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Azari A, Kristjánsdóttir I, Gatti P, Berge A, Gadler F. Long- and short-term outcomes after transvenous lead extraction in a large single-centre patient cohort using the clinical frailty scale as a risk assessment tool. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00080-9. [PMID: 38992492 DOI: 10.1016/j.ipej.2024.07.001] [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: 03/03/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND AIMS The rate of cardiac implantable electronic device (CIED) implantations and the need for transvenous lead extraction (TLE) are growing worldwide. This study examined a large Swedish cohort with the aim of identifying possible predictors of post-TLE mortality with special focus on systemic infection patients and frailty. METHODS This was a single centre study. Records of patients undergoing TLE between 2010 and 2018 were analysed. Statistical analyses were conducted to compare baseline characteristics of patients with different indications and identify risk factors of 30-day and 1-year mortality. RESULTS A total of 893 patients were identified. Local infection was the dominant indication and pacemaker was the most common CIED. The mean age was 65 ± 16 years, 73 % were male and median follow-up was 3.9 years. Heart failure was the most common comorbidity. Patients with systemic infection were significantly older, frailer and had significantly higher levels of comorbidities. 30-day mortality and 1-year mortality rates were 2.5 % and 9.9 %, respectively. Systemic infection and chronic kidney disease (CKD) were independently associated with 30-day and 1-year mortality. Clinical frailty scale (CFS) 5-7 correlated independently with 1-year mortality in the entire cohort and specifically in systemic infection patients. CKD, cardiac resynchronization therapy and CFS 5-7 were significant risk factors for long-term mortality (death >1 year after TLE) in multivariable analysis. CONCLUSIONS Systemic infection, kidney failure in addition to the novel parameter of frailty were associated with post-TLE all-cause mortality. These risk factors should be considered during pre-procedure risk stratification to improve post-TLE outcomes.
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Affiliation(s)
- Ava Azari
- Karolinska University Hospital Solna, Cardiology Department, 171 76, Stockholm, Sweden.
| | | | - Paolo Gatti
- Karolinska Institute, 171 77, Stockholm, Sweden
| | - Andreas Berge
- Karolinska University Hospital Solna, Department of Infectious Diseases, 171 76, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska University Hospital Solna, Cardiology Department, 171 76, Stockholm, Sweden
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2
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Al-Maisary S, Romano G, Karck M, De Simone R, Kremer J, Arif R. Octogenarian patients and laser-assisted lead extraction: Should we put a limit? PLoS One 2023; 18:e0284802. [PMID: 37862289 PMCID: PMC10588874 DOI: 10.1371/journal.pone.0284802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/08/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Transvenous laser lead extraction (TLE) for cardiac implantable electric devices (CIED) is a challenging procedure especially if performed in octogenarians. In this study we evaluated the safety and efficacy of transvenous laser lead extraction in elderly patients. METHODS This is a retrospective study of octogenarian patients who underwent laser-assisted lead extraction (LLE) (GlideLight laser sheath, Philips, San Diego, USA). 270 Consecutive patients were included. Patients were divided into two groups. Octogenarian group and non-octogenarian group. The Data was gathered from patients treated between September 2013 and January 2020 and is retrospectively analyzed. RESULTS Of 270 consecutive patients, 38 (14.0%) were 80 years old or more. The total number of the extracted leads was 556 among which 84(15.0%) from the Octogenarian group. From these leads were 155 single coil leads, 82 dual coil leads, 129 right ventricular pacing leads, 155 right atrial leads, and 35 left ventricular leads. In the Octogenarian group the number of removed leads was as follows: 13 single coil leads, 10 dual coil leads, 28 right ventricular pacing leads, 28 right atrial leads and 5 left ventricular leads. No mortality was recorded in the Octogenarian group. One patient in the YG suffered from a superior vena cava tear and one patient suffered from pulmonary embolism. CONCLUSION In octogenarian laser assisted lead extraction patients is a safe and effective procedure. No increase in morbidity, mortality or perioperative complication could be recorded in this group. Age should not be a limiting factor to perform this procedure.
