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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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Lee JZ, Talaei F, Tan MC, Srivathsan K, Sorajja D, Valverde A, Scott L, Asirvatham SJ, Kusumoto F, Mulpuru SK, Cha YM. Long-term outcomes with abandoning versus extracting sterile leads: A 10-year population-based study. Pacing Clin Electrophysiol 2024; 47:626-634. [PMID: 38488756 DOI: 10.1111/pace.14940] [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: 05/29/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Long-term outcomes of sterile lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) remain unclear. METHODS We performed a retrospective study of a population residing in southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE of sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10 years or until their death were included. RESULTS A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. Indications for subsequent lead extraction arose in 9.1% (n = 14) of patients with initial LA and 5.3% (n = 1) in patients with initial TLE, after an average of 7 years. Moreover, 28.6% of patients in the LA cohort who required subsequent extraction did not proceed with the extraction, and among those who proceeded, 60% had clinical success and 40% had a clinical failure. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges (5.2% vs. 5.3%). There was no difference in 10-year survival probability among the LA group and the TLE group (p = .64). CONCLUSION An initial lead abandonment strategy was associated with more complicated subsequent extraction procedures compared to patients with an initial transvenous lead extraction strategy. However, there was no difference in 10-year survival probability between both lead management approaches.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fred Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Talaei F, Ang QX, Tan MC, Hassan M, Scott L, Cha YM, Lee JZ, Tamirisa K. Impact of infective versus sterile transvenous lead removal on 30-day outcomes in cardiac implantable electronic devices. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01775-1. [PMID: 38459202 DOI: 10.1007/s10840-024-01775-1] [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: 09/24/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection. METHODS From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied. RESULTS Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33-6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23-4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97-1.29) or vascular complications (OR = 1.12; 95% CI 0.73-1.72) between the two groups. CONCLUSION Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients.
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Affiliation(s)
- Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Internal Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Qi-Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Min-Choon Tan
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Mustafa Hassan
- Department of Cardiovascular Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kamala Tamirisa
- Texas Cardiac Arrhythmia Institute, Austin and Dallas, TX, USA.
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Knorr D, Bandorski D, Bogossian H, Iliodromitis K, Schiedat F, Karosiene Z, Mijic D, Lemke B, Seyfarth M, Voß S, Knippschild S, Aweimer A, Zarse M, Kloppe A, Botsios S. Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up. J Clin Med 2024; 13:1044. [PMID: 38398357 PMCID: PMC10888737 DOI: 10.3390/jcm13041044] [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: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. METHODS Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. RESULTS In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). CONCLUSIONS The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.
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Affiliation(s)
- Dario Knorr
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Harilaos Bogossian
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Zana Karosiene
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Dejan Mijic
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Bernd Lemke
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Melchior Seyfarth
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany
| | - Sabrina Voß
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
| | - Markus Zarse
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Axel Kloppe
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Spiridon Botsios
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
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Kwon S, Lee E, Choi EK, Lee SR, Oh S, Choi YS. Long-term outcomes of abandoned leads of cardiac implantable electronic devices. Heart Rhythm 2023; 20:1639-1646. [PMID: 37543304 DOI: 10.1016/j.hrthm.2023.07.068] [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: 01/17/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Evidence of the long-term outcomes of abandoned leads (ALs) in patients with cardiac implantable electronic devices (CIEDs) is scarce. OBJECTIVE This study aimed to investigate the long-term outcomes of ALs. METHODS This retrospective cohort study reviewed a single-center CIED registry of 2962 procedures performed from 1984-2018 and identified 130 patients with AL (AL group). We matched 2 controls without AL (by age, sex, device type, and device revision/removal date) to each patient with AL (n = 260) and compared CIED-related infection, venous thrombosis/stenosis, and all-cause mortality between groups using a Cox proportional hazard model analysis. RESULTS For a mean follow-up period of 11.2 ± 8.2 years, 14 (3.6%), 7 (1.8%), and 143 (36.7%) patients had a CIED-related infection, venous thrombosis/stenosis, or experienced all-cause mortality, respectively. The AL group had more comorbidities than the control group. Lead malfunction was the most common cause of abandonment (64.6%). After adjustment for covariates, no significant intergroup differences were noted in the risks of infection, venous thrombosis/stenosis, or all-cause mortality (adjusted hazard ratio [aHR] 2.52; 95% confidence interval [CI] 0.77-8.25; aHR 1.18; 95% CI 0.25-5.64; aHR 1.26; 95% CI 0.89-1.80, respectively). Patients with multiple ALs had increased risks of infection and all-cause mortality vs controls (aHR 8.61; 95% CI 2.13-34.84; aHR 2.42; 95% CI 1.17-5.00, respectively). CONCLUSION Patients with a single AL showed similar risks of CIED-related infections, venous thrombosis/stenosis, and all-cause mortality as those without ALs, whereas those with multiple ALs showed increased risks of infection and all-cause mortality.
