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Igbinomwanhia E, Jiwani S, Karim S, Pimentel R. Case Series and Review of Literature for Superior Vena Cava Injury During Laser Lead Extraction. Card Electrophysiol Clin 2024; 16:117-124. [PMID: 38749629 DOI: 10.1016/j.ccep.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Transvenous laser lead extraction poses a risk of major complications (0.19%-1.8%), notably injury to the superior vena cava (SVC) in 0.19% to 0.96% of cases. Various factors contribute to SVC injury, which can be categorized as patient-related (such as female gender, low body mass index, diabetes, renal problems, anemia, and reduced ejection fraction), device-related (including the number, dwell time, and type of leads), or procedural-related (such as reason for extraction, venous obstructions, and bilateral lead placements).
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Affiliation(s)
- Efehi Igbinomwanhia
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
| | - Sania Jiwani
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
| | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
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2
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Stefańczyk P, Jacheć W, Kutarski A, Dąbrowski P, Głowniak A, Nowosielecka D. Extraction of His Bundle Pacing Lead: More Difficult than Coronary Sinus Lead Extraction: An Analysis of 3897 Lead Extraction Procedures Including 27 His and 253 Coronary Sinus Lead Removals. Biomedicines 2024; 12:1154. [PMID: 38927361 PMCID: PMC11200661 DOI: 10.3390/biomedicines12061154] [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: 03/24/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Experience with the transvenous extraction of leads used for His bundle pacing (HBP) is limited. METHODS Analysis of 3897 extractions including 27 HBP and 253 LVP (left ventricular pacing) leads. RESULTS The main reason for HBP lead extraction was lead failure (59.26%). The age of HBP and LVP leads (54.52 vs. 50.20 months) was comparable, whereas procedure difficulties were related to the LVP lead dwell time. The extraction of HBP leads > 40 months old was longer than the removal of younger leads (8.57 vs. 3.87 min), procedure difficulties occurred in 14.29%, and advanced tools were required in 28.57%. There were no major complications. The extraction time of dysfunctional or infected leads was similar in the HBP and LVP groups (log-rank p = 0.868) but shorter when compared to groups with other leads. Survival after the procedure did not differ between HBP and LVP groups but was shorter than in the remaining patients. CONCLUSIONS 1. HBP is used in CRT-D systems for resynchronisation of the failing heart in 33.33%. 2. Extraction of HBP leads is most frequently performed for non-infectious indications (59.26%) and most often because of lead dysfunction (33.33%). 3. The extraction of "old" (>40 months) HBP leads is longer (8.57 vs. 3.87 min) and more difficult than the removal of "young" leads due to unexpected procedure difficulties (14.29%) and the use of second line/advanced tools (28.57%), but it does not entail the risk of major complications and procedure-related death and is comparable to those encountered in the extraction of LVP leads of a similar age. 4. Survival after lead extraction was comparable between HBP and LVP groups but shorter compared to patients who underwent the removal of other leads.
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Affiliation(s)
- Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (P.S.); (P.D.)
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.K.); (A.G.)
| | - Paweł Dąbrowski
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (P.S.); (P.D.)
| | - Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.K.); (A.G.)
| | - Dorota Nowosielecka
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland
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Shanafelt C, Middour TG, Ibrahim R, Leal M, Lloyd MS, Shah AD, Westerman SB, El-Chami MF, Merchant FM, Bhatia NK. Outcomes of tricuspid regurgitation after lead extraction. J Cardiovasc Electrophysiol 2024; 35:929-938. [PMID: 38450808 DOI: 10.1111/jce.16227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/04/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. METHODS We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0 = none/trivial, 1 = mild, 2 = moderate, 3 = severe). A change of >1 grade following extraction was considered significant. RESULTS A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference on average TR grade pre- and postextraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p = 0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e., >1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR postextraction (44.0% vs. 31.6%, p = 0.04). CONCLUSION In our single-center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction.
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Affiliation(s)
- Colby Shanafelt
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas G Middour
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rand Ibrahim
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Miguel Leal
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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McGuire JA, Hayanga JWA, Thibault D, Zukowski A, Grose B, Woods K, Schwartzman D, Hayanga HK. Anesthetic Choice for Cardiovascular Implantable Electronic Device Placement and Lead Removal: A National Anesthesia Clinical Outcomes Registry Analysis. J Cardiothorac Vasc Anesth 2023; 37:2461-2469. [PMID: 37714760 DOI: 10.1053/j.jvca.2023.07.026] [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: 03/15/2023] [Revised: 07/01/2023] [Accepted: 07/19/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE The authors evaluated the anesthetic approach for cardiovascular implantable electronic device (CIED) placement and transvenous lead removal, hypothesizing that monitored anesthesia care is used more frequently than general anesthesia. DESIGN A retrospective study. SETTING National Anesthesia Clinical Outcomes Registry data. PARTICIPANTS Adult patients who underwent CIED (permanent cardiac pacemaker or implantable cardioverter-defibrillator [ICD]) placement or transvenous lead removal between 2010 and 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Covariates were selected a priori within multivariate models to assess predictors of anesthetic type. A total of 87,530 patients underwent pacemaker placement, 76,140 had ICD placement, 2,568 had pacemaker transvenous lead removal, and 4,861 had ICD transvenous lead extraction; 51.2%, 45.64%, 16.82%, and 45.64% received monitored anesthesia care, respectively. A 2%, 1% (both p < 0.0001), and 2% (p = 0.0003) increase in monitored anesthesia care occurred for each 1-year increase in age for pacemaker placement, ICD placement, and pacemaker transvenous lead removal, respectively. American Society of Anesthesiologists (ASA) physical status ≤III for pacemaker placement, ASA ≥IV for ICD placement, and ASA ≤III for pacemaker transvenous lead removal were 7% (p = 0.0013), 5% (p = 0.0144), and 27% (p = 0.0247) more likely to receive monitored anesthesia care, respectively. Patients treated in the Northeast were more likely to receive monitored anesthesia care than in the West for all groups analyzed (p < 0.0024). Male patients were 24% less likely to receive monitored anesthesia care for pacemaker transvenous lead removal (p = 0.0378). For every additional 10 pacemaker or ICD lead removals performed in a year, a 2% decrease in monitored anesthesia care was evident (p = 0.0271, p < 0.0001, respectively). CONCLUSIONS General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
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Affiliation(s)
- Joseph A McGuire
- Department of Anesthesiology, West Virginia University, Morgantown, WV
| | - J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Dylan Thibault
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Anna Zukowski
- West Virginia University School of Medicine, Morgantown, WV
| | - Brian Grose
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV
| | - Kaitlin Woods
- Department of Medical Education, West Virginia University, Morgantown, WV
| | - David Schwartzman
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV
| | - Heather K Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV.
