1
|
Ibrahim R, Al-Gibbawi M, Mekary W, Bhatia NK, Kiani S, Westerman SB, Shah AD, Lloyd MS, Leal M, De Lurgio DB, Patel AM, Tompkins C, Leon AR, Merchant FM, El-Chami MF. Long-term performance of single-connector (DF4) implantable defibrillator leads. Europace 2023; 25:euad347. [PMID: 38000900 PMCID: PMC10751803 DOI: 10.1093/europace/euad347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
AIMS Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports. METHODS AND RESULTS We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2×) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise. We documented time to failure, predictors of failure, and management strategies. Mean follow-up after implant was 4.15 ± 3.6 years (median = 3.63), with 37% of leads followed for >5 years. A total of 80 (1.5%) leads demonstrated electrical abnormalities requiring revision with an average time to failure of 4 ± 2.8 years (median = 3.5). Of the leads that malfunctioned, 62/80 (78%) were extracted and replaced with a new lead and in the other 18 cases, malfunctioned DF4 leads were abandoned, and a new lead implanted. In multivariable models, younger age at implant (OR 1.03 per year; P < 0.001) and the presence of Abbott/St. Jude leads increased the risk of malfunction. CONCLUSION DF4 defibrillator leads demonstrate excellent longevity with >98.3% of leads followed for at least 5 years still functioning normally. Younger age at implant and lead manufacturer are associated with an increased risk of DF4 lead malfunction. The differences in lead survival between manufacturers require further investigation.
Collapse
Affiliation(s)
- Rand Ibrahim
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Mounir Al-Gibbawi
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Wissam Mekary
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Neal Kumar Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Soroosh Kiani
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Miguel Leal
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - David B De Lurgio
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Anshul M Patel
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Christine Tompkins
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Angel R Leon
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| |
Collapse
|
2
|
Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
Collapse
Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| |
Collapse
|
3
|
Kellnar A, Fichtner S, Reitinger P, Sadoni S, Heyn O, Sams L, Estner HL, Lackermair K. Prevalence, management, and prediction of venous access site occlusion in patients undergoing lead revision surgery. Int J Cardiol 2023; 381:16-19. [PMID: 37044179 DOI: 10.1016/j.ijcard.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Implantable electronic cardiac devices (CIED) have emerged as an essential component in the treatment of cardiac arrhythmias and heart failure. Due to increased life expectancy, expanding indications and limited technical survival, an increasing number of revision procedures can be anticipated. Venous access site occlusion (VASO) is the main obstacle during revision surgery. In this retrospective study we evaluated the prevalence, predictive parameters and operative management of venous access site occlusion. METHODS AND RESULTS Between 01/2016 and 12/2020 304 patients underwent lead revision surgery of transvenous CIED in our department. Prevalence of VASO was 25.7% (n = 78), one patient was symptomatic. Independent predicting clinical parameters were male sex (2.86 (1.39-5.87), p < 0.01) and lead age (1.11 (1.05-1.18), p < 0.01)). Revision surgery despite VASO was successful in 97.4% (n = 76) without prolongation of the total surgery time or higher complication rates. Yet, lead extraction was possible in 92% of patients with VASO vs. 98.2% of patients without VASO (p 0.01). CONCLUSION VASO is a frequent condition in patients undergoing lead revision surgery, but successful revision is feasible in most cases without preceding lead extraction. However, the lower success rates of lead extractions may be prognostically relevant, especially for younger patients.
