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Kaul R, Yang F, Shokr M, Jankelson L, Knotts RJ, Holmes D, Aizer A, Chinitz LA, Barbhaiya CR. Caudal tilt ultrasound-guided axillary venous access for transvenous pacing lead implant. Heart Rhythm 2024; 21:662-667. [PMID: 38266750 DOI: 10.1016/j.hrthm.2024.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Risheek Kaul
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Felix Yang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York.
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Schvartz N, Haidary A, Wakili R, Hecker F, Kupusovic J, Zsigmond EJ, Miklos M, Saghy L, Szili-Torok T, Erath JW, Vamos M. Risk of Cardiac Implantable Electronic Device Infection after Early versus Delayed Lead Repositioning. J Cardiovasc Dev Dis 2024; 11:117. [PMID: 38667735 PMCID: PMC11049932 DOI: 10.3390/jcdd11040117] [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: 12/30/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Early reintervention increases the risk of infection of cardiac implantable electronic devices (CIEDs). Some operators therefore delay lead repositioning in the case of dislocation by weeks; however, there is no evidence to support this practice. The aim of our study was to evaluate the impact of the timing of reoperation on infection risk. (2) Methods: The data from consecutive patients undergoing lead repositioning in two European referral centers were retrospectively analyzed. The odds ratio (OR) of CIED infection in the first year was compared among patients undergoing early (≤1 week) vs. delayed (>1 week to 1 year) reoperation. (3) Results: Out of 249 patients requiring CIED reintervention, 85 patients (34%) underwent an early (median 2 days) and 164 (66%) underwent a delayed lead revision (median 53 days). A total of nine (3.6%) wound/device infections were identified. The risk of infection was numerically lower in the early (1.2%) vs. delayed (4.9%) intervention group yielding no statistically significant difference, even after adjustment for typical risk factors for CIED infection (adjusted OR = 0.264, 95% CI 0.032-2.179, p = 0.216). System explantation/extraction was necessary in seven cases, all being revised in the delayed group. (4) Conclusions: In this bicentric, international study, delayed lead repositioning did not reduce the risk of CIED infection.
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Affiliation(s)
- Noemi Schvartz
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Arian Haidary
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Reza Wakili
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Florian Hecker
- Department of Cardiac Surgery, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Jana Kupusovic
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Elod-Janos Zsigmond
- Doctoral School of Clinical Medicine, University of Szeged, 6725 Szeged, Hungary
- Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Marton Miklos
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Laszlo Saghy
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Tamas Szili-Torok
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Julia W. Erath
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Mate Vamos
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
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Cosgun MS, Cosgun C. Relationship between CIED extent of displacement toward the shoulder while in the supine position and shoulder impairment. Pacing Clin Electrophysiol 2023; 46:235-241. [PMID: 36440530 DOI: 10.1111/pace.14635] [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: 05/27/2022] [Revised: 08/08/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Device-related shoulder impairment is a common complication in cardiac implantable electronic device (CIED) recipients. This study examined the relationship between the extent of device displacement toward the shoulder while in the supine position and ipsilateral shoulder impairment. METHODS This cross-sectional study included 142 consecutive patients with CIEDs. The effects of the extent of device displacement on functional limitations, muscle strength, pain-disability, and quality of life were evaluated. Range of motion (ROM), grip strength (GS), the Shoulder Pain and Disability Index (SPADI), and the 36-item Short-Form (SF-36) Health Survey were used. RESULTS The mean device displacement was greater in patients with than without device-related shoulder impairment (51 ± 19 vs. 38 ± 15 mm; p < .001). Female gender (p = .046), high body mass index (p = .008), and defibrillator implantation (p = .004) were significantly more frequent in patients with than without impairment. Patients with excessive device displacement had significantly higher ROM limitation rates (p = .003) and SPADI scores (p = .02) and significantly lower GS (p = .04) and SF-36 scores (p = .032). Defibrillator implantation (OR: 2.569, 95% CI: 1.216-4.681; p = .03) and the extent of device displacement (OR: 1.502, 95% CI: 1.186-1.852; p = .01) were independent predictors of shoulder impairment. CONCLUSIONS Excessive displacement of the device toward the shoulder while in the supine position causes shoulder impairment by contacting more muscle fibers. Obese female patients with defibrillators have the highest risk.