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Bardwell Speltz LJ, Shu Y, Watson RE, Trzasko JD, In MH, Gray EM, Halverson MA, Tarasek MR, Hua Y, Huston J, Cogswell PM, Foo TKF, Bernstein MA. Evaluation of a compact 3 T MRI scanner for patients with implanted devices. Magn Reson Imaging 2023; 103:109-118. [PMID: 37468020 PMCID: PMC10528046 DOI: 10.1016/j.mri.2023.07.009] [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: 05/15/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
Access to high-quality MR exams is severely limited for patients with some implanted devices due to labeled MR safety conditions, but small-bore systems can overcome this limitation. For example, a compact 3 T MR scanner (C3T) with high-performance gradients can acquire exams of the head, extremities, and infants. Because of its reduced bore size and the patient being advanced only partially into the bore, the associated electromagnetic (EM) fields drop off rapidly caudal to the head, compared to whole-body systems. Therefore, some patients with MR conditional implanted devices can safely receive 3 T brain exams on the C3T using its strong gradients and a multiple-channel receive coil, while a corresponding exam on whole-body MR is precluded. The purpose of this study is to evaluate the performance of a small-bore scanner for subjects with MR conditional spinal or sacral nerve stimulators, or abandoned cardiac implantable electronic device (CIED) leads. The spatial dependence of specific absorption rate (SAR) on the C3T was compared to whole-body scanners. A device assessment tool was developed and applied to evaluate MR safety individually on the C3T for 12 subjects with implanted devices or abandoned CIED leads. Once MR safety was established, the subjects received a C3T brain exam along with their clinical, 1.5 T exam. The resulting images were graded by three board-certified neuroradiologists. The C3T exams were well-tolerated with no adverse events, and significantly outperformed the whole-body 1.5 T exams in terms of overall image quality.
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Affiliation(s)
- Lydia J Bardwell Speltz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Yunhong Shu
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Robert E Watson
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Joshua D Trzasko
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Myung-Ho In
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Erin M Gray
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Yihe Hua
- GE Research, Niskayuna, NY, United States
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Matt A Bernstein
- Department of Radiology, Mayo Clinic, Rochester, MN, United States.
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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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Domain G, Strubé C, Jacques F, Marzouk M, Dumont É, Villeneuve J, Plourde B, Albert G, Sarrazin JF, Steinberg C, Philippon F. Superior vena cava tear during transvenous lead extraction: Medical management in hemodynamically stable patients. Pacing Clin Electrophysiol 2023. [PMID: 37196145 DOI: 10.1111/pace.14718] [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: 10/24/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Superior vena cava (SVC) tear is the most lethal complication during transvenous lead extraction (TLE) with a mortality rate as high as 50%. Treatment involves aggressive attempts to maintain cardiac output and immediate sternotomy to localize and repair the vascular tear. Occlusion balloons have been developed to provisionally occlude the lacerated SVC and to provide hemodynamic stability allowing time for surgery. In case of mediastinal hematoma without hemodynamic instability, the strategy remains unclear. METHODS AND RESULTS We describe two cases of SVC tear during TLE. The first case was a 60-year-old man who presented with a right ventricular single-chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28-year-old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual-chamber defibrillator (ICD). CONCLUSION Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.
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Affiliation(s)
- Guillaume Domain
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Camille Strubé
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Frédéric Jacques
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Mohamed Marzouk
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Éric Dumont
- Cardiac Surgery Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Jacques Villeneuve
- Anesthesiology Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Benoît Plourde
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Gabriella Albert
- Radiology Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Jean-François Sarrazin
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Christian Steinberg
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - François Philippon
- Electrophysiology Division, Institut Uuniversitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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Boarescu PM, Popa ID, Trifan CA, Roşian AN, Roşian ŞH. Practical Approaches to Transvenous Lead Extraction Procedures-Clinical Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:379. [PMID: 36612704 PMCID: PMC9819065 DOI: 10.3390/ijerph20010379] [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: 09/01/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Transvenous lead extraction (TLE) is regarded as the first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIEDs), when lead removal is mandatory. The decision to perform a lead extraction should take into consideration not only the strength of the clinical indication for the procedure but also many other factors such as risks versus benefits, extractor and team experience, and even patient preference. TLE is a procedure with a possible high risk of complications. In this paper, we present three clinical cases of patients who presented different indications of TLE and explain how the procedures were successfully performed. In the first clinical case, TLE was necessary because of device extravasation and suspicion of CIED pocket infection. In the second clinical case, TLE was necessary because occlusion of the left subclavian vein was found when an upgrade to cardiac resynchronization therapy was performed. In the last clinical case, TLE was necessary in order to remove magnetic resonance (MR) non-conditional leads, so the patient could undergo an MRI examination for the management of a brain tumor.