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Affiliation(s)
- Sameer Al-Maisary
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
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3
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Mehta VS, Wijesuriya N, DeVere F, Howell S, Elliott MK, Mannakarra N, Hamakarim T, Niederer S, Razavi R, Rinaldi CA. Long-term survival following transvenous lead extraction: unpicking differences according to sex. Europace 2023; 25:euad214. [PMID: 37466333 PMCID: PMC10410196 DOI: 10.1093/europace/euad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. METHODS AND RESULTS Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23-2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99-5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03-3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06-1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95-0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. CONCLUSION Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Nadeev Wijesuriya
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Felicity DeVere
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Sandra Howell
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Mark K Elliott
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Nilanka Mannakarra
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Tatiana Hamakarim
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Reza Razavi
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, 4th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK
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Arabia G, Mitacchione G, Cersosimo A, Calvi E, Salghetti F, Bontempi L, Giacopelli D, Cerini M, Curnis A. Long-term outcomes following transvenous lead extraction: Data from a tertiary referral center. Int J Cardiol 2023; 378:32-38. [PMID: 36841289 DOI: 10.1016/j.ijcard.2023.02.040] [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: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) has shown a safe and efficacy profile in the intraoperative and short-term setting; however, data on long-term outcomes are limited. OBJECTIVE The purpose of this study was to assess long-term outcomes and prognostic factors in patients who underwent TLE. METHODS Consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were retrospectively studied. The primary outcome was the composite endpoint of death and repeated TLE stratified by infective/non-infective indication. Individual components of the primary outcome were also evaluated. RESULTS One hundred ninety-one patients were included in the analysis, 50% extracted for CIED-related infection. Complete procedural success was achieved in 189 patients (99%) with no major acute complications. After a median of 6.5 years, infection indication was associated with significantly lower event-free survival (67% vs. 83% non-infection group, adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02-3.81, p = 0.04). All-cause mortality rate was higher in the TLE infection group (30% vs. 10%, p < 0.01). The rate of repeated TLE did not differ between groups (4% vs. 7%, p = 0.62). Among patients who had TLE for infection, the presence of vegetation (aHR 2.56; 95%CI 1.17-5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04-6.70, p = 0.04) were independently associated with the primary outcome. CONCLUSION Patients who underwent TLE for CIED-related infection exhibit a high mortality risk during long-term follow-up. Vegetation and positive blood cultures in patients with CIED-related infection are associated with a worse prognosis regardless of successful and uncomplicated TLE.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy.
| | | | - Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Emiliano Calvi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Francesca Salghetti
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Luca Bontempi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Cologno Monzese (MI), Italy; Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
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Lakkireddy DR, Segar DS, Sood A, Wu M, Rao A, Sohail MR, Pokorney SD, Blomström-Lundqvist C, Piccini JP, Granger CB. Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:1283-1295. [PMID: 36990548 DOI: 10.1016/j.jacc.2023.01.038] [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: 11/01/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 03/31/2023]
Abstract
Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.
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Affiliation(s)
| | - Douglas S Segar
- Ascension Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Ami Sood
- Philips Image Guided Therapy Corporation, Colorado Springs, Colorado, USA
| | | | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - M Rizwan Sohail
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sean D Pokorney
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Science, Uppsala University, Uppsala, Sweden
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Christopher B Granger
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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6
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Okada A, Higuchi S, Shoda M, Tabata H, Kataoka S, Shoin W, Kobayashi H, Okano T, Yoshie K, Kato K, Saigusa T, Ebisawa S, Motoki H, Kuwahara K. Utility of a multipurpose catheter for transvenous extraction of old broken leads: A novel technique for fragile leads. Heart Rhythm 2023:S1547-5271(23)00514-3. [PMID: 37001747 DOI: 10.1016/j.hrthm.2023.03.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system and injury to the veins or heart, have been reported. OBJECTIVE The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported. METHODS In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction. RESULTS Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted. CONCLUSION All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.
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Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tama Metropolitan Medical Center, Tokyo, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Villegas EG, Juárez Del Río JI, Carmona JCR, Valdíris UR, Peinado ÁA, Peinado RP. Efficacy and safety of the extraction of cardiostimulation leads using a mechanical dissection tool. A single center experience. Pacing Clin Electrophysiol 2023; 46:217-225. [PMID: 36401870 DOI: 10.1111/pace.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). METHODS A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X-ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. RESULTS A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). CONCLUSION In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.
