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Bracke F, Rademakers LM. When pacing or defibrillator leads become redundant: Extract or abandon? Heart Rhythm 2024:S1547-5271(24)03089-3. [PMID: 39094726 DOI: 10.1016/j.hrthm.2024.07.113] [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: 06/10/2024] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
The 2017 Heart Rhythm Society expert consensus paper on lead management and extraction did not express a preference for either extracting or abandoning pacing or defibrillator leads that are dysfunctional or superfluous after an upgrade (hereafter referred to as redundant leads). However, no randomized or even nonrandomized trials show a better patient outcome with extraction. Many experienced centers currently advise patients to have redundant leads removed to prevent more complicated procedures after years of abandonment. According to the literature, however, not all abandoned leads need to be extracted as >90% will have an uneventful follow-up. As immediate extraction of redundant leads has a small but significant risk, this will generate more adverse events at the population level than when extraction is limited to the patients with future lead complications, even considering a higher extraction risk at that time. Lead extraction is also limited to specialized centers and often necessitates expensive tools, in contrast to abandoning leads, which can be safely performed by any experienced device specialist without additional cost.
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Affiliation(s)
- Frank Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
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Coiado OC, Lowe J, O'Brien WD. Therapeutic Ultrasound in Cardiovascular Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 40:1061-1076. [PMID: 32964505 DOI: 10.1002/jum.15493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
An advantage of therapeutic ultrasound (US) is the ability to cause controlled biological effects noninvasively. Depending on the magnitude and frequency of exposure parameters, US can interact in different ways with a variety of biological tissues. The development and clinical utility of therapeutic US techniques are now rapidly growing, especially with regard to the application of US pulses for cardiac pacing and the potential treatment of cardiovascular diseases. This review outlines the basic principles of US-based therapy in cardiology, including the acoustic properties of the cardiovascular tissue, and the use of US in therapeutic cardiovascular medicine.
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Affiliation(s)
- Olivia C Coiado
- Department of Biomedical and Translational Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jacques Lowe
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - William D O'Brien
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Abstract
Subclavian obstruction is common after lead implantation and the need to add or replace a lead is increasing. Subclavian venoplasty (SV) is a safe and effective option for venous occlusion. Peripheral venography overestimates the severity of the obstruction. A wire can usually be advanced into the central circulation for SV. Compared with dilators, SV improves the quality of venous access, providing unrestricted catheter manipulation for His bundle pacing and left ventricular lead implantation. SV preserves venous access and reduces lead burden. SV can easily be added to the implanting physicians lead management options.
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Affiliation(s)
- Jose M Marcial
- Department of Medicine, Division of Cardiology, Cardiac Arrhythmia Center, Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Seth J Worley
- Department of Medicine, Division of Cardiology, Cardiac Arrhythmia Center, Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
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Barakat AF, Wazni OM, Tarakji K, Saliba WI, Nimri N, Rickard J, Brunner M, Bhargava M, Kanj M, Baranowski B, Martin DO, Cantillon D, Callahan T, Dresing T, Niebauer M, Chung M, Lindsay BD, Wilkoff B, Hussein AA. Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes. Heart Rhythm 2017; 14:1807-1811. [DOI: 10.1016/j.hrthm.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 10/19/2022]
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Coiado OC, O'Brien WD. The Negative Chronotropic Effect in Rat Heart Stimulated by Ultrasonic Pulses: Role of Sex and Age. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:799-808. [PMID: 28072471 PMCID: PMC5359037 DOI: 10.7863/ultra.16.02017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The goal of this study is to investigate the role of sex and age of the negative chronotropic effect after exposure of 3.5-MHz pulsed ultrasound (US) to the rat heart. METHODS Forty F344 rats were exposed transthoracically to ultrasonic pulses at a duty factor of approximately 1.0% at 2.0-MPa peak rarefactional pressure amplitude. The transthoracic ultrasonic bursts were delivered consecutively in five 10-s intervals, that is, 10 s of 6-Hz pulse repetition frequency (PRF), 10 s of 5-Hz PRF, 10 s of 4-Hz PRF, 10 s of 5-Hz PRF, and 10 s of 6-Hz, for a 50-s total exposure duration. The rats were divided into 8 groups (n = 5 each): US young male, control young male, US young female, control young female, US old male, control old male, US old female, and control old female. RESULTS Two-way ANOVA for repeated measures was used to compare heart rate, cardiac output, arterial pressure, and other hemodynamic values (baseline) before and after US stimulation. Sex versus age versus US interaction was detected for heart rate. Cardiac output showed an age effect, and ejection fraction showed age and US effects. The arterial pressure showed a sex effect. A negative chronotropic effect (∼30% decrease in heart rate) was observed for young female rats. An hypothesis is that the US effect is weight (menopause) dependent, because the young (premenopausal) female rats weighed approximately 40 to 60% less than other groups of rats. CONCLUSIONS It is likely that the ovarian hormones are responsible for different US-induced cardiac bioeffects in different ages and sexes.