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Affiliation(s)
- Paul-Mihai Boarescu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Gheorghe Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Iulia Diana Popa
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Cătălin Aurelian Trifan
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
| | - Adela Nicoleta Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Ştefan Horia Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiology—Heart Institute, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
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Wijesuriya N, Elliott MK, Mehta V, Behar JM, Niederer S, Wilkoff BL, Rinaldi CA. Transvenous lead extraction in conduction system pacing. Front Physiol 2022; 13:993604. [PMID: 36035491 PMCID: PMC9410714 DOI: 10.3389/fphys.2022.993604] [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: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Conduction System Pacing (CSP) delivered by His Bundle Pacing (HBP) or Left Bundle Pacing (LBP) are exciting novel interventions in the field of Cardiac Resynchronization Therapy (CRT). As the evidence base for CSP grows, the volume of implants worldwide is projected to rise significantly in the coming years. As such, physicians will be confronted with increasingly prevalent and vital issues arising in long-term follow up, including the management of infected, malfunctioning, or redundant CSP leads. Transvenous lead extraction (TLE) is the first-line option for removal of pacing leads when indicated in these circumstances. The evidence base for TLE in the context of CSP is still in its infancy. In this article, we first provide a brief overview of TLE. We then examine the data on the long-term performance of HBP leads. Next, we describe the features of the Medtronic Select Secure 3,830 lead, and how experience of TLE of this lead in the paediatric population has informed our practice. Finally, we review the current evidence for TLE in HBP and LBP, and discuss how future studies can address gaps in our current knowledge.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bruce L Wilkoff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Deb Family Endowed Chair in Lead Management, Cleveland Clinic, Cleveland, OH, United States
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, United Kingdom
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10
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An Unusual Cause of Cerebral Embolism. JACC Case Rep 2022; 4:854-856. [PMID: 35912334 PMCID: PMC9334140 DOI: 10.1016/j.jaccas.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/04/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
Abstract
We report an exceptionally rare complication of cardiac pacing: a case of spontaneous fracture of a modern bipolar pacing lead that led to migration across a patent foramen ovale into the left atrium and embolic stroke. (Level of Difficulty: Advanced.)
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11
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(Cardiac electronic device extraction - our experience). COR ET VASA 2022. [DOI: 10.33678/cor.2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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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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13
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Rojas E, Morgaenko K, Brown L, Kim S, Mazimba S, Malhotra R, Darby A, Monfredi O, Mason P, Mangrum JM, Haines DE, Campbell C, Bilchick K, Mehta N. Evaluation of a novel mechanical compression device for hematoma prevention and wound cosmesis after CIED implantation. Pacing Clin Electrophysiol 2022; 45:491-498. [PMID: 35174901 PMCID: PMC9310802 DOI: 10.1111/pace.14454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND An important complication of cardiac implantable electronic devices (CIED) is the development of hematoma and device infection. OBJECTIVE We aimed to evaluate a novel mechanical compression device for hematoma prevention and cosmetic outcomes following CIED. METHODS An open, prospective, randomized, single-center clinical trial was performed in patients undergoing CIED implantation. Patients were randomized to receive a novel mechanical compression device (PressRite, PR) or to receive the standard of care post device implantation. Skin pliability was measured with a calibrated durometer; the surgical site was evaluated using the Manchester Scar Scale (MSS) by a blinded plastic surgeon and the Patient and Observer Scar Scale (POSAS). Performance PR was assessed through pressure measurements, standardized scar scales and tolerability. RESULTS From the total of 114 patients evaluated for enrollment, 105 patients were eligible for analysis. Fifty-one patients were randomized to management group (PR) and 54 to the control group. No patients required early removal or experienced adverse effects from PR application. There were 11 hematomas (14.8% vs. 5.9% in the control and PR group respectively, p = NS). The control group had higher post procedure durometer readings in the surgical site when compared with the PR group (7.50 ± 3.45 vs. 5.37 ± 2.78; p = <0.01). There were lower MSS scores in the PR group after 2 weeks (p = 0.03). CONCLUSION We have demonstrated the safety of PR application and removal. In addition, PR appears to lower post-operative skin pliability, which could improve wound healing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Edward Rojas
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - Louis Brown
- University of Virginia Health System, Charlottesville, VA, USA
| | - Sieu Kim
- University of Virginia Health System, Charlottesville, VA, USA
| | - Sula Mazimba
- University of Virginia Health System, Charlottesville, VA, USA
| | - Rohit Malhotra
- University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew Darby
- University of Virginia Health System, Charlottesville, VA, USA
| | - Oliver Monfredi
- University of Virginia Health System, Charlottesville, VA, USA
| | - Pamela Mason
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - David E Haines
- William Beaumont Oakland University School of Medicine, Royal Oak, MI, USA
| | | | | | - Nishaki Mehta
- William Beaumont Oakland University School of Medicine, Royal Oak, MI, USA.,University of Virginia Health System, Charlottesville, VA, USA
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14
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Immohr MB, Boeken U, Smiris K, Erbel-Khurtsidze S, Oehler D, Dalyanoglu H, Westenfeld R, Aubin H, Tudorache I, Lichtenberg A, Akhyari P. Removal of Electrophysiological Devices in the Context of Heart Transplantation: Comparison of Combined and Staged Extraction Procedures. Thorac Cardiovasc Surg 2021; 70:467-474. [PMID: 34894633 DOI: 10.1055/s-0041-1736532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND During heart transplantation (HTx), tip of the leads of cardiac implantable electrophysiological devices (CIEPD) has to be cut when resecting the heart. Timing of the removal of the remaining device and leads is still discussed controversially. METHODS Between 2010 and 2021, n = 201 patients underwent HTx, of those n = 124 (61.7%) carried a present CIEPD. These patients were divided on the basis of the time of complete device removal (combined procedure with HTx, n = 40 or staged procedure, n = 84). RESULTS CIEPD was removed 11.4 ± 6.7 days after the initial HTx in staged patients. Dwelling time, number of leads as well as incidence of retained components (combined: 8.1%, staged: 7.7%, p = 1.00) were comparable between both groups. While postoperative incidence of infections (p = 0.52), neurological events (p = 0.47), and acute kidney injury (p = 0.44) did not differ, staged patients suffered more often from primary graft dysfunction with temporary mechanical assistance (combined: 20.0%, staged: 40.5%, p = 0.03). Consecutively, stay on intensive care unit (p = 0.02) was prolonged and transfusions of red blood cells (p = 0.15) and plasma (p = 0.06) as well as re-thoracotomy for thoracic bleeding complications (p = 0.10) were numerically increased in this group. However, we did not observe any differences in postoperative survival. CONCLUSION Presence of CIEPD is common in HTx patients. However, the extraction strategy of CIEPD most likely did not affect postoperative morbidity and mortality except primary graft dysfunction. Especially, retained components, blood transfusions, and infective complications are not correlated to the timing of CIEPD removal.
