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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System. CJC Open 2024; 6:649-655. [PMID: 38708054 PMCID: PMC11065736 DOI: 10.1016/j.cjco.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 05/07/2024] Open
Abstract
Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS). Methods A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres. Results A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation. Conclusions Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Burger H, Strauß M, Chung DU, Richter M, Ziegelhöffer T, Hakmi S, Reichenspurner H, Choi YH, Pecha S. Infection remediation after septic device extractions: analysis of three treatment strategies including a 1-year follow-up. Front Cardiovasc Med 2024; 10:1342886. [PMID: 38274307 PMCID: PMC10808596 DOI: 10.3389/fcvm.2023.1342886] [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: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction In CIED infections, all device material needs to be removed. But, especially in pacemaker-dependent patients it is often not possible to realize a device-free interval for infection remediation. In those patients, different treatment options are available, however the ideal solution needs still to be defined. Methods This retrospective analysis includes 190 patients undergoing CIED extractions due to infection. Three different treatment algorithms were analyzed: Group 1 included 89 patients with system removal only (System removal group). In Group 2, 28 patients received an epicardial electrode during extraction procedure (Epicardial lead group) while 78 patients in group 3 (contralateral reimplantation group) received implantation of a new system contralaterally during extraction procedure. We analyzed peri- and postoperative data as well as 1-year outcomes of the three groups. Results Patients in the system removal and epicardial lead groups were significantly older, had more comorbidities, and suffered more frequently from systemic infections than those in contralateral reimplantation group. Lead extraction procedures had comparable success rates: 95.5%, 96.4%, and 93.2% of complete lead removal in the System removal, Epicardial Lead, Contralateral re-implantation group respectively. Device reimplantation was performed in all patients in Epicardial lead and Contralateral reimplantation group, whereas only 49.4% in System removal group received device re-implantation. At 1-year follow-up, freedom from infection and absence of pocket irritation were comparable for all groups (94.7% Contralateral reimplantation group and Epicardial lead group, 100% System removal group). No procedure-related mortality was observed, whereas 1-year mortality was 3.4% in System removal group, 4.1% in Contralateral re-implantation group and 21.4% in Epicardial lead group (p < 0.001). Conclusion In patients with CIED infection, systems should be removed completely and reimplanted after infection remediation. In pacemaker-dependent patients, simultaneous contralateral CIED re-implantation or epicardial lead placement may be performed, depending on route, severity and location of infection.
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Affiliation(s)
- Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- Department of Angiology and Cardiology, CardioVascular Center, Frankfurt/Main, Germany
| | - Mona Strauß
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Da-Un Chung
- Department of Cardiology& Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Tibor Ziegelhöffer
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Frankfurt/Main, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
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Neuzil P, Petrů J, Šedivá L, Chovanec M, Šorf J, Funasako M. Retrieval and replacement feasibility of 7-year-old implanted leadless pacemaker with tines fixation. HeartRhythm Case Rep 2024; 10:2-5. [PMID: 38264113 PMCID: PMC10801068 DOI: 10.1016/j.hrcr.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Petrů
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Lucie Šedivá
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Milan Chovanec
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Šorf
- Medtronic Czechia, Prague, Czech Republic
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Bertolino L, Florio LL, Patauner F, Gallo R, Peluso AM, Scafuri A, De Vivo S, Corrado C, Zampino R, Ruocco G, D’Onofrio A, Durante-Mangoni E. Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review. J Clin Med 2023; 12:7573. [PMID: 38137641 PMCID: PMC10743511 DOI: 10.3390/jcm12247573] [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: 11/11/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Leadless pacemakers (LPs) have been proposed as a reimplantation strategy in pacing-dependent patients undergoing cardiac implantable electronic device (CIED) extraction for infection. In this study, we analysed the risk of LP infection when this device is implanted before lead extraction. (2) Methods: This was a retrospective study including patients who underwent LP implantation between 2017 and 2022. Patients were divided in two groups according to whether LP was implanted following CIED extraction for infection (Group 1) or other indications (Group 2). The primary aim was to describe the risk of LP infection. (3) Results: We included in this study 49 patients with a median age of 81 [20-94] years, mostly males (36, 73%). In Group 1 patients, 17 cases (85%) showed systemic CIED infections, and 11 (55%) had positive lead cultures. Most Group 1 cases (n = 14, 70%) underwent one stage of LP implantation and CIED extraction. Mortality rate during follow-up was 20% (nine patients). Patients were followed up for a median of 927 [41-1925], days and no cases of definite or suspected LP infections were identified. (4) Conclusions: The risk of LP infection was extremely low. LP appears as a potential option for reimplantation in this setting and should be considered in pacing-dependent patients at a high risk of CIED infection recurrence.
