
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Affiliation(s)
| | - Merritt H Raitt
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | | | - Karen S MacMurdy
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | - Cynthia M Dougherty
- University of Washington, Seattle, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
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25
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Pecha S, Ziegelhoeffer T, Yildirim Y, Choi YH, Willems S, Reichenspurner H, Burger H, Hakmi S. Safety and efficacy of transvenous lead extraction of very old leads. Interact Cardiovasc Thorac Surg 2021; 32:402-407. [PMID: 33257960 DOI: 10.1093/icvts/ivaa278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Transvenous lead extraction using mechanical rotational- or laser sheaths is an established procedure. Lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications. We therefore investigated the safety and efficacy of transvenous extraction of leads with an implant duration of more than 10 years. METHODS Between January 2013 and March 2017, a total of 403 patients underwent lead extraction in 2 high-volume lead extraction centres. One hundred and fifty-four patients with extraction of at least 1 lead aged over 10 years were included in this analysis. Laser lead extraction was the primary extraction method, with additional use of mechanical rotational sheaths or femoral snares, if necessary. All procedural- and patient-based data were collected into a database and retrospectively analysed. RESULTS Mean patient's age was 65.8 ± 15.8 years, 68.2% were male. Three hundred and sixty-two leads had to be extracted. The mean lead dwell time of treated leads was 14.0 ± 6.1 years. Complete procedural success was achieved in 91.6% of cases, while clinical success was achieved in 96.8%. Failure of extraction occurred in 3.2%. Leads that could not be completely removed had a significantly longer lead dwell time (18.2 vs 13.2 years; P = 0.016). Additional mechanical rotational sheaths or femoral snares were used in 26 (16.9%) patients. Overall complication rate was 4.6%, including 5 (3.3%) major and 2 (1.3%) minor complications. There was no procedure-related mortality. CONCLUSIONS Transvenous lead extraction in leads aged over 10 years is safe and effective when performed in specialized centres and with use of multiple tools and techniques. Leads that could not be completely extracted had a statistically significant longer lead dwell time.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.,Justus-Liebig-University Gießen, Campus Kerckhoff-Klinik, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt/Main, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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26
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Zhou X, Ze F, Li X, Wang B. Efficacy and safety of transvenous lead extraction in the Chinese octogenarian patients. Clin Cardiol 2021; 44:971-977. [PMID: 34137040 PMCID: PMC8259144 DOI: 10.1002/clc.23629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. We report the safety and effectiveness of transvenous lead extraction in Chinese octogenarian patients. HYPOTHESIS Transvenous lead extraction can be performed safely and successfully in the Chinese octogenarians. METHODS We retrospectively identified all patients who underwent TLE at our institution between March 2013 and January 2021. This population was divided into the following two groups based solely on age: octogenarians and non-octogenarians. These two groups were compared on the basis of several characteristics and clinical outcomes. RESULTS Consecutive 1106 patients were analyzed, including 184 (16.6%) octogenarians and 922(83.4%) non-octogenarians. The octogenarians presented more comorbidities. A total of 378 leads and 2004 leads were removed from the patients in the octogenarian group and non-octogenarian group, respectively. The mean lead implant duration was 6.1 ± 5.1 and 5.8 ± 4.6 years for octogenarians and non-octogenarians (p = 0.296). The majority of the patients in both groups underwent TLE through the femoral approach (67.5% vs 61.6%, p = 0.14). The complete procedure success rate was similar between the octogenarian and non-octogenarian group (96.7% vs.95.3%, p = 0.39). There were no differences with respect to the proportion of minor, major complications and deaths. Long-term mortality (median time 3.3 years) after TLE in octogenarians was significantly higher compared with younger individuals. CONCLUSIONS At experienced centers, transvenous lead extraction can be performed safely in Chinese octogenarians with procedural success rate and complication rate comparable to younger individuals.