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Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Konstantinos Smiris
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | | | - Daniel Oehler
- Department of Cardiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
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15
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Dhawan R, Khan F, Samant S, Asawaeer M, Merritt Genore H, Erickson CC. A 37-Year-Old Woman with Hypertrophic Cardiomyopathy with a Dual-Chamber Implantable Cardioverter-Defibrillator Requiring Percutaneous Transvenous Lead Extraction and Multidisciplinary Management. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932073. [PMID: 34675166 PMCID: PMC8546269 DOI: 10.12659/ajcr.932073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 37-year-old
Final Diagnosis: Hypertrophic cardiomyopathy
Symptoms: None
Medication:—
Clinical Procedure: Percutaneous ICD lead extraction • Surgical ICD lead extraction
Specialty: Cardiac Electrophysiology • Cardiac Surgery • Cardiology
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Affiliation(s)
- Rahul Dhawan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Faris Khan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Saurabhi Samant
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Majid Asawaeer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - HelenMari Merritt Genore
- Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher C Erickson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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16
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Jiratham-Opas J, Prasertwitayakij N, Nantsupawat T, Wongcharoen W. Procedural outcome of lead explant and countertraction-assisted femoral lead extraction in Thai patients with cardiac implantable electronic device infection. J Arrhythm 2021; 37:1124-1130. [PMID: 34621410 PMCID: PMC8485811 DOI: 10.1002/joa3.12574] [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: 08/24/2020] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) implantation rate has been increasing worldwide. Despite proper surgical technique and preincisional intravenous antibiotics, the incidence of infected CIED remains high and leads to serious complications. When encountered with CIED infection, complete CIED system removal is indicated. Several lead extraction approaches have shown a high success rate. However, the facilities are limited in Thailand. In our current practice, we perform lead extraction using the Dotter basket snare femoral approach as our primary method. There are no prior data on this countertraction-assisted transfemoral technique. Therefore, we aim to study the procedural outcome of countertraction-assisted transfemoral lead removal technique of CIED infection in Thai patients. METHODS Patients diagnosed with CIED infection and with a history of device infection were retrospectively included. Simple manual removal was performed. In case of failure, we proceeded with the modified countertraction-assisted transfemoral technique. RESULTS There were 35 patients in the study. The success rate was 94.3%. Most of the leads, 62.8%, were removed by simple manual traction. In the 37.1% who required further femoral approach lead extractions, procedural failure was observed in 5.7% and procedure-related adverse events in 5.6%. CIED infection-related death accounted for 5.7% and nosocomial infection-related death, 2.8%. CONCLUSION The success rate of CIED infection lead explant and countertraction-assisted transfemoral lead extraction technique was high with small complications and can be performed without advanced facilities. However, the procedure required a main center with a cardiovascular thoracic surgery support team.
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Affiliation(s)
- Jirarat Jiratham-Opas
- Department of Internal Medicine Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | | | - Teerapat Nantsupawat
- Department of Internal Medicine Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | - Wanwarang Wongcharoen
- Department of Internal Medicine Faculty of Medicine Chiang Mai University Chiang Mai Thailand
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17
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Lee WC, Chen YL. Double Twist. Int Heart J 2021; 62:1156-1159. [PMID: 34544971 DOI: 10.1536/ihj.21-019] [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: 11/18/2022]
Abstract
A rare complication about "Twiddler syndrome" is reported, and an interesting image about "double twist" is presented. A 78-year-old woman received a single-chamber implantable cardioverter defibrillator (ICD) for secondary prevention of ventricular arrhythmia. After she played mahjong (a traditional Chinese board game) overnight, her ICD lead sense amplitude decreased suddenly and did not recover. The intracardiac electrogram of ICD also found ventricular lead noise before this episode. Chest radiography revealed a twisted lead at the ICD pocket and a twisted and retracted ICD lead in the right atrium. An old ICD lead could not be straightened and removed, and a new ICD lead was implanted at the right ventricle. Anti-coagulation was used to prevent thrombosis for the old ICD lead.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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18
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Late papillary muscle rupture and tricuspid regurgitation related to transvenous endocardial lead extraction. HeartRhythm Case Rep 2021; 7:577-580. [PMID: 34552845 PMCID: PMC8441198 DOI: 10.1016/j.hrcr.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Ksela J, Prevolnik J, Racman M. Transvenous lead extraction outcomes using a novel hand-powered bidirectional rotational sheath as a first-line extraction tool in a low-volume centre. Interact Cardiovasc Thorac Surg 2021; 32:395-401. [PMID: 33249479 DOI: 10.1093/icvts/ivaa286] [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: 06/30/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Extraction of cardiovascular implantable electronic devices in low-volume medical centres with limited clinical experience and an evolving lead extraction programme may be challenging. We aimed to evaluate the safety and efficacy of stepwise transvenous lead extraction (TLE) using a novel type of hand-powered rotational sheath as a first-line tool for extraction of chronically implanted devices in a single, low-volume centre. METHODS Sixty-seven consecutive patients undergoing a TLE procedure using the novel Evolution® RL rotational sheath as the first-line extraction tool between 2015 and 2019 at our institution were enrolled in the study. Their short-term and 30-day outcomes were observed. RESULTS Sixty-nine devices and 131 leads were explanted. Procedural and clinical success rates were 92.4% and 98.5%, respectively. Two procedures were classified as failures due to lead remnants >4 cm remaining in patients' vascular systems. One major (1.5%) and 3 minor (4.4%) adverse events and no deaths were observed. CONCLUSIONS TLE procedures, performed in a stepwise manner, using the Evolution RL sheath as a first-line extraction device and conducted by an experienced, surgically well-trained operator, offer excellent results with clinical and procedural success rates comparable to those, achieved in dedicated, high-volume institutions. Opting for optimal lead extraction approach in low-volume centres or institutions with evolving TLE programmes, a stepwise extraction strategy using the Evolution RL sheath by skilled operator may provide the optimal scheme with an excellent ratio between clinical and/or procedural success and complications.