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8
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Mehta VS, O'Brien H, Elliott MK, Wijesuriya N, Auricchio A, Ayis S, Blomstrom-Lundqvist C, Bongiorni MG, Butter C, Deharo JC, Gould J, Kennergren C, Kuck KH, Kutarski A, Leclercq C, Maggioni AP, Sidhu BS, Wong T, Niederer S, Rinaldi CA. Machine learning-derived major adverse event prediction of patients undergoing transvenous lead extraction: Using the ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry. Heart Rhythm 2022; 19:885-893. [PMID: 35490083 DOI: 10.1016/j.hrthm.2021.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) remains a high-risk procedure. OBJECTIVE The purpose of this study was to develop a machine learning (ML)-based risk stratification system to predict the risk of major adverse events (MAEs) after TLE. A MAE was defined as procedure-related major complication and procedure-related death. METHODS We designed and evaluated an ML-based risk stratification system trained using the European Lead Extraction ConTRolled (ELECTRa) registry to predict the risk of MAEs in 3555 patients undergoing TLE and tested this on an independent registry of 1171 patients. ML models were developed, including a self-normalizing neural network (SNN), stepwise logistic regression model ("stepwise model"), support vector machines, and random forest model. These were compared with the ELECTRa Registry Outcome Score (EROS) for MAEs. RESULTS There were 53 MAEs (1.7%) in the training cohort and 24 (2.4%) in the test cohort. Thirty-two clinically important features were used to train the models. ML techniques were similar to EROS by balanced accuracy (stepwise model: 0.74 vs EROS: 0.70) and superior by area under the curve (support vector machines: 0.764 vs EROS: 0.677). The SNN provided a finite risk for MAE and accurately identified MAE in 14 of 169 "high (>80%) risk" patients (8.3%) and no MAEs in all 198 "low (<20%) risk" patients (100%). CONCLUSION ML models incrementally improved risk prediction for identifying those at risk of MAEs. The SNN has the additional advantage of providing a personalized finite risk assessment for patients. This may aid patient decision making and allow better preoperative risk assessment and resource allocation.
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Affiliation(s)
- Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom.
| | - Hugh O'Brien
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, Marseille, France
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, Goteborg, Sweden
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy; European Society of Cardiology, EORP, Biot, Sophia Antipolis Cedex, France
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Wong
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
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Mehta VS, O'Brien H, Elliott MK, Sidhu BS, Gould J, Shetty AK, Niederer S, Rinaldi CA. Assessing long-term survival and hospitalization following transvenous lead extraction in patients with cardiac resynchronization therapy devices: A propensity score-matched analysis. Heart Rhythm O2 2022; 2:597-606. [PMID: 34988504 PMCID: PMC8703147 DOI: 10.1016/j.hroo.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices. Objectives A propensity score (PS)–matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed. Methods Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (<7 days) or late (>7 days) reimplantation was associated with poorer outcomes. Results Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00–93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74–1.39], P = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87–1.66], P = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04–2.57], P = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00–2.46], P = .049]. Conclusion Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Hugh O'Brien
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark K Elliott
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Baldeep S Sidhu
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Justin Gould
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Anoop K Shetty
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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10
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Subcutaneous Versus Transvenous Implantable Defibrillator in Patients with Hypertrophic Cardiomyopathy. Heart Rhythm 2022; 19:759-767. [DOI: 10.1016/j.hrthm.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
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11
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Sidhu BS, Gould J, Elliott M, Mehta V, Kennergren C, Butter C, Deharo JC, Kutarski A, Maggioni AP, Auricchio A, Kuck KH, Blomström-Lundqvist C, Bongiorni MG, Rinaldi CA. The effect of centre volume and procedure location on major complications and mortality from transvenous lead extraction: an ESC EHRA EORP European Lead Extraction ConTRolled ELECTRa Registry subanalysis-Author's reply. Europace 2021; 23:1149-1150. [PMID: 33718966 DOI: 10.1093/europace/euab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Mark Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Charles Kennergren