Collapse
Affiliation(s)
- Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | | | - Philipp Reitinger
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Oliver Heyn
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Lauren Sams
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
4
|
LoPresti MA, Huang J, Shlobin NA, Curry DJ, Weiner HL, Lam SK. Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series. Childs Nerv Syst 2023; 39:435-441. [PMID: 36434283 DOI: 10.1007/s00381-022-05769-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Vagus nerve stimulation (VNS) is an adjunctive treatment in children with intractable epilepsy. When lead replacement becomes necessary, the old leads are often truncated and retained and new leads are implanted at a newly exposed segment of the nerve. Direct lead removal and replacement are infrequently described, with outcomes poorly characterized. We aimed to describe our experience with feasibility of VNS lead removal and replacement in pediatric patients. METHODS Retrospective review examined 14 patients, at a single, tertiary-care, children's hospital, who underwent surgery to replace VNS leads, with complete removal of the existing lead from the vagus nerve and placement of a new lead on the same segment of the vagus nerve, via blunt and sharp dissection without use of electrocautery. Preoperative characteristics, stimulation parameters, and outcomes were collected. RESULTS Mean age at initial VNS placement was 7.6 years (SD 3.5, range 4.5-13.4). Most common etiologies of epilepsy were genetic (5, 36%) and cryptogenic (4, 29%). Lead replacement was performed at a mean of 6.0 years (SD 3.8, range 2.1-11.7) following initial VNS placement. Reasons for revision included VNS lead breakage or malfunction. There were no perioperative complications, including surgical site infection, voice changes, dysphagia, or new deficits postoperatively. Stimulation parameters after replacement surgery at last follow-up were similar compared to preoperatively, with final stimulation parameters ranging from 0.25 mA higher to 1.5 mA lower to maintain baseline seizure control. The mean length of follow-up was 7.9 years (SD 3.5, range 3.1-13.7). CONCLUSION Removal and replacement of VNS leads are feasible and can be safely performed in children. Further characterization of surgical technique, associated risk, impact on stimulation parameters, and long-term outcomes are needed to inform best practices in VNS revision.
Collapse
Affiliation(s)
- Melissa A LoPresti
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Huang
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
5
|
Shirwaiker A, William J, Mariani JA, Kistler PM, Patel HC, Voskoboinik A. Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience. Heart Lung Circ 2022; 31:993-998. [PMID: 35219598 DOI: 10.1016/j.hlc.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term implications of pacemaker insertion in younger adults are poorly described in the literature. METHODS We performed a retrospective analysis of consecutive younger adult patients (18-50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986-2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed. RESULTS Eighty-one (81) patients (median age 41.0 yrs IQR=35-47.0, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1-14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients. CONCLUSIONS Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
Collapse
Affiliation(s)
| | | | - Justin A Mariani
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Peter M Kistler
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | - Hitesh C Patel
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
| |
Collapse
|
6
|
Ajit Deshpande S, Udyavar A. A case report of lead dysfunction presenting as high ventricular premature complex burden. Indian Pacing Electrophysiol J 2022; 22:34-37. [PMID: 34666177 PMCID: PMC8811311 DOI: 10.1016/j.ipej.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Pacemaker-troubleshooting is an important step in the evaluation of a patient with syncope post-pacemaker-implantation. The basic functions of sensing, pacing and impedance may remain spuriously normal in the case of lead-microfracture or insulation break. We report a case in which the lead dysfunction was diagnosed based on multiple episodes of premature ventricular beats.
Collapse
Affiliation(s)
| | - Ameya Udyavar
- Cardiology, Institution: P D Hinduja Hospital, Mumbai, India
| |
Collapse
|
7
|
Beer D, Subzposh FA, Colburn S, Naperkowski A, Vijayaraman P. His bundle pacing capture threshold stability during long-term follow-up and correlation with lead slack. Europace 2021; 23:757-766. [PMID: 33236070 DOI: 10.1093/europace/euaa350] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS His bundle pacing (HBP) is the most physiologic form of pacing. Long-term HBP capture threshold stability and its relation to lead characteristics at the time of implantation have not been adequately described. The aim of this study was to characterize HB capture threshold in follow-up and to identify potential lead characteristics predictive of lead capture instability. METHODS AND RESULTS Consecutive patients with successful HBP for bradycardia indications were identified from the Geisinger HBP registry. His bundle capture thresholds, baseline comorbidities, and radiographic lead slack characteristics were analysed. An increase in HB capture threshold ≥1 V above implant values at any time during follow-up was tracked. Forty-four of the 294 studied (15%) experienced HB capture threshold increase by ≥ 1 V. Threshold increase was seen early (41% by 8 weeks, 66% by 1 year). Eighteen (6%) patients required lead revision in follow-up. Abnormal slack shape was associated with a trend toward capture threshold increase [hazard ratio (HR) 2.07; 95% confidence interval (CI) 0.9-4.6; P = 0.08]. Non-perpendicular angle of lead insertion on radiography was associated with the capture threshold increase (HR 2.81, 95% CI 1.4-5.8; P < 0.01). CONCLUSION His bundle capture threshold remains stable in the majority (85%) of patients. Implant characteristics may predict the threshold rise. Further evaluation of the aetiology of threshold increase and design changes in lead and delivery systems may lead to chronically stable capture thresholds.
