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Ngan HT, Li KY, Wong SL, Tse HF. Decision-making regarding subcutaneous implantable cardioverter defibrillator as primary prevention in patients with low ejection fraction. Pacing Clin Electrophysiol 2024; 47:1285-1292. [PMID: 39161154 DOI: 10.1111/pace.15065] [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: 02/13/2024] [Revised: 06/16/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Conventional transvenous implantable cardioverter-defibrillator (TV-ICD) is the standard device used for primary prevention of sudden cardiac death (SCD) in patients with reduced left ventricular ejection fraction (LVEF). Nonetheless its use is associated with lead-related complications including infection and malfunction. A subcutaneous implantable cardioverter-defibrillator (S-ICD) offers an alternative option without the need for a transvenous lead but has limitations. The decision to implant a TV-ICD or S-ICD in patients with impaired LVEF for primary prevention of SCD is controversial. Several randomised controlled trials and large observational studies have confirmed similar safety and efficacy of S-ICDs and TV-ICDs in such population. METHODS A literature review was conducted to compare the outcomes of subcutaneous (S-ICD) versus transvenous (TV-ICD) implantable cardioverter-defibrillators. Databases including PubMed, MEDLINE, and Cochrane were searched for relevant peer-reviewed articles. Studies were selected based on relevance and quality. Key outcomes like complication rates, efficacy, and patient survival were summarized in a comparative table. RESULTS Different factors that influence the choice between an TV-ICD and S-ICD for primary prevention of SCD in patients with LVEF are highlighted to guide selection of the appropriate device in different patient populations. Moreover, future perspective on the combination of SICD with leadless pacemaker, and the latest development of the extravascular implantable cardioverter defibrillator are also discussed. CONCLUSIONS S-ICD offers a safe and efficacious option to primary prevention in reduced ejection fraction. Future development including incorporation of leadless pacemaker will add to the arsenal of choice to protect patients from sudden cardiac death.
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Affiliation(s)
- Ho-Ting Ngan
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ka-Ying Li
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Shing-Lung Wong
- Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, Shenzhen, China
- Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, the University of Hong Kong, Hong Kong SAR, China
- Center for Translational Stem Cell Biology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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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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Migliore F, Pittorru R, De Lazzari M, Dall’Aglio PB, Cecchetto A, Previtero M, Pergola V, Thiene G, Masiero G, Tarantini G, Tarzia V, Gerosa G. Evaluation of tricuspid valve regurgitation following transvenous rotational mechanical lead extraction. Europace 2024; 26:euae191. [PMID: 38989913 PMCID: PMC11282457 DOI: 10.1093/europace/euae191] [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: 04/29/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024] Open
Abstract
AIMS Transvenous lead extraction (TLE) is potentially complicated by significant tricuspid valve regurgitation increase (TRI). However, there are limited data on the effect of the bidirectional rotational mechanical sheaths on significant TRI. The aim of the present study was to investigate the rate of significant changes in tricuspid regurgitation (TR) severity following mechanical rotational TLE and their outcomes. METHODS AND RESULTS In 158 patients (mean age 66 ± 16.9 years) undergoing mechanical rotational TLE, acute changes in TR severity were assessed by echocardiography evaluation. A significant acute TRI was defined as an increase of at least one grade with a post-extraction severity at least moderate. A total of 290 leads were extracted (mean implant duration, 93 ± 65 months). Significant TRI was noted in 5.7% of patients, and it was linked to tricuspid valve damage, TLE infection indication, and longer lead implant duration. Univariate predictors of significant TRI included implant duration of all leads [odds ratio (OR) 1.01; 95% confidence interval (CI) 1.003-1.018; P = 0.001] and right ventricular leads (OR 1.01; 95% CI 1.004-1.017; P = 0.002). Severe increase of TR following TLE was an independent predictor of mortality [hazard ratio (HR) 5.20; 95% CI 1.44-18.73; P = 0.012 ] along with severe systolic dysfunction (HR 2.37; 95% CI 1.01-5.20; P = 0.032), and systemic infection (HR 2.28; 95% CI 1.06-4.89; P = 0.035). CONCLUSION Significant TRI was detected in 5.7% of patients following transvenous rotational mechanical lead extraction. The duration of lead implantation emerged as the sole predictor of significant TRI. Physicians engaged in TLE should exercise greater vigilance for this potential complication.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Antonella Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Marco Previtero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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Polewczyk A, Jacheć W, Nowosielecka D, Kutarski A. Tricuspid valve damage and improvement following transvenous lead extraction procedures. J Cardiovasc Electrophysiol 2024; 35:939-941. [PMID: 38515000 DOI: 10.1111/jce.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland
- Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Poland Department of Cardiology, Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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Shanafelt C, Middour TG, Ibrahim R, Leal M, Lloyd MS, Shah AD, Westerman SB, El-Chami MF, Merchant FM, Bhatia NK. Outcomes of tricuspid regurgitation after lead extraction. J Cardiovasc Electrophysiol 2024; 35:929-938. [PMID: 38450808 DOI: 10.1111/jce.16227] [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: 10/18/2023] [Revised: 02/04/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. METHODS We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0 = none/trivial, 1 = mild, 2 = moderate, 3 = severe). A change of >1 grade following extraction was considered significant. RESULTS A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference on average TR grade pre- and postextraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p = 0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e., >1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR postextraction (44.0% vs. 31.6%, p = 0.04). CONCLUSION In our single-center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction.
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Affiliation(s)
- Colby Shanafelt
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas G Middour
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rand Ibrahim
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Miguel Leal
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Dasgupta S, Mah DY. Lead Management in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:481-491. [PMID: 37865521 DOI: 10.1016/j.ccep.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted. Given the young age of patients, it is important to have an "eye on the future" when making pacemaker/defibrillator decisions, as one can expect several generator changes, lead revisions, and potential lead extractions during their lifetime.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, 231 East Chestnut Street, Louisville, KY 40202, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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Polewczyk A, Jacheć W, Nowosielecka D, Tomaszewski A, Brzozowski W, Szczęśniak-Stańczyk D, Duda K, Kutarski A. Tricuspid Valve Damage Related to Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912279. [PMID: 36231579 PMCID: PMC9566121 DOI: 10.3390/ijerph191912279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. METHODS This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed. RESULTS In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1-5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE. CONCLUSIONS Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE.
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Affiliation(s)
- Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Andrzej Tomaszewski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | - Wojciech Brzozowski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
| | | | - Krzysztof Duda
- Department of Cardiac Surgery, Masovian Specialistic Hospital, 26-617 Radom, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin Poland, 20-059 Lublin, Poland
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Tułecki Ł, Czajkowski M, Targońska S, Polewczyk A, Jacheć W, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. The role of cardiac surgeon in transvenous lead extraction: experience from 3462 procedures. J Cardiovasc Electrophysiol 2022; 33:1357-1365. [PMID: 35474258 DOI: 10.1111/jce.15510] [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: 12/29/2021] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The professional society guidelines recommend that transvenous lead extraction (TLE) operating teams collaborate closely with cardiac surgeons in the management of life-threatening complications. METHODS AND RESULTS We assessed the role of cardiac surgeons participating in 3462 TLE procedures at a high-volume center between 2006 and 2021. The roles for cardiac surgery in TLE can be categorized into five areas: emergency surgical interventions for the management of cardiac laceration and severe bleeding (1.184%), cardiac surgery complementing partially successful TLE or vegetation removal (0.693%), delayed surgical treatment of TLE-related tricuspid valve dysfunction (0.751%), epicardial pacemaker implantation through sternotomy during emergency, complementing or delayed surgical interventions (0.607%) and delayed epicardial lead implantation (0.491%). Isolated damage to the wall of the right atrium was the most common cause of cardiac tamponade (53.66% of emergency surgeries) followed by injury to the right ventricle and vena cava (both 7.317%). CONCLUSIONS Emergency cardiac surgery for the management of severe hemorrhagic complications is still the most common treatment option. The remaining areas include surgery complementing partially successful TLE: repair of tricuspid valve or epicardial ventricular lead placement to achieve permanent cardiac resynchronization. The experience at a single high-volume TLE center indicates the necessity of close collaboration with the cardiac surgeons whose roles appear broader than the mere surgical standby. Mortality in patients who survived cardiac surgery during transvenous lead extraction does not differ from the survival of other patients after TLE without complications requiring surgical intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Sylwia Targońska
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Centrum of Cardiology, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Kamil Karpeta
- Department of Cardiac Surgery Masovian Specialistic Hospital of Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
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Lead Extraction at a Pediatric/Congenital Heart Disease Center: The Importance of Patient Age at Implant. JACC Clin Electrophysiol 2022; 8:343-353. [PMID: 35331429 DOI: 10.1016/j.jacep.2021.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and efficacy of transvenous lead extraction (TLE) at a single pediatric/congenital heart disease (CHD) center. BACKGROUND Data on TLE in pediatric and CHD patients are limited. METHODS Retrospective cohort study evaluating TLE from 2008 to 2019. RESULTS A total of 113 patients underwent TLE with 162 leads removed (including 38 high-voltage leads). Median age at lead implantation was 13 years (range 0.6-61.8 years), with a median age at extraction of 21.6 years (6.4-64.3 years). Median lead age was 7.2 years (1.0-35.3 years). Successful extraction occurred in 110 (97%) patients, 159 (98%) leads. Complex extraction was needed for 120 leads; 52 (44%) using laser alone, 27 (23%) mechanical sheath alone, and 21 (18%) using both. Femoral extraction was used for 19 (16%) leads. Risk factors for complex extraction were ≥2 leads extracted (odds ratio: 3.36; 95% confidence interval [CI]: 1.2-9.36; P = 0.021), lead within the right ventricle (odds ratio: 2.8; 95% CI: 1.2-6.5; P = 0.017), and a combination of younger patient age at implant and older lead age at extraction, with patients ≤12 years of age at implant and leads ≥7 years of age having an odds ratio: of 10.1 (95% CI: 2.21-45.9; P = 0.003). Major complications occurred in 5 (4.4%) of patients, with no mortality, but a high incidence of tricuspid valve injury. CONCLUSIONS TLE can be performed successfully and safely in a pediatric and CHD center. Patient age at lead implantation, not age at extraction, is an important predictor of needing a complex extraction, with younger patients at implant and older leads at extraction having the highest risk.
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11
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:913-929. [DOI: 10.1093/ehjci/jeac009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
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Transvenous lead extraction using the TightRail mechanical rotating dilator sheath for Asian patients. Sci Rep 2021; 11:22251. [PMID: 35039566 PMCID: PMC8764071 DOI: 10.1038/s41598-021-99901-w] [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: 04/28/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
The need for transvenous lead extraction (TLE) is increasing worldwide including in Asia–Pacific regions. However, supporting evidence for TightRail, a relatively new rotating mechanical dilator sheath, is still lacking in Asian patients. The efficacy and safety of TLE using TightRail performed between March 2018 and June 2021 were evaluated in 86 consecutive patients with 131 leads. The mean lead age was 11.7 ± 7.3 (range, 1.0–41.4) years. Clinical and complete procedural success using TightRail were achieved in 93.0% and 89.5% of 86 patients, respectively, with 6 min of median fluoroscopic time and 9.3% of major complication rate: death (1.2%), cardiac tamponade (3.5%), severe tricuspid regurgitation (3.5%), and stroke (1.2%). However, in 46 patients with longest lead age ≤ 10 years, clinical/complete success and major cardiac complication rates turned out better as 97.8%, 95.7%, and 2.2%, respectively. Additionally, when patients were divided into 3 groups: the first 28, second 29, and the last 29 patients, there was a clear trend toward better efficacy and safety outcomes with more experience with TightRail (Ptrend < 0.05). Longest lead age > 10 years was closely associated with TLE-related major cardiac complication (P = 0.046) with 85.7% sensitivity, 57.0% specificity, 15.0% positive predictive value, and 97.8% negative predictive values. In conclusion, TLE using TightRail may be effectively and safely performed by experienced operators for Asian patients with the longest lead age ≤ 10 years. However, as TightRail is a potentially aggressive tool, special attention should be paid to patients with longer lead dwelling times (e.g., > 10 years).