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Affiliation(s)
- Jus Ksela
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.,Department of Surgery, Faculty of Medicine, Ljubljana, Slovenia
| | - Jan Prevolnik
- Department of Surgery, Faculty of Medicine, Ljubljana, Slovenia
| | - Mark Racman
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
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20
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Maciel ADS, Silva RMFLD. Clinical Profile and Outcome of Patients with Cardiac Implantable Electronic Device-Related Infection. Arq Bras Cardiol 2021; 116:1080-1088. [PMID: 33825793 PMCID: PMC8288527 DOI: 10.36660/abc.20190546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
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21
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Topaz M, Athamna A, Ashkenazi I, Shpitz B, Freimann S. In-vitro model for bacterial growth inhibition of compartmentalized infection treated by an ultra-high concentration of antibiotics. PLoS One 2021; 16:e0252724. [PMID: 34101731 PMCID: PMC8186763 DOI: 10.1371/journal.pone.0252724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), and Staphylococcus aureus (S. aureus) are common pathogens encountered in infected cardiovascular-implantable electronic device (CIED). Continuous, in-situ targeted, ultra-high concentration antibiotic (CITA) treatment is a novel antibiotic treatment approach for localized infections. CITA provides sufficient local antibiotic concentrations to heavily infected cavities while avoiding systemic toxicity. AIM In-vitro confirmation of the efficacy of the CITA treatment approach in simulated compartmentalized infections. MATERIALS AND METHODS A rapid automated bacterial culture analyzing system) Uro4 HB&L™ (was applied to compare the efficacy of selected antibiotics at a standard minimal inhibitory concentration (1MIC), 4MIC, and CITA at 103MIC, for growth inhibition of high bacterial loads (106 colony-forming-units/ml) of ATCC strains of P. aeruginosa, E. coli, and S. aureus. RESULTS The addition of gentamicin and amikacin at 1MIC concentrations only temporarily inhibited the exponential growth of E. coli and P. aeruginosa. 4MIC level extended the delay of exponential bacterial growth. Increasing concentrations of vancomycin similarly temporarily delayed S. aureus growth. All tested antibiotics at CITA of 103MIC totally inhibited the exponential growth of the tested bacteria through 72 hours of exposure. (P<0.001). CONCLUSION In this in-vitro model, CITA at 103MIC effectively inhibited exponential bacterial growth of high loads of P. aeruginosa, E. coli, and S. aureus. This model offers preliminary laboratory support for the benefit of the in-situ antibiotic treatment, providing ultra-high concentrations directly at the compartmentalized infection site, not achievable by the conventional intravenous and oral routes.
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Affiliation(s)
- Moris Topaz
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Abed Athamna
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Baruch Shpitz
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sarit Freimann
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
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22
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Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort. J Interv Card Electrophysiol 2021; 66:847-855. [PMID: 33723694 DOI: 10.1007/s10840-021-00974-4] [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: 01/19/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The use of cardiac implantable electronic devices (CIEDs) has increased significantly over the last decades. With the development of transvenous lead extraction (TLE), procedural success rates also improved; however, data regarding long-term outcomes are still limited. The aim of our study was to analyze the outcomes after TLE, including reimplantation data, all-cause and cause-specific mortality. METHODS Data from consecutive patients undergoing TLE in our institution between 2012 and 2020 were retrospectively analyzed. Periprocedural, 30-day, long-term, and cause-specific mortalities were calculated. We examined the original and the revised CIED indications and survival rate of patients with or without reimplantation. RESULTS A total of 150 patients (age 66 ± 14 years) with 308 leads (dwelling time 7.8 ± 6.3 years) underwent TLE due to pocket infection (n = 105, 70%), endocarditis (n = 35, 23%), or non-infectious indications (n = 10, 7%). All-cause mortality data were available for all patients, detailed reimplantation data in 98 cases. Procedural death rate was 2% (n = 3), 30-day mortality rate 2.6% (n = 4). During the 3.5 ± 2.4 years of follow-up, 44 patients died. Arrhythmia, as the direct cause of death, was absent. Cardiovascular cause was responsible for mortality in 25%. There was no significant survival difference between groups with or without reimplantation (p = 0.136). CONCLUSIONS Despite the high number of pocket and systemic infection and long dwelling times in our cohort, the short- and long-term mortality after TLE proved to be favorable. Moreover, survival without a new device was not worse compared to patients who underwent a reimplantation procedure. Our study underlines the importance of individual reassessment of the original CIED indication, to avoid unnecessary reimplantation.