- Sahlgrenska University Hospital, Cardiothoracic Surgery, Sahlgrenska/SU, 41345, Goteborg, Sweden
| | - Christian Butter
- Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Department of Cardiology, Ladeburger Straße 17, 16321, Bernau, Germany
| | - Jean-Claude Deharo
- CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, 13385, Marseille, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego Street Nr 8, 20-090, Lublin, Poland
| | - Aldo P Maggioni
- European Society of Cardiology, 2035 route des Colles, Biot, Sophia Antipolis, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Karl-Heinz Kuck
- Asklepios Klinik St. Georg, Lohmühlenstraße 5, - D-20099, Hamburg, Germany
| | | | | | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Guy's and St Thomas' Hospital, London, UK
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12
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Mehta VS, Elliott MK, Sidhu BS, Gould J, Kemp T, Vergani V, Kadiwar S, Shetty AK, Blauth C, Gill J, Bosco P, Rinaldi CA. Long-term survival following transvenous lead extraction: Importance of indication and comorbidities. Heart Rhythm 2021; 18:1566-1576. [PMID: 33984526 DOI: 10.1016/j.hrthm.2021.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term outcomes are poorly understood, and data in patients undergoing transvenous lead extraction (TLE) are lacking. OBJECTIVE The purpose of this study was to evaluate factors influencing survival in patients undergoing TLE depending on extraction indication. METHODS Clinical data from consecutive patients undergoing TLE in the reference center between 2000 and 2019 were prospectively collected. The total cohort was divided into groups depending on whether there was an infective or noninfective indication for TLE. We evaluated the association of demographic, clinical, and device-related and procedure-related factors on mortality. RESULTS A total of 1151 patients were included. Mean follow-up was 66 months, and mortality was 34.2% (n = 392). Of these patients, 632 (54.9%) and 519 (45.1%) were for infective and noninfective indications, respectively. A higher proportion in the infection group died (38.6% vs 28.5%; P <.001). In the total cohort, multivariable analysis demonstrated increased mortality risk with age >75 years (hazard ratio [HR] 2.98; 95% confidence interval [CI] 2.35-3.78; P <.001), estimated glomerular filtration rate <60 mL/min/1.73 m2 (HR 1.67; 95% CI 1.31-2.13; P <.001), higher cumulative comorbidity (HR 1.17; 95% CI 1.09-1.26; P <.001), reduced risk per percentage increase in left ventricular ejection fraction (HR 0.98; 95% CI 0.97-0.99; P <.001), and near unity per year of additional lead dwell time (HR 0.98; 95% CI 0.96-1.00; P = .037). Kaplan-Meier survival curves demonstrated worse prognosis, with a higher number of leads extracted and increasing comorbidities. CONCLUSION Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests also assessing longer-term outcomes when considering TLE in those with a high risk of medium- and long-term mortality, particularly for noninfective indications.
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Affiliation(s)
- Vishal S Mehta
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
| | - Mark K Elliott
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Baldeep S Sidhu
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Justin Gould
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Tiffany Kemp
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vittoria Vergani
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Suraj Kadiwar
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anoop Kumar Shetty
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Christopher Blauth
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jaswinder Gill
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Paolo Bosco
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
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13
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Sidhu BS, Ayis S, Gould J, Elliott MK, Mehta V, Kennergren C, Butter C, Deharo JC, Kutarski A, Maggioni AP, Auricchio A, Kuck KH, Blomström-Lundqvist C, Bongiorni MG, Rinaldi CA. Risk stratification of patients undergoing transvenous lead extraction with the ELECTRa Registry Outcome Score (EROS): an ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry analysis. Europace 2021; 23:1462-1471. [PMID: 33615342 DOI: 10.1093/europace/euab037] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Transvenous lead extraction is associated with a significant risk of complications and identifying patients at highest risk pre-procedurally will enable interventions to be planned accordingly. We developed the ELECTRa Registry Outcome Score (EROS) and applied it to the ELECTRa registry to determine if it could appropriately risk-stratify patients. METHODS AND RESULTS EROS was devised to risk-stratify patients into low risk (EROS 1), intermediate risk (EROS 2), and high risk (EROS 3). This was applied to the ESC EORP European Lead Extraction ConTRolled ELECTRa registry; 57.5% EROS 1, 31.8% EROS 2, and 10.7% EROS 3. Patients with EROS 3 or 2 were significantly more likely to require powered sheaths and a femoral approach to complete procedures. Patients with EROS 3 were more likely to suffer procedure-related major complications including deaths (5.1 vs. 1.3%; P < 0.0001), both intra-procedural (3.5 vs. 0.8%; P = 0.0001) and post-procedural (1.6 vs. 0.5%; P = 0.0192). They were more likely to suffer post-procedural deaths (0.8 vs. 0.2%; P 0.0449), cardiac avulsion or tear (3.8 vs. 0.5%; P < 0.0001), and cardiovascular lesions requiring pericardiocentesis, chest tube, or surgical repair (4.6 vs. 1.0%; P < 0.0001). EROS 3 was associated with procedure-related major complications including deaths [odds ratio (OR) 3.333, 95% confidence interval (CI) 1.879-5.914; P < 0.0001] and all-cause in-hospital major complications including deaths (OR 2.339, 95% CI 1.439-3.803; P = 0.0006). CONCLUSION EROS successfully identified patients who were at increased risk of significant procedural complications that require urgent surgical intervention.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, 41345 Goteborg, Sweden
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, 16321 Bernau, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego Street Nr 8, 20-090 Lublin, Poland
| | - Aldo P Maggioni
- European Society of Cardiology, EORP, 2035 route des Colles, Biot, Sophia Antipolis, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstraße 5, D-20099 Hamburg, Germany
| | | | - Maria Grazia Bongiorni
- Cardiology Department, Direttore UO Cardiologia 2 SSN, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.,Cardiology Department, Guy's and St Thomas' Hospital, London, UK
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14
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Costa R, Silva KRD, Crevelari ES, Nascimento WTJ, Nagumo MM, Martinelli Filho M, Jatene FB. Effectiveness and Safety of Transvenous Removal of Cardiac Pacing and Implantable Cardioverter-defibrillator Leads in the Real Clinical Scenario. Arq Bras Cardiol 2021; 115:1114-1124. [PMID: 33470310 PMCID: PMC8133723 DOI: 10.36660/abc.20200476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Fundamento Remoção de cabos-eletrodos de dispositivos cardíacos eletrônicos implantáveis (DCEI) é procedimento pouco frequente e sua realização exige longo treinamento profissional e infraestrutura adequada. Objetivos Avaliar a efetividade e a segurança da remoção de cabos-eletrodos de DCEI e determinar fatores de risco para complicações cirúrgicas e mortalidade em 30 dias. Métodos Estudo prospectivo com dados derivados da prática clínica. De janeiro/2014 a abril/2020, foram incluídos, consecutivamente, 365 pacientes submetidos à remoção de cabos-eletrodos, independentemente da indicação e técnica cirúrgica utilizada. Os desfechos primários foram: taxa de sucesso do procedimento, taxa combinada de complicações maiores e morte intraoperatória. Os desfechos secundários foram: fatores de risco para complicações intraoperatórias maiores e morte em 30 dias. Empregou-se análise univariada e multivariada, com nível de significância de 5%. Resultados A taxa de sucesso do procedimento foi de 96,7%, sendo 90,1% de sucesso completo e 6,6% de sucesso clínico. Complicações maiores intraoperatórias ocorreram em 15 (4,1%) pacientes. Fatores preditores de complicações maiores foram: tempo de implante dos cabos-eletrodos ≥ 7 anos (OR= 3,78, p= 0,046) e mudança de estratégia cirúrgica (OR= 5,30, p= 0,023). Classe funcional III-IV (OR= 6,98, p<0,001), insuficiência renal (OR= 5,75, p=0,001), infecção no DCEI (OR= 13,30, p<0,001), número de procedimentos realizados (OR= 77,32, p<0,001) e complicações maiores intraoperatórias (OR= 38,84, p<0,001) foram fatores preditores para mortalidade em 30 dias. Conclusões Os resultados desse estudo, que é o maior registro prospectivo de remoção de cabos-eletrodos da América Latina, confirmam a segurança e a efetividade desse procedimento no cenário da prática clínica real. (Arq Bras Cardiol. 2020; 115(6):1114-1124)
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Affiliation(s)
- Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Katia Regina da Silva
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Elizabeth Sartori Crevelari
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Marcia Mitie Nagumo
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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15