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A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910416. [PMID: 34639716 PMCID: PMC8508178 DOI: 10.3390/ijerph181910416] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Background: Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Methods: Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Results: Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Conclusions: Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools.
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Late papillary muscle rupture and tricuspid regurgitation related to transvenous endocardial lead extraction. HeartRhythm Case Rep 2021; 7:577-580. [PMID: 34552845 PMCID: PMC8441198 DOI: 10.1016/j.hrcr.2021.05.013] [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: 11/21/2022] Open
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Tułecki Ł, Polewczyk A, Jacheć W, Nowosielecka D, Tomków K, Stefańczyk P, Kosior J, Duda K, Polewczyk M, Kutarski A. Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179100. [PMID: 34501689 PMCID: PMC8431163 DOI: 10.3390/ijerph18179100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 01/28/2023]
Abstract
Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (Ł.T.); (K.T.)
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-369 Kielce, Poland
- Correspondence:
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland;
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (Ł.T.); (K.T.)
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital of Radom, 26-617 Radom, Poland;
| | - Krzysztof Duda
- Department of Cardiac Surgery,
Masovian Specialist Hospital of Radom, 26-617 Radom, Poland;
| | - Maciej Polewczyk
- Faculty of Medicine and Health Studies, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-509 Lublin, Poland;
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Breeman KTN, du Long R, Beurskens NEG, van der Wal AC, Wilde AAM, Tjong FVY, Knops RE. Tissues attached to retrieved leadless pacemakers: Histopathological evaluation of tissue composition in relation to implantation time and complications. Heart Rhythm 2021; 18:2101-2109. [PMID: 34461305 DOI: 10.1016/j.hrthm.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Leadless pacemakers (LPs) have proven safe and effective, but device revisions remain necessary. Either replacing the LP or implanting a new adjacent LP is feasible. Replacement seems more appealing, but encapsulation and tissue adhesions may hamper the safety and efficacy of LP retrieval. OBJECTIVE We determined the incidence and cellular characteristics of tissue adherent to retrieved LPs and the potential implications for end-of-life strategy. METHODS All 15 consecutive successful Nanostim LP retrievals in a tertiary center were included. We assessed the histopathology of adherent tissue and obtained clinical characteristics. RESULTS Adherent tissue was present in 14 of 15 retrievals (93%; median implantation duration 36 months; range 0-96 months). The tissue consisted of fibrosis (n = 2), fibrosis and thrombus (n = 9), or thrombus only (n = 3). In short-term retrievals (<1 year), mostly fresh thrombi without fibrosis were seen. In later retrievals, the tissue consisted of fibrosis often with organizing or lytic thrombi. Fibrosis showed different stages of organization, notably early fibrocellular and later fibrosclerotic tissue. Inflammatory cells were seen (n = 4) without signs of infection. Tricuspid valve material was retrieved in 1 patient after 36 months, resulting in increased tricuspid regurgitation. CONCLUSION Our results suggest that fibrosis and thrombus adherent to LPs are common and encapsulate the LP as seen in transvenous pacemakers. LPs may adhere to the tricuspid valve or subvalvular apparatus affecting retrieval safety. The end-of-life strategy should be optimized by incorporating risk stratification for excessive fibrotic encapsulation and adhesions.