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23
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Moriarty JM, Rueda V, Liao M, Kim GHJ, Rochon PJ, Zayed MA, Lasorda D, Golowa YS, Shavelle DM, Dexter DJ. Endovascular Removal of Thrombus and Right Heart Masses Using the AngioVac System: Results of 234 Patients from the Prospective, Multicenter Registry of AngioVac Procedures in Detail (RAPID). J Vasc Interv Radiol 2021; 32:549-557.e3. [PMID: 33526346 DOI: 10.1016/j.jvir.2020.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess device and procedural safety and technical success associated with the use of the AngioVac System to remove vascular thrombi and cardiac masses. MATERIALS AND METHODS The Registry of AngioVac Procedures in Detail (RAPID) study prospectively collected data for 234 patients receiving treatment with AngioVac at 21 sites between March 2016 and August 2019: 84 (35.9%) with caval thromboemboli (CTEs), 113 (48.3%) with right heart masses (RHMs), 20 (8.5%) with catheter-related thrombi (CRTs), and 4 (1.7%) with pulmonary emboli (PEs). Thirteen patients had a combination of procedures during the same admission. RESULTS Using the AngioVac system, 70%-100% thrombus or mass removal was achieved in 73.6% of patients with CTEs, 58.5% of patients with RHMs, 60% of patients with CRTs, and 57.1% of patients with PEs. Extracorporeal bypass time was < 1 hour for 176 (75.2%) procedures. Estimated blood loss was < 250 mL for 179 procedures (76.5%). Mean hemoglobin decreased from 10.4 g/dL ± 2.9 preoperatively to 9.4 g/dL ± 2.6 postoperatively. Transfusions were administered in 59 procedures (25.2%) with 47 transfusions (78.2%) being ≤ 2 U. There were 36 procedure-related complications, including 1 death. CONCLUSIONS The RAPID registry data demonstrate that the AngioVac System can be safely and effectively used to remove vascular thrombi and cardiac masses across a broad range of patient populations. The limited use of the device to remove pulmonary emboli in the present series precludes recommending the use of the AngioVac device for this indication.
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Affiliation(s)
- John M Moriarty
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Victoria Rueda
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Millie Liao
- Loma Linda University School of Medicine, Loma Linda, California
| | - Grace Hyun J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul J Rochon
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David Lasorda
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Yosef S Golowa
- Department of Vascular and Interventional Radiology, Montefiore Medical Center, New York, New York
| | - David M Shavelle
- Division of Cardiovascular Medicine, Keck School of Medicine at USC, Los Angeles, California
| | - David J Dexter
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Virginia
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24
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Vamos M, Nemeth M, Balazs T, Zima E, Duray GZ. Rationale and feasibility of the atrioventricular single-lead ICD systems with a floating atrial dipole (DX) in clinical practice. Trends Cardiovasc Med 2021; 32:84-89. [PMID: 33482321 DOI: 10.1016/j.tcm.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/30/2023]
Abstract
Cardiac implantable electronic devices establish proper therapy for the prevention of sudden cardiac death, significantly reducing the morbidity and mortality of patients with arrhythmias and heart failure. It is well-known that the number of electrodes increases the risk of complications. To preserve the benefit of atrial sensing without the need to implant an additional lead, a single-lead ICD system with a floating atrial dipole (DX ICD lead) has been developed. Besides all of the potential benefits, the necessity of a reliable and stable atrial sensing via the floating dipole could be the main concern against the use of this lead type. In the current generation of DX devices, the specially filtered atrial signal seems to be high enough and stable over time, which is crucial in the early detection of atrial arrhythmias, discrimination between different forms of tachycardias in order to prevent inappropriate ICD therapy, and achieving an optimal atrioventricular and interventricular synchrony in patients with a two-lead CRT-DX system. The present review summarizes the benefits and potential drawbacks of the DX ICD systems based on the available literature, furthermore, proposes an evidence-based algorithm of ICD type selection.
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Affiliation(s)
- Mate Vamos
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Semmelweis u. 8., 6725 Szeged, Szeged, Hungary.
| | | | | | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Medical Centre, Hungarian Defense Forces, Budapest, Hungary
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25
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Archontakis S, Pirounaki M, Aznaouridis K, Karageorgopoulos D, Sideris K, Tolios P, Triantafyllou K, Gatzoulis K, Tousoulis D, Sideris S. Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications. J Cardiovasc Electrophysiol 2020; 32:491-499. [PMID: 33345428 DOI: 10.1111/jce.14841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection. METHODS AND RESULTS Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001). CONCLUSIONS Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.
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Affiliation(s)
| | - Maria Pirounaki
- Second Department of Medicine, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | | | | | - Panagiotis Tolios
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
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Tabbah RN, Abi-Saleh B. Erosion of Cardiovascular Implantable Device: Conservative Therapy or Extraction? Cureus 2020; 12:e12032. [PMID: 33457133 PMCID: PMC7797431 DOI: 10.7759/cureus.12032] [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: 11/05/2022] Open
Abstract
The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases. Despite the importance of lead extraction techniques, these techniques are complex and have some major risks. Success rates were high, but they are less favorable in patients with several comorbidities. An 80-year-old male presented for device erosion. The patient is known to have several cardiac comorbidities: a transcatheter aortic valve replacement (TAVR), mitral clips for severe aortic stenosis, mitral regurgitation, dual-chamber implantable cardioverter defibrillators (ICD) for secondary prevention. Several weeks ago, he noted tenderness and redness at the site of his device pocket, and his physician, after checking his wound, suggested a possible skin irritation with no systemic infection and started antibiotics treatment. Two weeks later, he noted thinning of the skin around the device with a hematoma and ecchymosis, and slight skin erosion. Strategies for assessment of the wound and pocket cleaning were taken. The strategy was to remove the left-sided device and keep the leads since the patient lately has no elevated inflammatory labs, negative cultures, no fever, nor signs of vegetation on transesophageal echocardiography (TEE) and refused any additional examination as positron emission tomography (PET) scan, and reimplant a new system on the contralateral side. The procedure was divided into two sequences: extracting the device and after one-week implantation of a right-sided new system. In this case, chronic antibiotics were discussable to decrease the recurrence rate, but they did increase the severity of the patient's thrombocytopenia. Despite extraction being the gold standard of treatment in most cases of devices with local and systemic infection, there are some frail patients with several comorbidities where extraction is unbearable due to its major risks and complex procedure. In these specific cases with local infection and device erosion with no signs of any systemic infection, conservative therapy could be a viable option.