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Affiliation(s)
- Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Cardiovascular Medicine, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun-Shik Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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Miguelena Hycka J, López Menéndez J, Martín García M, Muñoz Pérez R, Castro Pinto M, Torres Terreros CB, García Chumbiray PF, Rodriguez-Roda J. Electrodos no funcionantes ¿Extracción o abandono? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Empfehlungen zur Sondenextraktion – Gemeinsame Empfehlungen der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Darden D, Boateng BA, Tseng AS, Alshawabkeh L, Pollema T, Cha YM, Birgersdotter-Green U. Transvenous Laser Lead Extraction in Patients with Congenital Complete Heart Block. Heart Rhythm 2022; 19:1158-1164. [DOI: 10.1016/j.hrthm.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
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Zeitler EP, Wang Y, Pokorney SD, Curtis J, Prutkin JM. Comparative outcomes of Riata and Fidelis lead management strategies: Results from the NCDR-ICD Registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1897-1906. [PMID: 34520564 DOI: 10.1111/pace.14361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi-center population are unknown. We aim to describe patients with functional, recalled ICD leads undergoing elective generator replacement and report outcomes according to lead management strategies. METHODS Using data from the NCDR ICD Registry, patients with a functioning Riata® or Fidelis® lead undergoing generator replacement are described according to lead management: reuse, abandon/replace, and extract/replace. Adjusted rates of death and pre-discharge complications are reported. RESULTS There were 13,144 generator replacement procedures involving a functioning, non-infected Riata® or Fidelis® lead (extraction n = 414, abandonment n = 427). Extraction patients were younger (mean 58 vs. 67 years) with fewer comorbidities than the reuse group. Maximum lead dwell time was similar between groups with average 94, 90, and 99 months in the extraction, abandonment, and reuse groups, respectively. In-hospital complications or mortality were more common in the extraction group (10.14%, 4.35%) compared with abandonment (1.64%, 0.47%) and reuse (0.22%, 0.07%). Compared with reuse, the adjusted odds of death or pre-discharge complication were significantly higher in the extraction group (OR 7.77 95% CI 2.42-24.95, p < .001) but not the abandonment group (OR 1.70 95% CI 0.52-5.61, p = .38). CONCLUSIONS In this real-world population, extraction of functional recalled ICD leads was associated with significant risk of in-hospital mortality and complications. Additional work is needed to clarify whether longer term outcomes balance these peri-procedural risks.
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Affiliation(s)
- Emily P Zeitler
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Yongfei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Sean D Pokorney
- Duke University Hospital, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jeptha Curtis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Jordan M Prutkin
- Division of Cardiology, Section of Electrophysiology, University of Washington, Seattle, Washington, USA
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12
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Alonso C, Marquie C, Defaye P, Clementy N, Mondoly P, Sadoul N, Boveda S, Hidden-Lucet F, Dompnier A, Da Costa A, Marijon E, Leclercq C, Caudron G, Piot O, Deharo JC. FRAGILE: FRench Attitude reGistry in case of ICD LEad replacement. Europace 2021; 23:389-394. [PMID: 33257986 DOI: 10.1093/europace/euaa290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups. METHODS AND RESULTS Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications. CONCLUSION In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
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Affiliation(s)
- Christine Alonso
- CMC Ambroise Paré, 25-27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord Saint-Denis, France
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13
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Elgaard AF, Johansen JB, Nielsen JC, Gerdes C, Riahi S, Philbert BT, Haarbo J, Melchior TM, Larsen JM. Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study. Europace 2021; 22:1097-1102. [PMID: 32447372 DOI: 10.1093/europace/euaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. METHODS AND RESULTS All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. CONCLUSION More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
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14
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A Review of Cardiac Implantable Electronic Device Infections for the Practicing Electrophysiologist. JACC Clin Electrophysiol 2021; 7:811-824. [PMID: 34167758 DOI: 10.1016/j.jacep.2021.03.021] [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] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
Cardiovascular implantable electronic device (CIED) infections are morbid, costly, and difficult to manage. This review explores the pathophysiology, diagnosis, and management of CIED infections. Diagnostic accuracy has been improved through increased awareness and improved imaging strategies. Pocket or bloodstream infection with virulent organisms often requires complete system extraction. Emerging prophylactic interventions and novel devices have expanded preventative strategies and options for re-implantation. A clear and nuanced understanding of CIED infection is important to the practicing electrophysiologist.