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Affiliation(s)
- Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Letizia Lucia Florio
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Anna Maria Peluso
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Antonio Scafuri
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Stefano De Vivo
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Carmelina Corrado
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy;
| | - Antonio D’Onofrio
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
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Ali H, Foresti S, De Ambroggi G, Cappato R, Lupo P. Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis. J Clin Med 2023; 12:6908. [PMID: 37959373 PMCID: PMC10649089 DOI: 10.3390/jcm12216908] [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: 08/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system's resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors' experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients' management and clinical outcomes.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy; (S.F.); (G.D.A.); (R.C.); (P.L.)
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Tan MC, Tan JL, Tay ST, Sorajja D, Scott L, Cha YM, Russo AM, Hussein A, Lee JZ. A Systematic Review of Short-Term Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device. Am J Cardiol 2023; 203:444-450. [PMID: 37542954 DOI: 10.1016/j.amjcard.2023.07.071] [Citation(s) in RCA: 2] [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] [Received: 02/19/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023]
Abstract
The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIEDs) are not well-established. This study sought to describe the outcomes of LP implantation after TLR of infected CIED. We conducted a literature search using PubMed and Embase for a combination of terms including LP implantation, transvenous lead extraction, TLR, transvenous lead explant, infected CIED, infected pacemaker, and infected implantable cardioverter defibrillator. The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for noninfectious reasons. Study end points included procedural complications and LP infection during follow-up. Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 174 [69%] males) were included. The most common indication of the initial device implantations was a high-degree atrioventricular block (n = 100 of 253, 39.5%). Of the 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during the TLR procedure, and 36 patients (14.2%) had temporary transvenous pacing as a bridge from TLR to LP implantation. Of the 148 patients with data on the type of CIED infection, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus aureus was the most common causative organism in 33% of the reported patients. The LP was implanted an average of 5.4 ± 10.7 days after TLR of infected CIED. During the LP implantation, 1 patient (0.4%) had unsuccessful implantation because of an intraprocedural complication requiring sternotomy. After LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ± 10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. This study suggests that LP implant is feasible and safe after removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%. Large prospective studies are needed to better evaluate the best timing of LP implantation after TLR of an infected CIED.
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Affiliation(s)
- Min Choon Tan
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey
| | - Jian Liang Tan
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Soon Tzeh Tay
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Dan Sorajja
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | - Luis Scott
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | - Yong-Mei Cha
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrea M Russo
- Division of Cardiovascular Medicine, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ayman Hussein
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Justin Z Lee
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Breeman KTN, Beurskens NEG, Driessen AHG, Wilde AAM, Tjong FVY, Knops RE. Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices. J Interv Card Electrophysiol 2023; 66:1477-1485. [PMID: 36534325 DOI: 10.1007/s10840-022-01457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers. METHODS We included all patients with LP implantation as a replacement for an infected CIED, between January 2013 and December 2021. The occurrence of reinfection was assessed during standard follow-up visits. RESULTS Twenty-nine patients (mean age 81 ± 9 years) were included, of which 21 (73%) had a pocket infection, 7 (24%) endocarditis, and 1 (3%) a systemic infection without endocarditis. All LP implantations were successful. LPs were implanted before extraction (n = 4, 13%), simultaneously with extraction (n = 5, 17%) and after extraction (n = 20, 70%). No reinfection occurred during the follow-up of median 32 months (IQR 13-66 months). Repeat blood cultures obtained in 9 (30%) patients and transthoracic echocardiography in all 7 patients with pacemaker endocarditis were negative for reinfection. In a subset of 6 LPs extracted during follow-up due to early battery depletion, prophylactically after the battery advisory or due to non-capture (median 36 months (range 0-67 months) post-implantation), histopathologic examination of tissues around the LPs showed no signs of infection. CONCLUSIONS After replacing infected CIEDs for an LP, no reinfections occurred in over 2.5 years follow-up. These results confirm that in case of CIED infection, the LP is an appealing replacement device. LP implantation before CIED extraction is feasible.