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Affiliation(s)
- Xu Zhou
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Feng Ze
- Department of Cardiac ElectrophysiologyPeking University People's HospitalBeijingChina
| | - Xuebin Li
- Department of Cardiac ElectrophysiologyPeking University People's HospitalBeijingChina
| | - Bin Wang
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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27
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Dahiya G, Wetzel A, Kyvernitakis A, Gevenosky L, Williams R, Shah M, Farah V, Doyle M, Biederman RW. Impact of magnetic resonance imaging on functional integrity of non-conditional cardiovascular implantable electronic devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1312-1319. [PMID: 34133778 DOI: 10.1111/pace.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) have historically restricted the use of magnetic resonance imaging (MRI) due to the potential clinical and configurational risks associated with electromagnetic interference. In this study, the authors investigated the impact of MRI on the functional integrity of non-conditional CIEDs and their clinical correlates. METHODS In this prospective, observational single-center study, we enrolled patients undergoing MRI over a 5-year period. Prior to assessing the impact of MRI on CIEDs, we performed interrogations in sequential duplication to assess the intrinsic variability of devices. Subsequently, we performed interrogations immediately after MRI, and monitored changes in device parameters and clinical events. RESULTS We completed 492 MRI studies, 58% in patients with permanent pacemakers (PPMs) and 42% with implantable cardioverter defibrillators (ICDs). Subsequent MRI exposures occurred in 15% encounters. Accounting for intrinsic variability in CIED leads, there were no significant changes in RA, RV, or LV parameters after MRI, regardless of the region imaged (thoracic vs. non-thoracic), type of CIED (PPMs vs. ICDs) and among those with serial MRIs. When ranked for % change pre- to post-MRI, the majority of RA, RV, and LV metrics for thresholds, sensing, and impedance conformed to ≤20% change from baseline. No significant clinical adverse cardiac events or effect on device microcircuitry occurred during the study. CONCLUSION Incorporating a novel reproducibility tactic, there were neither clinically meaningful device parameter changes nor adverse clinical events during or following MRIs, suggesting the effects of MRI on non-conditional CIED integrity are far less than previously perceived.
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Affiliation(s)
- Garima Dahiya
- Departments of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adam Wetzel
- Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andreas Kyvernitakis
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Loretta Gevenosky
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Ronald Williams
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Moneal Shah
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Victor Farah
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark Doyle
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Robert Ww Biederman
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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A Review of Cardiac Implantable Electronic Device Infections for the Practicing Electrophysiologist. JACC Clin Electrophysiol 2021; 7:811-824. [PMID: 34167758 DOI: 10.1016/j.jacep.2021.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
Cardiovascular implantable electronic device (CIED) infections are morbid, costly, and difficult to manage. This review explores the pathophysiology, diagnosis, and management of CIED infections. Diagnostic accuracy has been improved through increased awareness and improved imaging strategies. Pocket or bloodstream infection with virulent organisms often requires complete system extraction. Emerging prophylactic interventions and novel devices have expanded preventative strategies and options for re-implantation. A clear and nuanced understanding of CIED infection is important to the practicing electrophysiologist.
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Seiler A, Biundo E, Di Bacco M, Rosemas S, Nicolle E, Lanctin D, Hennion J, de Melis M, Van Heel L. Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: Time and Motion Workflow Evaluation. JMIR Cardio 2021; 5:e27720. [PMID: 34156344 PMCID: PMC8556635 DOI: 10.2196/27720] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/02/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows. CLINICALTRIAL
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ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case. Case Rep Infect Dis 2021; 2021:9250967. [PMID: 34055431 PMCID: PMC8112929 DOI: 10.1155/2021/9250967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections, and pocket-site infections, primarily involving Staphylococcus species. Infective endocarditis is a rare but life-threatening complication of gonococcal bacteremia. We report the first case of a CIED pocket-site infection secondary to Neisseria gonorrhoeae (N. gonorrhoeae). Case A 56-year-old male with a history of congestive heart failure status postimplantable cardioverter-defibrillator (ICD) insertion presented with a pocket-site swelling initially concerning for a hematoma which began to exhibit erythema and tenderness. The patient reported a history of high-risk sexual behavior. On presentation, he was afebrile and hemodynamically stable. Physical exam showed a 5 cm × 6 cm pocket-site swelling with overlying erythema. Labs revealed elevated ESR and CRP levels. Transthoracic and transesophageal echocardiography was concerning for infective endocarditis and lead vegetations. Blood cultures tested positive for N. gonorrhoeae. He underwent surgical debridement with complete ICD extraction and drainage of infected serosanguineous pocket fluid. Tissue cultures were negative, but isolation of N. gonorrhoeae in blood cultures confirmed it as the causative agent of the pocket-site infection in the absence of prior Gram-positive coverage. He was started on a prolonged course of ceftriaxone for 4 weeks with reimplantation of ICD at a different site after completion of treatment. Conclusion In patients with high-risk sexual behavior, gonococcal bacteremia can potentially lead to CIED infection. These individuals should be prudently evaluated for infective endocarditis or pocket-site infections as presenting complaints can be subtle.