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Safe and effective transvenous lead extraction for elderly patients utilizing non-laser and laser tools: a single-center experience in Japan. Heart Vessels 2021; 36:882-889. [PMID: 33394103 DOI: 10.1007/s00380-020-01761-3] [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: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Transvenous lead extraction (TLE) for cardiac implantable electric device (CIED) infection is becoming increasingly common, but is believed to be particularly risky in elderly patients. This study aimed to clarify the safety and effectiveness of TLE in the elderly, evaluating the use of both non-laser and laser extraction tools. We retrospectively analyzed the characteristics, device type, indications, procedures, and clinical results in younger (YG; age: 15-79 years; n = 48) and elderly groups (EG; age: ≥ 80 years; n = 27) of patients who underwent percutaneous TLE between April 2014 and December 2019 at our hospital. The average age was 68 and 88 years in the YG and EG, respectively. Indications for TLE were infection in 33 (68.8%) patients and other in 15 (30.6%) patients in the YG, and infection in all 27 (100%) EG patients. Bloodstream infection was detected in 9 and 4 patients in the YG and EG, respectively, with methicillin-resistant Staphylococcus epidermidis being the most common causative pathogen. All TLE procedures were performed under general anesthesia in an operating room with cardiovascular surgeon backup. An excimer laser sheath (76 leads), a laser followed by a mechanical sheath (45 leads), Evolution RL® (17 leads), a mechanical sheath (9 leads), and manual traction (one lead) were employed to extract a total of 148 leads (98 and 50 in the YG and EG, respectively). A mechanical sheath or Evolution RL® was more frequently used in the YG. The respective average implantation durations in the YG and EG were 5.3 and 5.0 years, respectively, which were comparable (p = 0.46). Procedural success rates were identical between the YG and EG (99% vs. 100%, respectively). There was only one procedure-related complication in the entire cohort (cardiac tamponade in a YG patient). Taken together, the success rates of TLE were high in the EG, with no complications, with extraction being the indication for infection in all EG patients. Percutaneous TLE was safe and effective in elderly patients using both non-laser and laser techniques.
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16
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Gould J, Sidhu BS, Porter B, Sieniewicz BJ, Freeman S, de Wilt EC, Glover JC, Razavi R, Rinaldi CA. Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre. Heart 2020; 106:931-937. [PMID: 31932286 PMCID: PMC7282498 DOI: 10.1136/heartjnl-2019-315839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre. METHODS Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors. RESULTS Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively. CONCLUSIONS Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.
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Affiliation(s)
- Justin Gould
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK .,King's College London, London, UK
| | - Baldeep S Sidhu
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Bradley Porter
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Benjamin J Sieniewicz
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | | | | | - Reza Razavi
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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17
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Herrmann FEM, Ehrenfeld F, Wellmann P, Hagl C, Sadoni S, Juchem G. Thrombocytopenia and end stage renal disease are key predictors of survival in patients with cardiac implantable electronic device infections. J Cardiovasc Electrophysiol 2019; 31:70-79. [PMID: 31702855 DOI: 10.1111/jce.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Our aim was to identify key predictors of survival in patients with CIED infections as to be able to detect high-risk patients and possibly affect modifiable factors. METHODS AND RESULTS In this observational study, we collected data from 277 patients with CIED infections treated in our department between 2001 and 2017; predictors of survival were evaluated. The median time since the last CIED procedure was 0.83 years (interquartile range [IQR]: 0.25-3.01), median time since initial CIED implant was 4.79 years (IQR: 0.90-11.0 years). Survival at 30 days was 94.9% (95% confidence interval [CI]: 92.3-97.5) and survival at 1 year was 80.9% (CI: 76.4-85.7). Age (odds ratio [OR]: 1.05, CI: 1.01-1.09; P = .009), end stage renal disease (ESRD) with dialysis (OR: 5.14, CI: 1.87-14.11; P = .001), positive blood cultures (OR: 2.19, CI: 1.08-4.45; P = .030), and thrombocytopenia (OR: 2.3, CI, 1.03-5.15; P = .042) were identified as predictors of death within 1 year of treatment of CIED infection. CONCLUSION Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1-year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. A greater understanding of the role of platelets in immunity may improve treatment of advanced infection in the future.