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Affiliation(s)
- Karel T N Breeman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Romy du Long
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niek E G Beurskens
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Nowosielecka D, Jacheć W, Polewczyk A, Kleinrok A, Tułecki Ł, Kutarski A. The prognostic value of transesophageal echocardiography after transvenous lead extraction: landscape after battle. Cardiovasc Diagn Ther 2021; 11:394-410. [PMID: 33968618 DOI: 10.21037/cdt-20-871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure. Methods We analyzed data from 936 TEE performed in patients undergoing TLE between 2015 and 2019 (mean follow-up 566.23±224.47 days) and assessed the role of echocardiographic phenomena after procedure. Results Increment in tricuspid regurgitation (TR) was observed in 9% of patients after TLE. Factors increasing the risk of TR were: binding sites between lead and right ventricle (RV) (OR: 5.429), tricuspid valve (TV) (OR: 3.42), superior vena cava (SVC) (OR: 3.30) and lead-to-lead adhesions (OR: 2.88). Predisposing factors of residual structures after TLE were: asymptomatic masses on the leads (AMEL) (OR: 1.68), binding sites between SVC and cardiac structures (OR: 1.72), and multiple leads (OR: 1.30). Probability of vegetation remnants increased in the presence of abandoned leads (OR: 7.91). The risk factors of tamponade were: dwell time of the oldest lead (OR: 1.17), lead-to-lead adhesion (OR: 22.47), binding sites between lead and TV (OR: 6.08), RA (OR: 11.50), SVC (OR: 4.47), higher LVEF (OR: 2.35; P=0.006), female gender (OR: 5.43), multiple leads (OR: 2.11), looped leads (OR: 4.90) and AMEL (OR: 6.42). The risk of lead fracture was increased by: lead-to-lead adhesion (OR: 5.69), fibrosis binding the lead to RV (OR: 5.16), RA (OR: 2.39) and dwell time of the oldest lead (OR: 1.068). The mortality rate was 11.97% during follow-up. The risk of death was increased by: severe TR and vegetation remnants. Conclusions The most important phenomena evaluated after TLE are: tricuspid valve function, residual fibrosis and vegetation remnants, progression of pericardial effusion and retained lead fragments. Postoperative TEE provides information about the results of TLE and helps establish further management.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland
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Qin D, Chokshi M, Sabeh MK, Maan A, Bapat A, Bode WD, Hanley A, Hucker WJ, Ng CY, Funamoto M, Barrett CD, Mela T. Comparison between TightRail rotating dilator sheath and GlideLight laser sheath for transvenous lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:895-902. [PMID: 33675073 DOI: 10.1111/pace.14206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction. OBJECTIVE To evaluate the effectiveness and safety of the TightRail sheath as a primary or secondary tool for transvenous lead extraction (TLE). METHODS Retrospective cohort analysis of 202 consecutive patients who underwent TLE using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital. The study population was divided into three groups: Group A underwent TLE with laser sheath only (N = 157), Group B with TightRail sheath only (N = 22), and Group C with both sheaths (N = 23). RESULTS During this period, 375 leads in 202 patients were extracted, including 297 leads extracted by laser sheath alone, 45 leads by TightRail sheath alone, and 33 by both TightRail sheath and laser sheaths. The most common indications included device infection (44.6%) and lead-related complications (44.1%). The median age of leads was 8.9 years. TightRail sheath (Group B) achieved similar efficacy as a primary extraction tool compared with laser sheath (Group A), with complete procedure success rate of 93.3% (vs. 96.6%, P = .263) and clinical success rate of 100.0% (vs. 98.1%, P = .513). Among 32 leads in which Tightrail was used after laser had failed (Group C), the complete procedure success rate was 75.8%. No significant difference in procedural adverse events was observed. CONCLUSION Our single-center experience confirms that the TightRail system is an effective first-line and second-line method for TLE. Further investigation is required to guide the selection of mechanical and laser sheaths in lead extraction cases.