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Comparison of new implantation of cardiac implantable electronic device between tertiary and non-tertiary hospitals: a Korean nationwide study. Sci Rep 2021; 11:3705. [PMID: 33723278 PMCID: PMC7961055 DOI: 10.1038/s41598-021-83160-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/28/2021] [Indexed: 01/09/2023] Open
Abstract
This study compared the characteristics and mortality of new implantation of cardiac implantable electronic device (CIED) between tertiary and non-tertiary hospitals. From national health insurance claims data in Korea, 17,655 patients, who underwent first and new implantation of CIED between 2013 and 2017, were enrolled. Patients were categorized into the tertiary hospital group (n = 11,560) and non-tertiary hospital group (n = 6095). Clinical outcomes including in-hospital death and all-cause death were compared between the two groups using propensity-score matched analysis. Patients in non-tertiary hospitals were older and had more comorbidities than those in tertiary hospitals. The study population had a mean follow-up of 2.1 ± 1.2 years. In the propensity-score matched permanent pacemaker group (n = 5076 pairs), the incidence of in-hospital death (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.43–1.32, p = 0.33) and all-cause death (hazard ratio [HR]: 0.92, 95% CI 0.81–1.05, p = 0.24) were not significantly different between tertiary and non-tertiary hospitals. These findings were consistently observed in the propensity-score matched implantable cardioverter-defibrillator group (n = 992 pairs, OR for in-hospital death: 1.76, 95% CI 0.51–6.02, p = 0.37; HR for all-cause death: 0.95, 95% CI 0.72–1.24, p = 0.70). In patients undergoing first and new implantation of CIED in Korea, mortality was not different between tertiary and non-tertiary hospitals.
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Burger H, Hakmi S, Petersen J, Yildirim Y, Choi YH, Willems S, Reichenspurner H, Ziegelhoeffer T, Pecha S. Safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:601-606. [PMID: 33594705 DOI: 10.1111/pace.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the aging population equipped with cardiac implantable electronic devices, an increasing number of octogenarians require lead extractions. This patient population is often considered as a high-risk group for surgical procedures. We, therefore, investigated the safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths. METHODS Between January 2013 and March 2017, 403 patients underwent lead extraction at two high-volume lead extraction centers. A total of 71 octogenarians were treated with laser lead extraction and were included in this analysis. Primary extraction method was laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. Patient-based and procedural data were collected and analyzed retrospectively. RESULTS Mean age was 83.5 ± 3.3 years, 64.7% were males. A total of 152 leads were extracted. The mean lead dwell time of treated leads was 10.2 ± 5.2 years. Complete procedural success rate was 92.9%, while clinical success was achieved in 98.6%. Failure of extraction occurred in one patient (1.4%). In six (7.7%) patients, additional mechanical rotational sheaths or femoral snares were used. Overall complication rate was 4.2%, including one (1.4%) major (RA perforation) and two (2.8%) minor complications. No procedure-related mortality was observed in any of the patients. CONCLUSION Transvenous lead extraction in octogenarians with old leads is safe and effective when performed in experienced centers. Patient's age should therefore not be considered as contraindication for lead extraction using powered extraction sheaths.
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Affiliation(s)
- Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.,Campus Kerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | | | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
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Abstract
In the past several decades there has been a continuous growth in the field of cardiac implantable electronic devices (CIED) implantation procedures as well as their technological development. CIEDs utilize transvenous leads that are introduced into the heart via the axillary, subclavian, or cephalic veins, as well as a devices generator that is implanted in a subcutaneous pocket, typically in the pre-pectoral region. Despite this significant improvement, complication rates range from 1-6% with current implant tools and techniques. In this review we will discuss the three central parts of the CIED implantation procedure, their impact on implantation site, infections, and possibilities for its prevention.