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Affiliation(s)
- Randa N Tabbah
- Cardiology, Centre Hospitalier Universitaire Notre Dame de Secours, Beirut, LBN
| | - Bernard Abi-Saleh
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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Lensvelt LMH, Egorova AD, Schalij MJ, Yilmaz D, Kennergren C, Bootsma M, van Erven L. Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:120-128. [PMID: 33067867 DOI: 10.1111/pace.14094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 12/29/2022]
Abstract
The aim of this study was to evaluate the efficacy and safety of the stepwise mechanical transvenous lead extraction approach in a patient population with chronically implanted transvenous leads with a long dwell time. From January 2014 till December 2018, all lead extractions with lead dwell time ≥5 years performed at our tertiary centre were retrospectively analysed. A total of 173 leads, from 78 patients (median age 68 years; 81% male) with a median dwell time of 9 years (interquartile range [IQR] 5) were extracted, with three or more leads in 42% of the patients. Right atrial leads: 41%; right ventricular pacing leads: 16%; implantable cardioverter-defibrillator (ICD) leads: 31% (72% dual coil); coronary sinus leads: 12%. The majority (75%) of the leads had an active fixation. Most frequent indication for extraction was pocket infection/erosion (76%). Overall clinical success was 97%, and complete procedural success was 93%. Venous patency, assessed with venous angiography, was well preserved in 93% of the cases. The overall procedural complication rate was 3.8% (2.6% major and 1.3% minor). Despite the complexity of the population and a very long dwell time (median 9 years), a clinical success rate of 97% was achieved with the stepwise mechanical approach. Analysis of impeding progression of pectoral extraction suggests that dense fibrosis and sharp lead curvature in the transvenous trajectory pose a challenge. Complication rate was low, and acute venous patency was generally well preserved.
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Affiliation(s)
- Leontine M H Lensvelt
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Dilek Yilmaz
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, University of Göteborg, Göteborg, Sweden
| | - Marianne Bootsma
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
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Transvenous lead extraction in patients with prior extraction procedures: Procedural profiles and outcomes. Heart Rhythm 2020; 17:1904-1908. [PMID: 32512177 DOI: 10.1016/j.hrthm.2020.05.042] [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: 05/06/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subclinical venous injuries are common during transvenous lead extraction (TLE), but their implications for future TLE are unclear. Little is known about whether a prior TLE adds risk or complexity to subsequent extraction procedures. OBJECTIVE The purpose of this study was to assess procedural profiles and outcomes of TLE based on whether patients had prior extraction procedures. METHODS All 3258 consecutive patients undergoing TLE at the Cleveland Clinic (1996-2012) were included. Procedural profiles and outcomes were determined. RESULTS Of 3258 TLEs, 198 had prior TLE. Median number of leads in place was 2 in both groups, but patients with prior TLE were more likely to have defibrillator leads (47% vs 41%; P = .08) and more likely to be pacemaker-dependent (32% vs 25%; P = .02). The age of oldest lead (median 2134 vs 1902 days; P = .4) and combined age of leads (median 2948 vs 2676 days; P = .6) were comparable. Procedures were longer in those with prior TLE (166 ± 79 minutes vs 149 ± 74 minutes; P = .004) with comparable fluoroscopy times (median 13 vs 11 minutes; P = .07), and successful extraction was more likely to require specialized tools (88% vs 81%; P = .006) with higher likelihood of rescue femoral workstation (12% vs 4%; P <.0001). Clinical success rates were comparable in those with prior TLE (99.5% vs 98.9%; P = .8) with similar major (3.0% vs 1.9%; P = .3) and minor (3.0% vs 3.7%; P = .8) complication rates. CONCLUSION Extraction procedures were more challenging in patients with prior TLE compared to those without prior TLE but with excellent success and low complication rates.
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Robinson J, Wang WYS, Kaye G. Mobile echodensities on intracardiac device leads: Is it always a cause for concern? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:388-393. [PMID: 32149409 DOI: 10.1111/pace.13899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIEDs) frequently undergo transthoracic echocardiography (TTE). As a result, incidental mobile echodensities (MEDs) attached to device leads are commonly detected. The aim of this study was to estimate the incidence and clinical outcomes of incidental MEDs on CIED leads. METHODS A retrospective analysis performed between 2011 and 2018 identified 3548 TTE studies performed on 1849 patients with CIEDs. RESULTS MEDs were identified in 30 patients (1.6%) without clinical suspicion of infective endocarditis (IE). Patients with incidental MEDs were apyrexial, and those tested demonstrated low inflammatory markers and negative blood cultures (BC). In this group, the majority (83%) of MEDs were in the right atrium and no MEDs were detected near the tricuspid valve. Transesophageal echocardiography (TEE) did not influence clinical outcomes. No patient required long-term antibiotics or lead extraction and no IE-related deaths were identified from electronic health records during a mean follow-up period of 43 months (1-89). In contrast, nine patients with suspected IE were all pyrexial with elevated inflammatory markers, had positive BC, and had proven IE. In these cases, the majority of MEDs were at the device lead/tricuspid valve interface. MEDs close to the tricuspid valve were strongly associated with IE (P < .0001). CONCLUSIONS The incidence of MEDs on CIED leads detected on routine TTE was 1.6%. Conservative management of asymptomatic patients with normal inflammatory markers and BC without TEE, antibiotics, or lead extraction did not reveal any signal for long-term adverse events within the limitations of the study.