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Affiliation(s)
- Olivia C Coiado
- Donald P. Shiley School of Engineering, University of Portland, Portland, Oregon USA
| | - William D O'Brien
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois USA
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Abstract
The population of patients with cardiac implantable electronic devices (CIEDs) continues to grow due to increasing indications in an aging population and breakthroughs in both the medical and the surgical care of patients with heart disease. As a result, there has been a growing need for device and lead extractions due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections, and lead advisory alerts.
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Hussein AA, Tarakji KG, Martin DO, Gadre A, Fraser T, Kim A, Brunner MP, Barakat AF, Saliba WI, Kanj M, Baranowski B, Cantillon D, Niebauer M, Callahan T, Dresing T, Lindsay BD, Gordon S, Wilkoff BL, Wazni OM. Cardiac Implantable Electronic Device Infections: Added Complexity and Suboptimal Outcomes With Previously Abandoned Leads. JACC Clin Electrophysiol 2016; 3:1-9. [PMID: 29759687 DOI: 10.1016/j.jacep.2016.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to assess the impact of previously abandoned leads on the clinical management of cardiac device infections, notably transvenous lead extraction and subsequent clinical course. BACKGROUND The population of patients with cardiac implantable electronic devices continues to grow with a disproportionate increase in device infections, which are invariably life threatening. A potentially complicating issue is the widely practiced strategy of device lead abandonment at the time of system revision, change, or upgrade, which is affecting an increasing number of patients. METHODS The study assessed the impact of previously abandoned leads in a prospectively maintained registry of consecutive patients undergoing percutaneous extraction of infected cardiac devices at the Cleveland Clinic between August 1996 and September 2012. The primary clinical endpoint was complete procedural and clinical success defined as the successful removal of the device and all lead material from the vascular space, in the absence of a major complication. RESULTS Of 1,386 patients with infected cardiac devices, 323 (23.3%) had previously abandoned leads. Failure to achieve the primary endpoint occurred more frequently in patients with abandoned leads (13.0% vs. 3.7%; p < 0.0001). This was primarily due to retention of lead material (11.5% vs. 2.9%; p < 0.0001), which was associated with poor clinical outcomes including higher rates of 1-month mortality (7.4% vs. 3.5% in those without lead remnants). Lead extraction procedures in patients with previously abandoned leads were longer (p < 0.0001), with longer fluoroscopy times (p < 0.0001), and more likely to require specialized extraction tools (94.4% vs. 81.8%; p < 0.0001) or adjunctive rescue femoral workstations (14.9% vs. 2.9%; p < 0.0001). Procedural complications occurred more frequently in patients with previously abandoned leads (11.5% vs. 5.6%; p = 0.0003), which was true for both major (3.7% vs. 1.4%; p = 0.009) and minor complications (7.7% vs. 4.4%; p = 0.02). CONCLUSIONS Previously abandoned leads complicate the management of cardiac device infections, leading to worse clinical outcomes.
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Affiliation(s)
- Ayman A Hussein
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - David O Martin
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Abhishek Gadre
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Fraser
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Alice Kim
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Brunner
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Amr F Barakat
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mark Niebauer
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Steven Gordon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
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Abstract
Defibrillator lead advisories stir a lot of emotions, both with patients and physicians, and this may influence lead management. We reviewed the literature for a more evidence-based approach to this issue. From the complications of two of the current advisory leads, the Medtronic Sprint Fidelis and St. Jude Riata leads, and the consequences of possible interventions, we can conclude that a restrained approach to premature replacement is appropriate. It may be opportune to replace the leads during a scheduled generator replacement in case of a higher electrical failure rate, in order to prevent future premature interventions. We found no support to extract non-functional advisory leads. In contrast, extraction is often more demanding than anticipated, and the risk substantially exceeds that of simply abandoning the leads.