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Affiliation(s)
- Muharrem Said Cosgun
- Department of Cardiology, Medical Faculty, Mengucek Gazi Education and Research Hospital, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Cansu Cosgun
- Department of Physical Therapy and Rehabilitation, Mengucek Gazi Education and Research Hospital, Medical Faculty, Erzincan Binali Yildirim University, Erzincan, Turkey
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Mlynarski R, Mlynarska A, Joniec M, Gladysz-Wanha S, Honkowicz M, Stachanczyk J, Golba KS. Predictors of Early Cardiac Implantable Electronic Device Lead Dislodgement in the Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14766. [PMID: 36429483 PMCID: PMC9690924 DOI: 10.3390/ijerph192214766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION One of the most frequent cardiac implantable electronic device (CIED) implantation complications is lead dislodgement, especially in the older adult population. Little evidence is available about the influence of frailty on the risk of lead dislodgment after CIED implantation procedures; thus, the evaluation of frailty could be relevant for the course and safety of the implantation procedure, especially among the elderly with cardiovascular diseases. This study aimed to assess the risks and predictors of early lead dislodgement in the elderly population. METHODS Between 2008 and 2021, 14,293 patients underwent implantations. In 400 elderly patients, lead dislodgement was confirmed, and frailty was retrospectively calculated. RESULTS The most frequent dislodgement according to the lead position was that of the atrial lead (133; 33.3%). In the logistic regression, frailty (OR: 1.8196, 95% CI:1.4991-2.2086; p < 0.0001) and age (OR: 1.0315, 95% CI:1.0005-1.0634; p < 0.0461) were independent predictors of early dislodgement. In the female group, frailty (OR: 2.1185, 95% CI: 1.5530-2.8899; p < 0.0001) was an independent predictor of early dislodgement. Similarly, in the male group, frailty (OR: 1.6321, 95% CI:1.2725-2.0934; p < 0.0001) was an independent predictor of early dislodgement. CONCLUSION Lead dislodgement often occurs in the elderly. Frailty in both men and women is a predictive factor of early lead dislodgment. Evaluating frailty may be an essential element of proper selection, especially in the elderly undergoing CIED procedures, and, consequently, it could help prevent further complications.
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Affiliation(s)
- Rafal Mlynarski
- Department of Electroradiology, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
- Department of Electrocardiology, Upper Silesian Heart Centre, 40-635 Katowice, Poland
| | - Agnieszka Mlynarska
- Department of Electrocardiology, Upper Silesian Heart Centre, 40-635 Katowice, Poland
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Michal Joniec
- Department of Electrocardiology, Upper Silesian Heart Centre, 40-635 Katowice, Poland
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Sylwia Gladysz-Wanha
- Department of Electrocardiology, Upper Silesian Heart Centre, 40-635 Katowice, Poland
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Maciej Honkowicz
- Department of Electroradiology, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Joanna Stachanczyk
- Department of Cardiac Rehabilitation, Murcki Hospital, 40-749 Katowice, Poland
| | - Krzysztof S. Golba
- Department of Electrocardiology, Upper Silesian Heart Centre, 40-635 Katowice, Poland
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
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Qin D, Filippaios A, Murphy J, Berg M, Lampert R, Schloss EJ, Noone M, Mela T. Short- and Long-Term Risk of Lead Dislodgement Events: Real-World Experience From Product Surveillance Registry. Circ Arrhythm Electrophysiol 2022; 15:e011029. [PMID: 35925831 DOI: 10.1161/circep.122.011029] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lead dislodgement (LD) has been one of the most common early complications after cardiovascular implantable electronic device implant. However, limited data are available on the clinical characteristics and long-term outcomes of LD events. The aim of this study was to examine the risk factors, clinical significance, and management strategies of LD events after cardiovascular implantable electronic device implant. METHODS This study was a retrospective cohort analysis of 20 683 patients who underwent cardiovascular implantable electronic device implant between January 1, 2010 and January 31, 2020 in Medtronic's Product Surveillance Registry, with a mean follow-up time of 3.3±2.5 SD years. The study population was divided into 2 groups: group A with LD events (N=350) and group B without LD events (N=20 333). RESULTS During this period, 350 patients (1.69%) had LD events involving 371 leads (0.95%), among a total of 39 060 leads implanted. Passive fixation type (right atrium pacing lead, P=0.041), lower sensing amplitude (right ventricle defibrillating lead, P=0.020), and lower lead impedance at implant (right atrium pacing lead, P=0.009) were associated with increased LD risk. Multivariate analysis showed female sex (hazard ratio, 1.520, P=0.008) and higher body mass index (hazard ratio, 1.012, P=0.001) were independently associated with increased risk of LD events. LD events were not associated with significant changes in the long-term risks of cardiac and overall mortality. In group A, repositioning the dislodged leads increased the risk of a second LD event compared with implanting new leads (P=0.012). CONCLUSIONS Female sex and higher body mass index were associated with higher risk of LD events in the Product Surveillance Registry. Among patients with dislodged leads, implanting new leads was associated with lower risk of future LD events. Further studies on how to reduce LD risk and to improve management of these events are needed. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01524276.
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Affiliation(s)
- Dingxin Qin
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, NH (D.Q.)
| | | | | | | | | | | | | | - Theofanie Mela
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (T.M.)
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Rav Acha M, Soifer E, Hasin T. Cardiac Implantable Electronic Miniaturized and Micro Devices. MICROMACHINES 2020; 11:E902. [PMID: 33003460 PMCID: PMC7600795 DOI: 10.3390/mi11100902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert for early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and the termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and the survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection resulting from the lifelong exposure of these leads to bacteria within the venous system. One of the important cardiac innovations in the last decade was the development of a leadless PPM functioning without venous leads, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, directly implanted into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices that are designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development. Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection that result from the lifelong exposure of these leads to bacteria within the venous system. The development of a leadless PPM functioning without venous leads was one of the important cardiac innovations in the last decade, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, implanted directly into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development.
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Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
| | - Elina Soifer
- Vectorious Medical Technologies, Tel Aviv 610000, Israel;
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
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Pelosi F. Reducing CIED lead dislodgements: Faithful alignment to small things. Pacing Clin Electrophysiol 2018; 42:63-64. [PMID: 30414180 DOI: 10.1111/pace.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Frank Pelosi
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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