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Affiliation(s)
- James Robinson
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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30
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Milman A, Zahavi G, Meitus A, Kariv S, Shafir Y, Glikson M, Luria D, Beinart R, Nof E. Predictors of short-term mortality in patients undergoing a successful uncomplicated extraction procedure. J Cardiovasc Electrophysiol 2020; 31:1155-1162. [PMID: 32141635 DOI: 10.1111/jce.14436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prognosis of patients with untreated cardiac implantable electronic device (CIED) infection is poor. Whether removal of all leads by a successful transvenous lead extraction (TLE) procedure changes the prognosis is unclear. OBJECTIVE To identify predictors of mortality in patients with CIED infection despite successful TLE. METHODS Retrospective single-center analysis of prospectively collected database from consecutive patients undergoing TLE at our center. Predictors for mortality were identified and a score predicting high mortality rate was calculated. RESULTS A total of 371 consecutive patients underwent TLE, of whom 337 (90.8%) had complete hardware removal. Most were extracted due to infectious causes (81.3%). Approximately one-third (35%) died during a mean follow-up of 1056 ± 868 days. There was significantly higher mortality observed in the infectious group. Multivariate logistic regression models for infectious group only identified creatinine and albumin measurements as risk markers for 30 days mortality (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.19-2.38; P = .003 and OR, 0.4; 95% CI, 0.16-0.97; P = .039, respectively). A risk score was created based on cutoff values of creatinine ≥2md/dL (1 point) and albumin ≤3.5 g/dL (1 point). A value of 2 points predicted a 50% chance of 30-day mortality and a 75% chance of 1-year mortality (P < .0001 for both). CONCLUSIONS Creatinine and albumin can be used as a combined risk score to successfully identify patients at risk of death despite undergoing a successful TLE procedure for infectious reasons. This score could help decision making when contemplating on conservative antibiotic treatment vs TLE.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Zahavi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesiology and Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Meitus
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saar Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Shafir
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Luria
- Jerusalem Medical School, Hebrew University, Jerusalem, Israel.,Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Bontempi L, Curnis A, Della Bella P, Cerini M, Radinovic A, Inama L, Melillo F, Salghetti F, Marzi A, Gargaro A, Giacopelli D, Mazzone P. The MB score: a new risk stratification index to predict the need for advanced tools in lead extraction procedures. Europace 2020; 22:613-621. [DOI: 10.1093/europace/euaa027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
Aims
A validated risk stratification schema for transvenous lead extraction (TLE) could improve the management of these procedures. We aimed to derive and validate a scoring system to efficiently predict the need for advanced tools to achieve TLE success.
Methods and results
Between November 2013 and March 2018, 1960 leads were extracted in 973 consecutive TLE procedures in two national referral sites using a stepwise approach. A procedure was defined as advanced extraction if required the use of powered sheaths and/or snares. The study population was a posteriori 1:1 randomized in derivation and validation cohorts. In the derivation cohort, presence of more than two targeted leads (odds ratio [OR] 1.76, P = 0.049), 3-year-old (OR 3.04, P = 0.001), 5-year-old (OR 3.48, P < 0.001), 10-year-old (OR 3.58, P = 0.008) oldest lead, implantable cardioverter-defibrillator (OR 3.84, P < 0.001), and passive fixation lead (OR 1.91, P = 0.032) were selected by a stepwise procedure and constituted the MB score showing a C-statistics of 0.82. In the validation group, the MB score was significantly associated with the risk of advanced extraction (OR 2.40, 95% confidence interval 2.02-2.86, P < 0.001) and showed an increase in event rate with increasing score. A low value (threshold = 1) ensured 100% sensibility and 100% negative predictive value, while a high value (threshold = 5) allowed a specificity of 92.8% and a positive predictive value of 91.9%.
Conclusion
In this study, we developed and tested a simple point-based scoring system able to efficiently identify patients at low and high risk of needing advanced tools during TLE procedures.
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Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Lorenza Inama
- Division of Cardiology, Manerbio Hospital, Manerbio, Italy
| | | | - Francesca Salghetti
- Division of Cardiology, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy
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32
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Sabitov YT, Dusypov AA, Abdrakhmanov AS, Orekhov AY, Turubaev EM. [Resynchronization Therapy for Chronic Heart Failure: Diagnostic and Therapeutic Approaches]. KARDIOLOGIYA 2019; 59:84-91. [PMID: 31849315 DOI: 10.18087/cardio.2019.12.n391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic heart failure (CHF) remains one of the most important problems of modern cardiology. One of the effective treatment methods is resynchronization therapy (RT). The article presents an analysis of literature data on the effectiveness of RT in improving the quality of life, reducing the number of hospitalizations and mortality in patients with heart failure with severe left ventricular systolic dysfunction and expanding QRS complex, and also discusses key methods for optimizing RT.
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Afzal MR, Daoud EG, Matre N, Shoben A, Burnside M, Gilliam C, Pinkhas D, Okabe T, Tyler J, Houmsse M, Kalbfleisch SS, Crestanello JA, Turner K, Weiss R, Hummel JD, Love CJ, Augostini RS. RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol). J Cardiovasc Electrophysiol 2019; 30:2453-2459. [DOI: 10.1111/jce.14151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Muhammad R. Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Emile G. Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Nancy Matre
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Abigail Shoben
- Department of Public Health, Division of Biostatistics, College of Public Health The Ohio State University Columbus Ohio
| | - Melissa Burnside
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Courtney Gilliam
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Daniel Pinkhas
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Steven S. Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | | | - Katja Turner
- Department of Internal Medicine, Electrophysiology Section, Division of Anesthesiology Ross Heart Hospital at the Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - John D. Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Charles J. Love
- Department of Internal Medicine, Division of Cardiovascular Medicine Johns Hopkins Hospital Baltimore Maryland
| | - Ralph S. Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
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