Collapse
Affiliation(s)
- Dominik Beer
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Faiz A Subzposh
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Shaun Colburn
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Angela Naperkowski
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Pugazhendhi Vijayaraman
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| |
Collapse
|
8
|
Teigeler T, Kolominsky J, Vo C, Shepard RK, Kalahasty G, Kron J, Huizar JF, Kaszala K, Tan AY, Koneru JN, Ellenbogen KA, Padala SK. Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience. Heart Rhythm 2021; 18:743-749. [PMID: 33418127 DOI: 10.1016/j.hrthm.2020.12.031] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear. OBJECTIVE The purpose of this study was to examine the intermediate-term performance and safety of HBP. METHODS All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead. RESULTS Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 ± 19.5 months (median 19.5; interquartile range 11-33). Mean age was 69 ± 15 years; 58% were males; and ejection fraction <50% was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. Mean HBP capture threshold at implant was 1.1 ± 0.9 V at 0.8 ± 0.2 ms, which significantly increased at chronic follow-up to 1.7 ± 1.1 V at 0.8 ± 0.3 ms (P <.001). Threshold was ≥2.5 V in 24% of patients, and 28% had an increase in HBP threshold ≥1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds. CONCLUSION Although HBP can prevent or improve pacing-induced cardiomyopathy, the elevated capture thresholds, loss of His-bundle capture, and lead revision rates at intermediate follow-up are of concern. Longer-term follow-up data from multiple centers are needed.
Collapse
Affiliation(s)
- Todd Teigeler
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey Kolominsky
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Chau Vo
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Richard K Shepard
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Gautham Kalahasty
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jordana Kron
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F Huizar
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Karoly Kaszala
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia.
| |
Collapse
|
9
|
Mar PL, John A, Kumar S, Barry N, Chen G, Longserre S, Kabra R, Atkins D, Koerber S, Hussein A, Bhakta D, Lakkireddy D, Gopinathannair R. Management and long-term outcomes associated with recalled implantable cardioverter-defibrillator leads: A multicenter experience. Heart Rhythm 2020; 17:1909-1916. [PMID: 32512178 DOI: 10.1016/j.hrthm.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been published. OBJECTIVES Determine outcomes (major complications [MC]; death, extended hospitalization, or rehospitalization within 60 days [RH]; lead malfunction) of LE, LA, and GC for recalled leads. METHODS Retrospective, multicenter, comparative study. RESULTS A total of 298 LE, 85 LA, and 310 GC were performed. In the clinical setting of a lead intervention, there was no difference in a composite of MC, death, RH, lead revision, inappropriate shocks, or device infection between LE and LA groups (15% vs 22%, P = .140). In the clinical setting of a device at elective replacement interval (ERI), there were significantly more acute events at 60 days (MC, death, and RH) in the LE and LA groups at 15.4% (4) and 15.4% (4), and this was significantly (P = .017) higher than the GC group at 5.1% (16). There was no difference (P = 1.000) in the composite of MC, death, RH, lead malfunction, lead revisions, device infections, or inappropriate shocks between LE, LA, and GC groups at 15.4% (4), 15.4% (4), and 17.4% (54), respectively. Following generator change, 14 of 175 Fidelis leads and 3 of 135 Riata leads failed over a total of 12,714 months of follow-up. CONCLUSIONS The failure rate of recalled leads was substantially lower compared to previous reports. It may be prudent to perform generator change only when the device is at ERI, especially when the recalled lead has historical performance that likely outweighs the risks of extraction/abandonment.