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Affiliation(s)
- Dingxin Qin
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moulin Chokshi
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamad Khaled Sabeh
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abhishek Maan
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aneesh Bapat
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Weeranun D Bode
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alan Hanley
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William J Hucker
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chee Yuan Ng
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theofanie Mela
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Anderson BA, Edwards NF. Traumatic tricuspid valve injury following pacemaker lead extraction: A case report. SONOGRAPHY 2020. [DOI: 10.1002/sono.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bonita A. Anderson
- Echocardiography Laboratory The Prince Charles Hospital Brisbane Australia
| | - Natalie F. Edwards
- Echocardiography Laboratory The Prince Charles Hospital Brisbane Australia
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20
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Katsikeris FN, Craig C, Salerno C, Kashef MA, Jiang L. Laser Lead Extraction Complicated by Avulsed Tricuspid Subvalvular Apparatus with Severe Tricuspid Regurgitation. J Innov Card Rhythm Manag 2020; 11:4042-4045. [PMID: 32368378 PMCID: PMC7192129 DOI: 10.19102/icrm.2020.110303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/20/2019] [Indexed: 02/04/2023] Open
Abstract
The use of laser lead extraction (LLE) to remove pacemaker or implantable cardioverter-defibrillator leads has become increasingly prevalent. This advanced technique has been shown to be highly effective and safe. We report a rare case of severe traumatic tricuspid regurgitation after LLE that led to death.
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Affiliation(s)
| | - Calvin Craig
- Internal Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Colby Salerno
- Internal Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Mohammad Amin Kashef
- Division of Heart and Vascular Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Leng Jiang
- Division of Heart and Vascular Medicine, Baystate Medical Center, Springfield, MA, USA
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Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Tomków K, Stefańczyk P, Kleinrok A, Kutarski A. A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures. Echocardiography 2020; 37:601-611. [DOI: 10.1111/echo.14628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Anna Polewczyk
- Collegium Medicum The Jan Kochanowski University Kielce Poland
- Department of Cardiac Surgery Swietokrzyskie Cardiology Center Kielce Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology Silesian Medical University Zabrze Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Paweł Stefańczyk
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Andrzej Kleinrok
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
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Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:622-636. [DOI: 10.1016/j.jcmg.2018.09.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022]
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Abstract
Lead extraction procedures have a low but real risk of major complications, such as superior vena cava tear and cardiac tamponade. Complications during lead removal are commonly related to lead binding sites, lead malposition, and lead perforation. Lead extraction imaging may indicate lead vascular binding sites, lead position, and perforation. Several imaging modalities are available, including chest radiograph, cardiac computed tomography, and echocardiography. The information provided by various imaging modalities will help assess the challenges of each lead extraction procedure and allows for better preprocedure planning.
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Affiliation(s)
- Pierce J Vatterott
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA.
| | - Imran S Syed
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
| | - Akbar H Khan
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
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Birgersdotter-Green U, Dawood FZ. Transvenous Extraction of Pacemaker and Defibrillator Leads and the Risk of Tricuspid Valve Regurgitation. JACC Clin Electrophysiol 2018; 4:1429-1430. [DOI: 10.1016/j.jacep.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
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Park SJ, Gentry JL, Varma N, Wazni O, Tarakji KG, Mehta A, Mick S, Grimm R, Wilkoff BL. Transvenous Extraction of Pacemaker and Defibrillator Leads and the Risk of Tricuspid Valve Regurgitation. JACC Clin Electrophysiol 2018; 4:1421-1428. [DOI: 10.1016/j.jacep.2018.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
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Ebrille E, Chang JD, Zimetbaum PJ. Tricuspid Valve Dysfunction Caused by Right Ventricular Leads. Card Electrophysiol Clin 2018; 10:447-452. [PMID: 30172281 DOI: 10.1016/j.ccep.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tricuspid regurgitation is increasingly recognized as a clinically significant valvular condition. The role of multiple pacemaker and implantable cardiac defibrillator leads in distortion of the valve structure and the risk of trauma to the valve and subvalvular apparatus with lead extraction contribute to the development of tricuspid regurgitation (TR). There is a clinical imperative to better understand the optimal way to diagnose lead-related TR, risk factors for the development of TR, and optimal strategies to mitigate this problem.