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Affiliation(s)
- Jane Taleski
- Electrophysiology and Electrostimulation, University Clinic of Cardiology, Skopje, MKD
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Traykov V, Bongiorni MG, Boriani G, Burri H, Costa R, Dagres N, Deharo JC, Epstein LM, Erba PA, Snygg-Martin U, Nielsen JC, Poole JE, Saghy L, Starck C, Strathmore N, Blomström-Lundqvist C. Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association. Europace 2020; 21:1270-1279. [PMID: 31209483 DOI: 10.1093/europace/euz137] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. METHODS AND RESULTS A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively. CONCLUSION Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory.
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Affiliation(s)
- Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Maria Grazia Bongiorni
- Cardiology and Arrhythmology Division, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- System Director, Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa, AOUP, Italy and Department on Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Laszlo Saghy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia
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Lin AY, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Safety and Efficacy of Cardiovascular Implantable Electronic Device Extraction in Elderly Patients: A Meta-Analysis and Systematic Review. Heart Rhythm O2 2020; 1:250-258. [PMID: 33604584 PMCID: PMC7889020 DOI: 10.1016/j.hroo.2020.07.005] [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] [Indexed: 11/29/2022] Open
Abstract
Background Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 - 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 - 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 - 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 - 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 - 2.29, p = 0.13). Conclusion In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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Ishiguchi H, Ishikura M, Yoshida M, Imoto K, Sonoyama K, Kawabata T, Ishihara Y, Yoshiga Y, Shimizu A, Oda T. Incidence and risk factors for cardiac implantable electronic device infection in current clinical settings in a Japanese population: A 20-year single-center observational study. J Cardiol 2020; 76:115-122. [DOI: 10.1016/j.jjcc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
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Yildirim Y, Petersen J, Tönnis T, Reichenspurner H, Pecha S. Hybrid transvenous lead extraction during cardiac surgery for valvular endocarditis. J Cardiovasc Electrophysiol 2020; 31:2101-2106. [PMID: 32478463 DOI: 10.1111/jce.14595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In patients with endocarditis and cardiac implantable electronic devices (CIED), lead extraction is recommended according to current guidelines. In patients with short lead implant duration, lead extraction by manual traction might be sufficient for intraoperative lead removal. However, in patients with long implant duration, specialized extraction tools like laser or mechanical rotational sheaths are necessary. We report our experience with transvenous lead extraction during concomitant cardiac surgery for valvular endocarditis using mechanical rotational sheaths. METHODS AND RESULTS Between December 2018 and April 2020, 12 patients were treated with transvenous lead extraction during open-heart surgery using mechanical rotational sheaths. Cardiac surgery was performed due to mitral, aortic, or tricuspid valve endocarditis. All patient-related and procedural data were collected, and in-hospital outcome was analyzed retrospectively. Mean patients' age was 65.2 ± 16.4 years, and 75.0% were male. Nine atrial, 15 ventricular, and 2 coronary sinus leads had to be extracted. The mean time from initial lead implantation was 94.3 ± 39.7 months. Complete procedural success was achieved in all patients with no major but one minor complication (pocket hematoma) occurring during lead extraction. Four patients with pacemaker dependency received epicardial leads, seven patients were treated in a two-step approach with endocardial leads, whereas one patient had no further CIED indication. No procedure-related mortality was seen. In-hospital survival was 91.7%. CONCLUSIONS Valvular endocarditis surgery in combination with lead extraction using mechanical rotational sheaths is safe and feasible. It results in a high procedural success rate with prompt infection control by immediate removal of all infected lead materials.
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Affiliation(s)
- Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Tobias Tönnis
- Department of Cardiology, Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
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Giannotti Santoro M, Segreti L, Zucchelli G, Barletta V, Fiorentini F, Di Cori A, De Lucia R, Bongiorni MG. Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:382-387. [PMID: 32144936 DOI: 10.1111/pace.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/09/2020] [Accepted: 03/02/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. METHODS Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2: < 80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. RESULTS Our analysis included 1316 patients (group 1: 202; group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities, more pacemakers than implantable cardioverter-defibrillators, whereas the dwelling time of the oldest lead and the number of leads were similar, irrespective of patient's age. In group 1, the radiological success rate for lead was higher (99.0% vs 95.9%; P < .001) and the fluoroscopy time lower (13.0 vs 15.0 min; P = .04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P = .36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P = .24) and with no procedure-related deaths in elderly group. CONCLUSIONS Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure.