Collapse
Affiliation(s)
- Philip L Mar
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Anub John
- Good Samaritan Hospital, Kearney, Nebraska
| | - Sundeep Kumar
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Neil Barry
- Good Samaritan Hospital, Kearney, Nebraska
| | - Guanhua Chen
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Sarah Longserre
- Division of Cardiology, University of Tennessee, Memphis, Tennessee
| | - Rajesh Kabra
- Division of Cardiology, University of Tennessee, Memphis, Tennessee
| | - Donita Atkins
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Scott Koerber
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Ahmed Hussein
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Deepak Bhakta
- Division of Cardiology, Indiana University, Indianapolis, Indiana
| | | | | |
Collapse
|
10
|
Janssen PTJ, Melenhorst J, Stassen LPS, Bouvy ND, Breukink SO. Clinical efficacy of lead revisions during the test phase in sacral neuromodulation for fecal incontinence. Int J Colorectal Dis 2019; 34:1369-1374. [PMID: 31187199 DOI: 10.1007/s00384-019-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Success rates of up to 80% have been reported for the SNM screening period in the treatment of fecal incontinence (FI). Some patients who have an unsuccessful index implantation are successfully treated with SNM after a lead revision. There is a lack of studies comparing the outcomes of successful index implantations and successful lead revision. Therefore, the results of index implantations were compared with lead revisions in a single-center cohort. METHODS Patients treated with SNM for FI between 2008 and 2016 were retrospectively reviewed. Patients with a successful index implantation were compared with patients who underwent lead revision after SNM screening. Primary outcome was a decrease in episodes of fecal incontinence of ≥ 50% documented by a 3-week bowel habit diary. RESULTS Two hundred sixty-one patients (232 index group, 29 revision group) were eligible for SNM. Two hundred thirty-one patients (208 index group, 23 revision group) received permanent SNM. Follow-up was 68.8 months for the index group and 62.2 months for the revision group. The number of episodes of FI decreased from 20.6 (SD 19.3) to 3.4 (SD 4.2) in the index group and from 12.6 (SD 5.8) to 2.0 (SD 2.3) in the revision group. This effect was maintained up to 5 and 2 years in the index and revision group, respectively. Adverse events such as loss of efficacy which required surgical intervention did not differ between the two groups. CONCLUSION Lead revision during the test phase is a valid option in patients with FI treated by SNM who suffer from loss of efficacy of the index electrode.
Collapse
Affiliation(s)
- Paul T J Janssen
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
| |
Collapse
|
11
|
Sherk WM, Khaja MS, Good ED, Cunnane RT, Dasika NL, Williams DM. Hybrid venous recanalization and cardiac implantable electronic device lead revision procedures: A single-center retrospective analysis of 38 patients. Clin Imaging 2019; 58:145-151. [PMID: 31336361 DOI: 10.1016/j.clinimag.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the safety and efficacy of hybrid recanalization procedures in a series of patients with obstructed central veins requiring cardiac implantable electronic device (CIED) revision. METHODS Between 2008 and 2016, 38 consecutive patients (24 M; age 60.5 ± 16.2 years; range 25-87 years) with central venous obstruction underwent 42 recanalization interventions performed in conjunction with CIED revision or extraction. Fifty percent of patients (19/38) presented with veno-occlusive symptoms, and 13% (5/38) of patients had CIED leads with an ipsilateral upper extremity dialysis conduit. RESULTS Ninety-one percent (38/42) of all procedures resulted in successful recanalization and CIED revision. Twenty-four percent (9/38) of all patients required secondary procedures due to recurrent stenosis, and 78% (7/9) of those requiring secondary procedures had indwelling dialysis conduits and/or clinical symptoms related to venous occlusion before the initial procedure. There were complications in 2 patients related to recanalization, and in 3 related to CIED revision. CONCLUSIONS Recanalization of central venous stenosis/occlusion in patients with CIED can be technically challenging but is successful in most patients. Symptomatic patients and those with dialysis conduits often require more aggressive revascularization interventions and may be at increased risk of complication or need for secondary interventions.
Collapse
Affiliation(s)
- William M Sherk
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Minhaj S Khaja
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Eric D Good
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America
| | - Ryan T Cunnane
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America.
| | - Narasimham L Dasika
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - David M Williams
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| |
Collapse
|
12
|
Waseem H, Raffa SJ, Benbadis SR, Vale FL. Lead revision surgery for vagus nerve stimulation in epilepsy: outcomes and efficacy. Epilepsy Behav 2014; 31:110-3. [PMID: 24389021 DOI: 10.1016/j.yebeh.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
We present, to our knowledge, the first published analysis of vagus nerve stimulation (VNS) lead revisions to incorporate quality of life, clinical response, and antiepileptic drug (AED) burden in postrevision clinical outcomes. Ten patients were followed and had no postoperative complications. Seven patients had improvement in quality of life, and three experienced no change. Eight patients noted a restoration of clinical response comparable with initial VNS implantation. Seven patients reported 30-60% improvement in seizure reduction, two experienced >60%, and one noted <30%. Six patients had no change in AED burden. Vagus nerve stimulation lead revision should be considered a safe option for patients with VNS lead failure and medically intractable epilepsy.
Collapse
Affiliation(s)
- Hena Waseem
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| | - Scott J Raffa
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| | - Selim R Benbadis
- Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| |
Collapse
|