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Affiliation(s)
- Karel T N Breeman
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands.
| | - Niek E G Beurskens
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Antoine H G Driessen
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
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Wu M, Su H. Simultaneous transvenous lead extraction and implantation of leadless cardiac pacemaker: A case report. Clin Case Rep 2023; 11:e7223. [PMID: 37384226 PMCID: PMC10293583 DOI: 10.1002/ccr3.7223] [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: 05/27/2022] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 06/30/2023] Open
Abstract
Cardiovascular implantable electronic device (CIED) infection is a serious complication and remains the most common indication for transvenous lead extraction (TLE). In addition, there are serious challenges such as venous access occlusion and reinfection after extraction. Leadless pacemaker (LP) provides a safe and effective pacing option for patients with device-related infections. We describe here a case of simultaneous transvenous lead extraction and leadless pacemaker implantation due to bilateral venous infection and pacing dependency.
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Affiliation(s)
- Mengwei Wu
- Department of CardiologyFirst Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital)HefeiChina
- Wannan Medical CollegeWuhuChina
| | - Hao Su
- Department of CardiologyFirst Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital)HefeiChina
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9
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Xynogalos P, Frey N, Karck M, DeSimone R. Excimer laser electrode extraction in the presence of a leadless pacemaker: a case report. Clin Res Cardiol 2023:10.1007/s00392-023-02229-w. [PMID: 37209149 DOI: 10.1007/s00392-023-02229-w] [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: 10/19/2022] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Affiliation(s)
- P Xynogalos
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - N Frey
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - R DeSimone
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [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: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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Pavon AG, Ceriani L, Raditchkova M, Leo LA, Pedrazzini G, Auricchio A, Caporali E. What is this image? 2023 image 5 result: Role of 18-Fluorodeoxyglucose positron emission tomography and computed tomography in cardiac implanted electronic device infection. J Nucl Cardiol 2023; 30:480-483. [PMID: 36972001 DOI: 10.1007/s12350-023-03228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Anna Giulia Pavon
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Mariana Raditchkova
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Laura Anna Leo
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Angelo Auricchio
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Elena Caporali
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland.
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Tong F, Sun Z. Strategies for Safe Implantation and Effective Performance of Single-Chamber and Dual-Chamber Leadless Pacemakers. J Clin Med 2023; 12:jcm12072454. [PMID: 37048538 PMCID: PMC10094832 DOI: 10.3390/jcm12072454] [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: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Leadless pacemakers (LPMs) have emerged as an alternative to conventional transvenous pacemakers to eliminate the complications associated with leads and subcutaneous pockets. However, LPMs still present with complications, such as cardiac perforation, dislodgment, vascular complications, infection, and tricuspid valve regurgitation. Furthermore, the efficacy of the leadless VDD LPMs is influenced by the unachievable 100% atrioventricular synchrony. In this article, we review the available data on the strategy selection, including appropriate patient selection, procedure techniques, device design, and post-implant programming, to minimize the complication rate and maximize the efficacy, and we summarize the clinical settings in which a choice must be made between VVI LPMs, VDD LPMs, or conventional transvenous pacemakers. In addition, we provide an outlook for the technology for the realization of true dual-chamber leadless and battery-less pacemakers.