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Affiliation(s)
| | - Luca Segreti
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Di Cori
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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39
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Transvenous excimer laser-assisted lead extraction of cardiac implantable electrical devices in the Japanese elderly population. J Cardiol 2020; 75:410-414. [DOI: 10.1016/j.jjcc.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
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Cipriano R, Gupta A, Subzposh F, McCaffrey JA, Koman E, Fridman D, Saltzman H, Kutalek SP. Outcomes of Standard Permanent Active Fixation Leads for Temporary Pacing. JACC Clin Electrophysiol 2020; 6:304-310. [DOI: 10.1016/j.jacep.2019.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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41
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Training, Triggers, and a Team for the Right Discussions. J Am Coll Cardiol 2019; 74:1693-1696. [DOI: 10.1016/j.jacc.2019.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
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Contractor T, Cooper JM, Parwani P, Abudayyeh I, Rubio MG, Mandapati R. Double trouble: Management of implantable cardioverter-defibrillator infection in the setting of severe aortic stenosis. HeartRhythm Case Rep 2019; 5:489-493. [PMID: 31700791 PMCID: PMC6831764 DOI: 10.1016/j.hrcr.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Diaz CL, Guo X, Whitman IR, Marcus GM, Pellegrini CN, Beygui RE, Lee SY, Lee BK. Reported mortality with rotating sheaths vs. laser sheaths for transvenous lead extraction. Europace 2019; 21:1703-1709. [DOI: 10.1093/europace/euz238] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Rotating sheaths and laser sheaths are commonly used for transvenous lead extraction. This study aims to compare observed mortality between both approaches.
Methods and results
The Manufacturer and User Facility Device Experience database was searched from 2011 to 2016 to determine number of deaths associated with each sheath. An independent analytics firm provided estimates for number of cases done, allowing calculation of market share. A sensitivity analysis was performed to determine relative risk (RR) of mortality at the calculated market share (36% rotating/64% laser) and two others. Additional sensitivity analyses assumed underreporting of deaths associated with rotating sheaths. An estimated 50 545 extractions were performed. Thirteen deaths were associated with rotating sheaths compared to 167 with laser sheaths. Of these, 92% (rotating) and 95% (laser) were due to cardiovascular injury. At the calculated market share, the RR of death was 7.2 times greater with laser sheaths [95% confidence interval (CI) 4.1–12.7, P < 0.0001]. At market share estimates of 25% rotating/75% laser and 45% rotating/55% laser, the RR of death with laser sheaths was 4.3 (95% CI 2.4–7.5, P < 0.0001) and 10.5 times greater (95% CI 6.0–18.5, P < 0.0001), respectively. The RR of death remained significant when assuming deaths with rotating sheaths were underreported and when deaths using both sheaths were attributed to the rotating sheath.
Conclusions
Lead extraction with laser sheaths appears to be associated with a higher risk of mortality compared to rotating sheaths. Further studies are warranted to confirm this finding.
