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Wan EY, Rogers AJ, Lavelle M, Marcus M, Stone SA, Ottoboni L, Srivatsa U, Leal MA, Russo AM, Jackson LR, Crossley GH. Periprocedural Management and Multidisciplinary Care Pathways for Patients With Cardiac Implantable Electronic Devices: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e183-e196. [PMID: 38984417 DOI: 10.1161/cir.0000000000001264] [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] [Indexed: 07/11/2024]
Abstract
The rapid technological advancements in cardiac implantable electronic devices such as pacemakers, implantable cardioverter defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices, necessitate an updated clinical framework for periprocedural management. The introduction of leadless pacemakers, subcutaneous and extravascular defibrillators, and novel device communication protocols underscores the imperative for clinical updates. This scientific statement provides an inclusive framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic. Expert contributions from anesthesiologists, cardiac electrophysiologists, and cardiac nurses are consolidated to appraise current evidence, offer patient and health system management strategies, and highlight key areas for future research. The statement, pertinent to a wide range of health care professionals, underscores the importance of quality care pathways for patient safety, optimal device function, and minimization of hemodynamic disturbances or arrhythmias during procedures. Our primary objective is to deliver quality care to the expanding patient cohort with cardiac implanted electronic devices, offering direction in the era of evolving technologies and laying a foundation for sustained education and practice enhancement.
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Carrington M, António PS, Rodrigues N, Nunes-Ferreira A, Bernardes A, Pinto FJ, Sousa JD, Marques P. New Technique for Preserving Cephalic Vein Flow in Pacemaker Implantation Ipsilateral to Arteriovenous Fistula. Arq Bras Cardiol 2023; 120:e20220926. [PMID: 37377197 DOI: 10.36660/abc.20220926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/08/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Mafalda Carrington
- Serviço de Cardiologia, Hospital do Espírito Santo de Évora, Évora - Portugal
| | - Pedro Silvério António
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Natacha Rodrigues
- Serviço de Nefrologia e Transplante Renal, Departamento de Medicina, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Ana Bernardes
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - João de Sousa
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
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Czajkowski M, Polewczyk A, Jacheć W, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies. Clin Physiol Funct Imaging 2023; 43:47-57. [PMID: 36251514 PMCID: PMC10092861 DOI: 10.1111/cpf.12792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/20/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Patients requiring temporal or permanent catheter or arterio-venous fistula (AVF) for haemodialysis may be in challenging situation, if they are cardiovascular implantable electronic devices (CIED) carriers. MATERIALS AND METHODS The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. RESULTS A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. CONCLUSION (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free-from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University , Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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Timal RJ, Karalis I, Cabezas JMM, Rotmans JI, Hensen LCR, Buiten MS, de Bie MK, van Erven L, Putter H, Schalij MJ, Rabelink TJ, Jukema JW. Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue. CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2022; 6:171-188. [PMID: 36016586 PMCID: PMC9401088 DOI: 10.26502/fccm.92920253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background In hemodialysis patients, implantable cardioverter-defibrillator (ICD) implantation may result in central venous stenosis (CVS) with associated symptoms, such as pain, edema of the ipsilateral arm, facial edema, and loss of dialysis access. However, literature concerning CVS in dialysis patients with a cardiac implantable electronic device is scarce. Methods We conducted a prospective cohort study in which we investigated the incidence of CVS in end-stage renal disease patients on chronic dialysis who received an ICD as part of participation in the randomized ICD2 trial. A venography was performed before ICD implantation and at 1 year follow-up. Results Between 2007 and 2017, 80 patients on dialysis received an ICD according to ICD2 trial protocol. Our population mainly consisted of males (76.3%), and had a median age of 67 years. Hemodialysis was the predominant dialysis modality (71.3%). The ICD was implanted in the right pectoral region in 58 patients (72.5%). A minority of the patients (27.5%) had a history of central venous catheters use, ipsilateral to ICD implantation site. Median follow-up was 16 months (IQR 13-35). Prospective assessment of central vein patency was possible in 56 patients (70.0%). Partial obstruction of central vein at follow-up was present in 19 out of 56 patients (33.9%) and complete occlusion in 4 patients (7.1%). With a complete clinical follow-up of all patients with a median duration of 3.5 years (IQR 2.7 - 6.3), 3 patients developed clinically significant symptoms of CVS. Conclusions Development of CVS in patients on chronic dialysis who received an ICD is a cause of concern. Prevention of such complications deserves attention and further research. Trial Registration ISRCTN20479861.
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Affiliation(s)
- Rohit J Timal
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ioannis Karalis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Liselotte C R Hensen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maurits S Buiten
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mihaly K de Bie
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [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] [Received: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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