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Bracke F. Letter to the Editor--Extraction of nonfunctional leads at the time of device upgrade: Still unproven benefit compared to abandoning leads. Heart Rhythm 2015; 12:e65. [PMID: 25839112 DOI: 10.1016/j.hrthm.2015.03.064] [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: 02/21/2015] [Indexed: 10/23/2022]
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Coiado OC, Buiochi EB, O’Brien WD. Ultrasound-induced heart rate decrease: role of the vagus nerve. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:329-36. [PMID: 25643082 PMCID: PMC4319370 DOI: 10.1109/tuffc.2014.006755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The goal of this study is to investigate the role of the vagus nerve (VN) in the ultrasound (US)-induced negative chronotropic effect (deceased heart rate). One of the functions of the VN is to mediate lowering of the heart rate. A previous study showed a decrease of ~20% in the heart rate but the mechanism of the effect was not investigated. Sprague Dawley rats (n = 20) were exposed transthoracically to ultrasonic pulses at an approximate duty factor of 1% with sequentially 2.0, 2.5, and 3.0 MPa peak rarefactional pressure amplitudes (PRPAs). The ultrasonic exposure parameters herein were chosen to match those of the previous study to have confidence that an ultrasound-induced negative chronotropic effect would occur. For each of the three PRPA sequences, the pulse repetition frequency (PRF) started slightly greater than the rat's heart rate and then was decreased sequentially in 1-Hz steps every 10 s (i.e., 6, 5, and 4 Hz for a total duration of 30 s). The experiments were organized in a standard (2 × 2) factorial design with VN (cut versus intact) as one factor and US (on versus off) as another factor. VN (intact/cut) and US (on/off) groups were divided into four groups each consisting of 5 animals: 1) VN intact-US off, 2) VN intact-US on, 3) VN cut-US off, and 4) VN cut-US on. Two-way analysis of variance for repeated measures was used to compare heart rate, cardiac output, systolic volume, ejection fraction, end-diastolic volume, end-systolic volume, respiratory rate, and arterial pressure before and after ultrasound stimulation. In this study, the heart rate decreased ~4% for the non-vagotomy and vagotomy groups. The ultrasound effect was significant for heart rate (p = 0.02) and cardiac output (p = 0.005) at 3 min post US exposure; the vagotomy effect was not significant. For heart rate, the Bonferroni test showed no differences between the four groups. The vagotomy group showed similar ultrasound-induced cardiac effects compared with the non-vagotomy group, suggesting that the vagus nerve is not influenced by the ultrasound exposure procedures. The US application caused a negative chronotropic effect of the rat heart without affecting the hemodynamic conditions. The results at this point are suggestive for an alternative cardiac pacing capability.
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Affiliation(s)
- Olivia C. Coiado
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Elaine B. Buiochi
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL
| | - William D. O’Brien
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL
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BIEFER HECTORRODRIGUEZCETINA, HÜRLIMANN DAVID, GRÜNENFELDER JÜRG, SALZBERG SACHAP, STEFFEL JAN, FALK VOLKMAR, STARCK CHRISTOPHT. Generator Pocket Adhesions of Cardiac Leads: Classification and Correlation with Transvenous Lead Extraction Results. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1111-6. [DOI: 10.1111/pace.12184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 03/25/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - DAVID HÜRLIMANN
- Clinic of Cardiology; University Hospital Zurich; Zurich Switzerland
| | | | | | - JAN STEFFEL
- Clinic of Cardiology; University Hospital Zurich; Zurich Switzerland
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Henrikson CA, Brinker JA. Extraction of Sterile Leads: Is it Beneficial? Card Electrophysiol Clin 2012; 4:199-207. [PMID: 26939817 DOI: 10.1016/j.ccep.2012.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Extraction of sterile leads remains a controversial area. The risks and benefits of abandoning a lead are largely unknown, whereas the risks of lead extraction are better studied. Lead management decisions need to be made on a patient-by-patient basis, with important input from the patient and family. This article presents several representative cases and reviews the major considerations in making the decision of whether or not to extract a sterile lead that has become either no longer needed or no longer functional.
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Affiliation(s)
- Charles A Henrikson
- Division of Cardiovascular Medicine, UHN-62, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Division of Cardiology, Johns Hopkins University, Carnegie 568, 600 North Wolfe Street, Baltimore, MD 21205, USA
| | - Jeffrey A Brinker
- Division of Cardiology, Johns Hopkins University, Carnegie 568, 600 North Wolfe Street, Baltimore, MD 21205, USA
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Worley SJ, Gohn DC, Pulliam RW, Raifsnider MA, Ebersole BI, Tuzi J. Subclavian venoplasty by the implanting physicians in 373 patients over 11 years. Heart Rhythm 2011; 8:526-33. [DOI: 10.1016/j.hrthm.2010.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 12/04/2010] [Indexed: 10/18/2022]
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Maytin M, Epstein LM. Lead Extraction Is Preferred for Lead Revisions and System Upgrades: When Less Is More. Circ Arrhythm Electrophysiol 2010; 3:413-24; discussion 424. [DOI: 10.1161/circep.110.954107] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Excimer laser to open refractory subclavian occlusion in 12 consecutive patients. Heart Rhythm 2010; 7:634-8. [DOI: 10.1016/j.hrthm.2010.01.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 01/19/2010] [Indexed: 11/20/2022]
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Scott PA, Chungh A, Zeb M, Yue AM, Roberts PR, Morgan JM. Is the use of an additional pace/sense lead the optimal strategy for the avoidance of lead extraction in defibrillation lead failure? A single-centre experience. Europace 2009; 12:522-6. [DOI: 10.1093/europace/eup406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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