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15
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Starck CT, Burger H, Osswald B, Hakmi S, Knaut M, Bimmel D, Bärsch V, Eitz T, Mierzwa M, Ghaffari N, Siebel A. HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Higuchi S, Shoda M, Saito S, Kanai M, Kataoka S, Yazaki K, Yagishita D, Ejima K, Hagiwara N. Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience. Pacing Clin Electrophysiol 2019; 42:1517-1523. [DOI: 10.1111/pace.13806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Satoshi Higuchi
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Satoshi Saito
- Department of Cardiovascular SurgeryTokyo Women's Medical University Tokyo Japan
| | - Miwa Kanai
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Kyoichiro Yazaki
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
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17
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Alqarawi W, Coppens J, Aldawood W, Ramirez FD, Redpath CJ, Nair GM, Nery PB, Davis DR, Abu Shama R, Aydin A, Klein A, Golian M, Schaller RD, Green MS, Birnie DH, Sadek MM. A Strategy of Lead Abandonment in a Large Cohort of Patients With Sprint Fidelis Leads. JACC Clin Electrophysiol 2019; 5:1059-1067. [DOI: 10.1016/j.jacep.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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18
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol 2019; 42:1006-1017. [DOI: 10.1111/pace.13715] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Jacheć
- 2nd Department of CardiologyMedical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze Zabrze Poland
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences KielceThe Jan Kochanowski University Kielce Poland
- Swietokrzyskie Cardiology Center Kielce Poland
| | - Luca Segreti
- Department of CardiologyUniversity Hospital of Pisa Pisa Italy
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19
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Harolds JA. Quality and Safety in Health Care, Part XLII: Introduction to the Implantable Cardioverter Defibrillator Registry. Clin Nucl Med 2018; 43:818-819. [PMID: 29939951 DOI: 10.1097/rlu.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implantable cardioverter defibrillators for both primary and secondary prevention have been successful in decreasing sudden cardiac death. The Implantable Cardioverter Defibrillator Registry was established partly for reimbursement for primary prevention. However, the registry also has been helpful in better understanding the risks and appropriate selection of patients to receive these devices, serving as an impetus for quality improvement by giving outcome information to the contributing institutions regarding their performance relative to the national results, and increasing research. It is also expected to be helpful to compare results from different devices and provide information to the public.
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Affiliation(s)
- Jay A Harolds
- From Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI
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20
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Merchant FM, Tejada T, Patel A, El-Khalil J, Desai Y, Keeling B, Lattouf OM, Leon AR, El-Chami MF. Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads. Heart Rhythm 2018; 15:855-859. [DOI: 10.1016/j.hrthm.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 10/18/2022]
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21
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Lau CP, Tse HF. An Unpleasant Legacy: Infected Abandoned Leads. JACC Clin Electrophysiol 2018; 4:209-211. [PMID: 29749939 DOI: 10.1016/j.jacep.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China; Shenzhen Institutes of Research and Innovation, University of Hong Kong, Hong Kong SAR, China
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22
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Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy L, Rao A, Tascini C, Lever N, Kutarski A, Fernandez Lozano I, Strathmore N, Costa R, Epstein L, Love C, Blomstrom-Lundqvist C, Fauchier L, Defaye P, Arnar DO, Klug D, Boveda S, Nielsen JC, Boriani G, Zhang S, Martin AP, Prutkin JM, de Zuloaga C. 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace 2018; 20:1217. [DOI: 10.1093/europace/euy050] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Jean C Deharo
- Department of Cardiology, CHU la Timone, Marseilles, France
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laszlo Saghy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Nigel Lever
- APHRS Reviewer, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Neil Strathmore
- APHRS Reviewer, Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Roberto Costa
- LAHRS Reviewer, Hospital das Clínicas, São Paulo, Brazil
| | - Laurence Epstein
- HRS Reviewer, Clinical Cardiac Electrophysiology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Love
- HRS Reviewer, Division of Cardiovascular Medicine, the Ohio State University Medical Center Columbus, Ohio, USA
| | | | | | - Pascal Defaye
- CHU Hopital Albert Michallon, Unite de Rythmologie Service De Cardiologie, Grenoble, France
| | - David O Arnar
- Landspitali University Hospital, Cardiology Department, Reykjavik, Iceland
| | - Didier Klug
- Hopital Cardiologique, Chru Lille, Service De Cardiologie A, Lille, France
| | - Serge Boveda
- Clinique Pasteur, Cardiology Department, Toulouse, France
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aaehus, Denmark
| | | | - Shu Zhang
- Beijing Fuwai Hospital, Cardiology Department, Beijing, China
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23
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Holzhauser L, Imamura T, Nayak HM, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Patel A, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation-An Underrecognized Problem. J Card Fail 2018; 24:101-108. [PMID: 29325797 PMCID: PMC5945281 DOI: 10.1016/j.cardfail.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. METHODS We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). RESULTS A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. CONCLUSION RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
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Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hemal M Nayak
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nitasha Sarswat
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sara Kalantari
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Onsager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
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24
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Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, Zeitler EP, Al-Khatib SM, Hegland DD, Piccini JP. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation 2017; 136:1387-1395. [DOI: 10.1161/circulationaha.117.027636] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Abstract
Background:
Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.
Methods:
Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.
Results:
Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years;
P
<0.0001), were less likely to be male (65% versus 68%;
P
=0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years;
P
<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7–14.4) and 54.3% (95% CI, 52.8–55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62–0.97;
P
=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.
Conclusions:
Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.
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Affiliation(s)
- Sean D. Pokorney
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Xiaojuan Mi
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Robert K. Lewis
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Melissa Greiner
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Laurence M. Epstein
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Roger G. Carrillo
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Emily P. Zeitler
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Sana M. Al-Khatib
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Donald D. Hegland
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Jonathan P. Piccini
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
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25
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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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