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Affiliation(s)
- Celso L Diaz
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gregory M Marcus
- Department of Medicine, Division of Cardiology, University of California, 500 Parnassus Avenue, Millberry Union East Room 429, San Francisco, CA, USA
| | - Cara N Pellegrini
- Department of Medicine, Division of Cardiology, University of California, 500 Parnassus Avenue, Millberry Union East Room 429, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, San Francisco VAMC, San Francisco, CA, USA
| | - Ramin E Beygui
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - Sun Yong Lee
- Department of Medicine, Division of Cardiology, University of California, 500 Parnassus Avenue, Millberry Union East Room 429, San Francisco, CA, USA
| | - Byron K Lee
- Department of Medicine, Division of Cardiology, University of California, 500 Parnassus Avenue, Millberry Union East Room 429, San Francisco, CA, USA
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Stoevelaar R, Brinkman-Stoppelenburg A, van Driel AG, van Bruchem-Visser RL, Theuns DA, Bhagwandien RE, Van der Heide A, Rietjens JA. Implantable cardioverter defibrillator deactivation and advance care planning: a focus group study. Heart 2019; 106:190-195. [PMID: 31537636 PMCID: PMC6993024 DOI: 10.1136/heartjnl-2019-315721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022] Open
Abstract
Objective Implantable cardioverter defibrillators can treat life-threatening arrhythmias, but may negatively influence the last phase of life if not deactivated. Advance care planning conversations can prepare patients for future decision-making about implantable cardioverter defibrillator deactivation. This study aimed at gaining insight in the experiences of patients with advance care planning conversations about implantable cardioverter defibrillator deactivation. Methods In this qualitative study, we held five focus groups with 41 patients in total. Focus groups were audio-recorded and transcribed. Transcripts were analysed thematically, using the constant comparative method, whereby themes emerging from the data are compared with previously emerged themes. Results Most patients could imagine deciding to have their implantable cardioverter defibrillator deactivated, for instance because the benefits of an active device no longer outweigh the harm of unwanted shocks, when having another life-limiting illness, or when relatives would think this would be in their best interest. Some patients expressed a need for advance care planning conversations with a healthcare professional about deactivation, but few had had these. Others did not, saying they solely focused on living. Some patients were hesitant to record their preferences about deactivation in advance care directives, because they were unsure whether their current preferences would reflect future preferences. Conclusions Although patients expressed a need for more information, advance care planning conversations about implantable cardioverter defibrillator deactivation seemed to be uncommon. Deactivation should be more frequently addressed by healthcare professionals, tailored to the disease stage of the patient and readiness to discuss this topic.
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Affiliation(s)
- Rik Stoevelaar
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Anne Geert van Driel
- Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.,Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Clémenty N, Carion PL, Léotoing LD, Lamarsalle L, Wilquin-Bequet F, Brown B, Verhees KJP, Fernandes J, Deharo JC. Infections and associated costs following cardiovascular implantable electronic device implantations: a nationwide cohort study. Europace 2019; 20:1974-1980. [PMID: 29672690 DOI: 10.1093/europace/eux387] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/08/2018] [Indexed: 11/12/2022] Open
Abstract
Aims This study assessed the contemporary occurrence of cardiac device infections (CDIs) following implantation in French hospitals and estimated associated costs. Methods and Results A retrospective analysis was conducted on the French National Hospital Database (PMSI). Patients with a record of de novo cardiac implantable electronic device (CIED) implantation or replacement interventions in France in 2012 were identified and followed until the end of 2015. Cardiac device infections (CDIs) were identified based on coding using the French classification for procedures [Classification Commune des Actes Médicaux (CCAM)] and International Classification of Diseases (ICD-10). Associated costs were estimated based on direct costs from the perspective of the French social security system. In total 78 267 CIED patients (72% de novo implants) were identified (15% defibrillators; 84% pacemakers). The 36-month infection rate associated with de novo defibrillator-only implants, as well as for cardiac resynchronisation therapy - defibrillators (CRT-Ds) was 1.6%. The CDI risk was 2.9% and 3.9% for replacement ICDs and CRT-Ds. Infection rates were lower for de novo single-chamber pacemaker (SCP)/dual-chamber pacemaker (DCP) (0.5%) and cardiac resynchronisation therapy - pacemaker (CRT-P) implants (1.0%), while for replacement procedures the risk increased to 1.4% (SCP/DCP) and 1.3% (CRT-P). Mean infection-related costs over 24 months were €20 623 and €23 234 for CDIs associated with replacement and de novo procedures, and overall costs were not significantly different between pacemaker and defibrillator patients. Conclusion Cardiac device infections in France are associated with substantial costs, when considering inpatient hospitalizations. Strategies to minimize the rate of CIED infection should be a priority for health care providers and payers.