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Affiliation(s)
| | - Felix Ehrenfeld
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Petra Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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18
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Gould J, Sidhu B, Porter B, Sieniewicz BJ, Teall T, Williams S, Shetty A, Bosco P, Blauth C, Gill J, Rinaldi CA. Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1355-1364. [DOI: 10.1111/pace.13791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 08/18/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Justin Gould
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Baldeep.S. Sidhu
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Bradley Porter
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Benjamin. J. Sieniewicz
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Thomas Teall
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Steven.E. Williams
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Anoop Shetty
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Paolo Bosco
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Christopher Blauth
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Jaswinder Gill
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Christopher. A. Rinaldi
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
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19
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Tsang DC, Perez AA, Boyle TA, Carrillo RG. Effect of Prior Sternotomy on Outcomes in Transvenous Lead Extraction. Circ Arrhythm Electrophysiol 2019; 12:e007278. [DOI: 10.1161/circep.119.007278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes.
Methods:
Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement.
Results:
Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (
P
=0.75,
P
=0.41), clinical success rate (
P
=0.26), and in-hospital mortality (
P
=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis.
Conclusions:
In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.
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Affiliation(s)
- Darren C. Tsang
- University of Miami Miller School of Medicine, FL (D.C.T., A.A.P., T.A.B.)
| | - Adryan A. Perez
- University of Miami Miller School of Medicine, FL (D.C.T., A.A.P., T.A.B.)
| | - Thomas A. Boyle
- University of Miami Miller School of Medicine, FL (D.C.T., A.A.P., T.A.B.)
| | - Roger G. Carrillo
- Division of Cardiothoracic Surgery, The Heart Institute at Palmetto General Hospital, Hialeah, FL (R.G.C.)
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20
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Burnhope E, Rodriguez-Guadarrama Y, Waring M, Guilder A, Malhotra B, Razavi R, Rinaldi CA, Pennington M, Carr-White G. Economic impact of introducing TYRX amongst patients with heart failure and reduced ejection fraction undergoing implanted cardiac device procedures: a retrospective model based cost analysis. J Med Econ 2019; 22:464-470. [PMID: 30744444 DOI: 10.1080/13696998.2019.1581621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Infection is a serious and expensive complication of Cardiac Implantable Electronic Device (CIED) procedures. A retrospective based cost analysis was performed to estimate Trust level savings of using the TYRX antibacterial envelope as a primary prevention measure against infection in a tertiary referral centre in South London, UK. METHODS A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures were evaluated. Decision-analytic modelling was performed to determine economic savings of using the envelope during CIED procedure vs CIED procedure alone. RESULTS Over a 12 month follow-up period following CIED procedure, the observed infection rate was 3.14% (n = 5/159). The average cost of a CIED infection inpatient admission was £41,820 and, further to economic analysis, the additional costs attributable to infection was calculated at £62,213.94. A cost saving of £624 per patient by using TYRX during CIED procedure as a primary preventative measure against infection was estimated. CONCLUSIONS TYRX would be a cost-saving treatment option amongst heart failure patients undergoing ICD and CRT device procedures based on analysis in the local geographical area of South London. If upscaled to the UK population, we estimate potential cost savings for the National Health Service (NHS).
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Affiliation(s)
- Emma Burnhope
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
- b Cardiology, Guy's and St Thomas Hospital , London , UK
| | - Yael Rodriguez-Guadarrama
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Michael Waring
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Andrew Guilder
- c Health Informatics, Guy's and St Thomas NHS Foundation Trust , London , UK
| | - Bharti Malhotra
- d TOHETI, Kings College London , London , UK
- e TOHETI, Guys and St. Thomas Hospital , London , UK
| | - Reza Razavi
- f Vice President, Kings College London , London , UK
| | - C A Rinaldi
- b Cardiology, Guy's and St Thomas Hospital , London , UK
| | - Mark Pennington
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
| | - Gerald Carr-White
- a School of Biomedical Engineering and Imaging Sciences , Rayne Institute, Kings College London , London , UK
- b Cardiology, Guy's and St Thomas Hospital , London , UK
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