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Affiliation(s)
- Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Breitenstein A, Cerini M, Palmisano P, Montemerlo E, Ziacchi M, Gulletta S, Salghetti F, Russo G, Monaco C, Mazzone P, Hofer D, Tundo F, Rovaris G, Russo AD, Biffi M, Pisanò ECL, Chierchia GB, Della Bella P, de Asmundis C, Saguner AM, Tondo C, Forleo GB, Curnis A. Outcomes of leadless pacemaker implantation following transvenous lead extraction in high-volume referral centers: Real-world data from a large international registry. Heart Rhythm 2023; 20:395-404. [PMID: 36496135 DOI: 10.1016/j.hrthm.2022.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data on the real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available. OBJECTIVE The purpose of this study was to assess the long-term safety and effectiveness of LPMs following TLE in comparison with LPMs de novo implantation. METHODS Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr Registry were enrolled. The primary end point was the comparison of LPM-related complication rate at implantation and during follow-up (FU) between groups. Differences in electrical performance were deemed secondary outcomes. RESULTS Of the 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 (interquartile range 24-47) months, LPM-related major complications and all-cause mortality did not differ between groups (TLE group: 1.6% and 5.4% vs de novo group: 2.2% and 7.8%; P = .785 and P = .288, respectively). Pacing threshold (PT) was higher in the TLE group at implantation and during FU, with very high PT (>2 V@0.24 ms) patients being more represented than in the de novo implantation group (5.4% vs 1.6 %; P = .004). When the LPM was deployed at a different right ventricular (RV) location than the one where the previous transvenous RV lead was extracted, a lower proportion of high PT (>1-2 V@0.24 ms) patients at implantation, 1-month FU, and 12-month FU (5.9% vs 18.2%, P = .012; 3.4% vs 12.9%, P = .026; and 4.3% vs 14.5%, P = .037, respectively) was found. CONCLUSION LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where the previous transvenous RV lead was extracted.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy.
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Manuel Cerini
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | | | - Matteo Ziacchi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesca Salghetti
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Tundo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
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Baykaner T, John RM. Leadless pacing after transvenous lead extraction: Are we out of the woods? Heart Rhythm 2023; 20:405-406. [PMID: 36572151 DOI: 10.1016/j.hrthm.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Tina Baykaner
- Department of Medicine, Stanford University, Stanford, California
| | - Roy M John
- Department of Medicine, Stanford University, Stanford, California.
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Palmisano P, Iacopino S, De Vivo S, D'Agostino C, Tomasi L, Startari U, Ziacchi M, Pisanò ECL, Santobuono VE, Caccavo VP, Sgarito G, Rillo M, Nicosia A, Zucchelli G. Leadless transcatheter pacemaker: Indications, implantation technique and peri-procedural patient management in the Italian clinical practice. Int J Cardiol 2022; 365:49-56. [PMID: 35907505 DOI: 10.1016/j.ijcard.2022.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Safety and efficacy of leadless pacemakers (L-PM) have been demonstrated in multiple clinical trials, but real-world data on patient selection, implantation technique, and peri-procedural patient management in a clinical practice setting are lacking. METHODS Consecutive patients undergoing L-PM implantation in 14 Italian centers were followed in a prospective, multicentre, observational project. Data on baseline patient characteristics, clinical indications, implantation procedure, and peri-procedural patient management were collected. The rate and nature of device-related complications were also recorded. RESULTS A total of 782 L-PM patients (68.4% male, 75.6 ± 12.4 years) were included in the analysis. The main patients-related reason leading to the choice of implanting a L-PM rather than a conventional PM was the high-risk of device infection (29.5% of cases). The implantation success rate was 99.2%. The median duration of the procedure was 46 min. In 90% of patients the device was implanted in the septum. Of patients on oral anticoagulant therapy (OAT) (n = 498) the implantation procedure was performed without interrupting (17.5%) or transiently interrupting OAT without heparin bridging (60.6%). During a median follow-up of 20 months major device-related complications occurred in 7 patients (0.9%): vascular access-site complications in 3 patients, device malfunction in 2 patients, pericardial effusion/cardiac tamponade in one patient, device migration in one patient. CONCLUSIONS In the real world setting of Italian clinical practice L-PM is often reserved for patients at high-risk of infection. The implantation success rate was very high and the risk of major complications was low. Peri-procedural management of OAT was consistent with available scientific evidence.
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Affiliation(s)
| | | | | | | | - Luca Tomasi
- U.O.C. Cardiologia - Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Matteo Ziacchi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | | | - Antonino Nicosia
- Azienda Sanitaria Provinciale, Ospedale Giovanni Paolo II, Ragusa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiothoracic and Vascular department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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