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Affiliation(s)
- Nicolas Clémenty
- Centre Hospitalier Régional Universitaire de Tours, Boulevard Tonnellé, Tours, France
| | - Phuong Lien Carion
- Medtronic France, Quai Alphonse le Gallo 27, Boulogne-Billancourt, France
| | - Lucie de Léotoing
- HEVA, Health Economics and Outcomes Research, Avenue Thiers 186, Lyon, France
| | - Ludovic Lamarsalle
- HEVA, Health Economics and Outcomes Research, Avenue Thiers 186, Lyon, France
| | | | - Benedict Brown
- Medtronic International Trading Sàrl, Route du Molliau 31, Tolochenaz, Switzerland
| | - Koen J P Verhees
- Medtronic, Bakken Research Center (BRC), Endepolsdomein 5, GW, Maastricht, The Netherlands
| | - Jérôme Fernandes
- OC Santé, Centre Médical Odysseum, Avenue Nina Simone 194, CS, Montpellier, France
| | - Jean-Claude Deharo
- Centre Hospitalier Universitaire (CHU), Hôpital de la Timone, Medical School of Marseille, Department of Cardiology, Rue Saint-Pierre 264, Marseille, France
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Steinhaus DA, Lubitz SA, Noseworthy PA, Kramer DB. Exercise Interventions in Patients With Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2019; 39:308-317. [PMID: 31397767 PMCID: PMC6715540 DOI: 10.1097/hcr.0000000000000389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. METHODS We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. RESULTS A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P < .001). (Equation is included in full-text article.)O2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P < .001). CONCLUSION In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
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Affiliation(s)
- Daniel A. Steinhaus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Steven A. Lubitz
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
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Burnhope E, Rodriguez-Guadarrama Y, Waring M, Guilder A, Malhotra B, Razavi R, Rinaldi CA, Pennington M, Carr-White G. Economic impact of introducing TYRX amongst patients with heart failure and reduced ejection fraction undergoing implanted cardiac device procedures: a retrospective model based cost analysis. J Med Econ 2019; 22:464-470. [PMID: 30744444 DOI: 10.1080/13696998.2019.1581621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Infection is a serious and expensive complication of Cardiac Implantable Electronic Device (CIED) procedures. A retrospective based cost analysis was performed to estimate Trust level savings of using the TYRX antibacterial envelope as a primary prevention measure against infection in a tertiary referral centre in South London, UK. METHODS A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures were evaluated. Decision-analytic modelling was performed to determine economic savings of using the envelope during CIED procedure vs CIED procedure alone. RESULTS Over a 12 month follow-up period following CIED procedure, the observed infection rate was 3.14% (n = 5/159). The average cost of a CIED infection inpatient admission was £41,820 and, further to economic analysis, the additional costs attributable to infection was calculated at £62,213.94. A cost saving of £624 per patient by using TYRX during CIED procedure as a primary preventative measure against infection was estimated. CONCLUSIONS TYRX would be a cost-saving treatment option amongst heart failure patients undergoing ICD and CRT device procedures based on analysis in the local geographical area of South London. If upscaled to the UK population, we estimate potential cost savings for the National Health Service (NHS).
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Affiliation(s)
- Emma Burnhope
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
- b Cardiology, Guy's and St Thomas Hospital , London , UK
| | - Yael Rodriguez-Guadarrama
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Michael Waring
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Andrew Guilder
- c Health Informatics, Guy's and St Thomas NHS Foundation Trust , London , UK
| | - Bharti Malhotra
- d TOHETI, Kings College London , London , UK
- e TOHETI, Guys and St. Thomas Hospital , London , UK
| | - Reza Razavi
- f Vice President, Kings College London , London , UK
| | - C A Rinaldi
- b Cardiology, Guy's and St Thomas Hospital , London , UK
| | - Mark Pennington
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Gerald Carr-White
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
- b Cardiology, Guy's and St Thomas Hospital , London , UK