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Affiliation(s)
- Elisa Ebrille
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - James D Chang
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - Peter J Zimetbaum
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA.
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Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
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Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 743] [Impact Index Per Article: 106.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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29
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Montgomery JA, Ellis CR, Crossley GH. Extraction of looped transvenous pacing leads to reduce tricuspid regurgitation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:644-647. [PMID: 28369957 DOI: 10.1111/pace.13085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/27/2017] [Accepted: 03/26/2017] [Indexed: 11/27/2022]
Abstract
Transvenous leads are a known source of iatrogenic tricuspid regurgitation. It is commonly held that extraction of chronic pacing and defibrillator leads will not reduce this, due to the inevitable trauma to the valve associated with the procedure. We demonstrate three cases of clinically significant reductions in tricuspid regurgitation after extraction of leads that were looped across the tricuspid valve.
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Affiliation(s)
- Jay A Montgomery
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher R Ellis
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - George H Crossley
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
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30
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Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol 2017; 69:2331-2341. [DOI: 10.1016/j.jacc.2017.02.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
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Pecha S, Castro L, Gosau N, Linder M, Vogler J, Willems S, Reichenspurner H, Hakmi S. Evaluation of tricuspid valve regurgitation following laser lead extraction†. Eur J Cardiothorac Surg 2017; 51:1108-1111. [DOI: 10.1093/ejcts/ezx011] [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: 09/18/2016] [Accepted: 01/03/2017] [Indexed: 01/11/2023] Open
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Hai T, Lerner AB, Khamooshian A. Severe Tricuspid Valve Injury During Right Ventricular Lead Extraction. J Cardiothorac Vasc Anesth 2016; 31:626-628. [PMID: 27989376 DOI: 10.1053/j.jvca.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ting Hai
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Adam B Lerner
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arash Khamooshian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Huang XM, Fu H, Osborn MJ, Asirvatham SJ, McLeod CJ, Glickson M, Acker NG, Friedman PA, Cha YM. Extraction of superfluous device leads: A comparison with removal of infected leads. Heart Rhythm 2015; 12:1177-82. [DOI: 10.1016/j.hrthm.2015.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Indexed: 10/24/2022]
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Case report: Pacemaker lead perforation of a papillary muscle inducing severe tricuspid regurgitation. J Cardiothorac Surg 2015; 10:39. [PMID: 25888033 PMCID: PMC4374532 DOI: 10.1186/s13019-015-0244-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 03/13/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction We report a rare but severe pacemaker complication of a pacemaker lead perforating the papillary muscle. This induced severe tricuspid regurgitation and right heart failure. Patients suffering from right heart failure have an increased operative risk of open-heart surgery and therefore represent a clinical challenge due to the lack of clear guidelines. Case presentation A 70-year-old male patient presented with severe tricuspid regurgitation and a history of decompensated right heart failure. One pacemaker lead was described as ‘whipping’. Four years earlier he had received a VVIR pacemaker with a passive lead. This lead failed after three years and a new ventricular lead had been placed. We performed on-pump beating heart surgery after a multidisciplinary decision process. One lead was perforating the posterior papillary muscle, severely impairing valve movement. The tricuspid valve was replaced with a stented bioprosthesis. Epicardial pacemaker wires were placed on the right and left ventricle to enable cardiac resynchronization therapy in the case of postoperative heart failure. However, the patient recovered quickly without left ventricular pacing and could be discharged home 12 days after surgery. Conclusion This particular case emphasizes the importance of meticulous surgical technique during pacemaker lead implantation and a tight postoperative follow-up including echocardiography in complicated cases. The management of patients with an indication for lead removal having developed secondary severe tricuspid valve dysfunction inducing ventricular impairment represents a clinical challenge and should be approached by a multidisciplinary team. Electronic supplementary material The online version of this article (doi:10.1186/s13019-015-0244-7) contains supplementary material, which is available to authorized users.
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Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure. Heart Rhythm 2015; 12:313-20. [DOI: 10.1016/j.hrthm.2014.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Indexed: 11/24/2022]
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