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Ahtela E, Oksi J, Porela P, Ekström T, Rautava P, Kytö V. Trends in occurrence and 30-day mortality of infective endocarditis in adults: population-based registry study in Finland. BMJ Open 2019; 9:e026811. [PMID: 31005935 PMCID: PMC6500343 DOI: 10.1136/bmjopen-2018-026811] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a life-threatening disease associated with significant mortality. We studied recent temporal trends and age and sex differences in the occurrence and short-term mortality of IE. DESIGN Population based retrospective cohort study. SETTING Data of IE hospital admissions in patients aged ≥18 years in Finland during 2005-2014 and 30-day all-cause mortality data were retrospectively collected from mandatory nationwide registries from 38 hospitals. OUTCOMES Trends and age and sex differences in occurrence. Thirty-day mortality. RESULTS There were 2611 cases of IE during the study period (68.2% men, mean age 60 years). Female patients were significantly older than males (62.0 vs 59.0 years, p=0.0004). Total standardised annual incidence rate of IE admission was 6.33/100 000 person-years. Men had significantly higher risk of IE compared with women (9.5 vs 3.7/100 000; incidence rate ratios [IRR] 2.49; p<0.0001) and difference was most prominent at age 40-59 years (IRR 4.49; p<0.0001). Incidence rate varied from 5.7/100 000 in 2005 to 7.1/100 000 in 2012 with estimated average 2.1% increase per year (p=0.036) and similar trends in both sexes. Significant increasing trend was observed in patients aged 18-29 years and 30-39 years (estimated annual increase 7.6% and 7.2%, p=0.002) and borderline in patients aged 40-49 years (annual increase 3.8%, p=0.08). In older population, IE incidence rate remained stable. The overall 30-day mortality after IE admission was 11.3%. Mortality was similar between sexes, increased with ageing, and remained similar during the study period. CONCLUSIONS Occurrence of IE is increasing in young adults in Finland. Men, especially middle-aged, are at higher risk for IE compared with women. Thirty-day mortality has remained stable at 11%, increased with ageing, and was similar between sexes.
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Affiliation(s)
- Elina Ahtela
- Infectious Diseases, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Infectious Diseases, Turku University Hospital, Turku, Finland
| | - Pekka Porela
- Heart Center, Turku University Hospital, Turku, Finland
| | - Tommi Ekström
- Heart Center, Turku University Hospital, Turku, Finland
| | - Paivi Rautava
- Clinical Research Centre, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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Singh A, Kawaji K, Goyal N, Nazir NT, Beaser A, O'Keefe-Baker V, Addetia K, Tung R, Hu P, Mor-Avi V, Patel AR. Feasibility of Cardiac Magnetic Resonance Wideband Protocol in Patients With Implantable Cardioverter Defibrillators and Its Utility for Defining Scar. Am J Cardiol 2019; 123:1329-1335. [PMID: 30739658 DOI: 10.1016/j.amjcard.2019.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 02/03/2023]
Abstract
Implantable cardioverter defibrillators (ICDs) have been a relative contraindication to cardiovascular magnetic resonance imaging. Although cardiovascular magnetic resonance provides valuable information regarding scar in patients with ventricular arrhythmias or cardiomyopathy, ICDs in these patients frequently cause artifacts hindering accurate interpretation of both cine and late gadolinium enhancement (LGE) images. We sought to quantify the frequency and severity of artifact on LGE images and assess whether a modified wideband LGE protocol could improve the diagnostic yield of scar identification in agreement with invasive electroanatomic mapping (EAM). Forty-nine patients with ICDs and ventricular tachycardia (VT) or cardiomyopathy underwent CMR (Philips 1.5T), including standard and wideband LGE imaging. A safety algorithm was followed throughout the protocol. Standard and wideband LGE short-axis images were graded using an artifact score on a per-slice basis. LGE on wideband images was compared with EAM in 27 of 49 patients who underwent VT ablation. There were no adverse patient- or device-related events. With standard LGE imaging, 84% of patients demonstrated some degree of hyperenhancement artifact, which persisted in 22% on wideband LGE but with much less extent. Wideband LGE imaging resulted in an increase from 48% to 94% diagnostic-quality slices, with a significant reduction in artifact score, and correlated with EAM in 21 of 27 patients (78%). In conclusion, assessment of standard LGE is markedly limited by artifact in patients with ICD. The use of wideband LGE significantly improves image quality and can accurately localize myocardial scar before VT ablation.
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Lee JH, Lee SR, Choi EK, Jeong J, Park HD, You SJ, Lee SS, Oh S. Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study. Korean Circ J 2019; 49:841-852. [PMID: 31074230 PMCID: PMC6713826 DOI: 10.4070/kcj.2018.0444] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background and Objectives Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. Methods Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. Results A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). Conclusions The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | | | | | | | - Sang Soo Lee
- Medtronic Korea, Ltd., Seoul, Korea.,Graduate School for Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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