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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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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: 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: 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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Lewis RK, Ehieli WL, Hegland DD, Pokorney SD, Chalian H, Iranmanesh R, Hurwitz Koweek LM, Piccini JP. Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication, technique, and approach to interpretation. J Cardiovasc Electrophysiol 2020; 31:723-732. [DOI: 10.1111/jce.14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Robert K. Lewis
- Cardiac Electrophysiology Section, Duke Clinical Research InstituteDuke University Medical Center Durham North Carolina
| | - Wendy L. Ehieli
- Department of RadiologyDuke University Medical Center Durham NC Durham North Carolina
| | - Donald D. Hegland
- Cardiac Electrophysiology Section, Duke Clinical Research InstituteDuke University Medical Center Durham North Carolina
| | - Sean D. Pokorney
- Cardiac Electrophysiology Section, Duke Clinical Research InstituteDuke University Medical Center Durham North Carolina
| | - Hamid Chalian
- Department of RadiologyDuke University Medical Center Durham NC Durham North Carolina
| | - Reggy Iranmanesh
- Department of RadiologyDuke University Medical Center Durham NC Durham North Carolina
| | | | - Jonathan P. Piccini
- Cardiac Electrophysiology Section, Duke Clinical Research InstituteDuke University Medical Center Durham North Carolina
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Svennberg E, Jacobs K, McVeigh E, Pretorius V, Birgersdotter-Green U. Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction. JACC Clin Electrophysiol 2019; 5:1439-1446. [PMID: 31857044 DOI: 10.1016/j.jacep.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to assess if pre-procedural computed tomography (CT) could identify high-risk operative features and predict increased procedural complexity. BACKGROUND Unpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads. METHODS Consecutive patients who had CTs performed ≤90 days before their planned lead extraction (LE) were included. CTs were reviewed blinded to outcome according to a preset checklist. The outcome was a combined endpoint of procedural complexity and major complications. RESULTS Between January 1, 2015 and July 1, 2018, 143 patients underwent CT and LE. Median age was 68 years (interquartile range [IQR]: 54.4 to 76.5), and 35% were female. Median age of extracted leads was 111 months, and 126 (43%) were >10 years. CT detected lead perforation ≥5 mm (n = 13), <5 mm (n = 55), severe lead adhesions (n = 65), leads touching vessel wall >1 cm (n = 102), lead fracture (n = 8), and severe ipsilateral venous stenosis/occlusion (n = 36). The procedure was complex in 63 cases. There were 2 deaths, and 6 major complications. Patients with severe lead adhesions had more complex procedures (n = 36 vs 29; p = 0.04), whereas none of the other findings on CT were significantly associated with worse outcome. In patients with leads that had an indwelling time <10 years (n = 72), severe lead adhesions on CT was associated with worse outcome in multivariable analysis (odds ratio: 6.4; 95% confidence interval: 1.4 to 30.2; p = 0.02). CONCLUSIONS Pre-procedural CT can be used to locate severe lead adhesions in patients planned for lead extraction. In patients with indwelling leads <10 years, pre-procedural CT aids in identifying patients prone to complex extractions.
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Affiliation(s)
- Emma Svennberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet Stockholm, Sweden.
| | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, California
| | - Elliot McVeigh
- Department of Radiology, University of California San Diego, San Diego, California; Department of Bioengineering, University of California San Diego, La Jolla, California; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
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Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:622-636. [DOI: 10.1016/j.jcmg.2018.09.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022]
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Bettin M, Larbig R, Rath B, Fischer A, Frommeyer G, Reinke F, Köbe J, Eckardt L. Long-Term Experience With the Subcutaneous Implantable Cardioverter-Defibrillator in Teenagers and Young Adults. JACC Clin Electrophysiol 2017; 3:1499-1506. [DOI: 10.1016/j.jacep.2017.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
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Use of Preprocedural MDCT for Cardiac Implantable Electric Device Lead Extraction: Frequency of Findings That Change Management. AJR Am J Roentgenol 2017; 208:770-776. [PMID: 28075624 DOI: 10.2214/ajr.16.16897] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequency of findings on dedicated MDCT that alter preprocedural planning for percutaneous CIED extraction. MATERIALS AND METHODS One hundred patients with CIEDs who underwent MDCT before percutaneous lead extraction were analyzed. Major findings that could preclude percutaneous removal, including lead course and termination, were distinguished from moderately significant findings that could alter but not preclude percutaneous removal, including endofibrosis of leads to the vasculature, lead termination abnormalities, central vein stenosis, or thrombus. Incidental findings were characterized separately. Findings were correlated with preprocedural decisions, the extraction procedure performed, and procedural outcomes. RESULTS Twenty-six women and 74 men with 125 right ventricular leads, 84 right atrial leads, and 26 coronary venous leads were evaluated. Major findings were present in 7% of patients, including six patients with lead perforation and one with a lead coursing outside a tricuspid annuloplasty ring. Moderately significant findings of endothelial fibrosis were found in 78% of patients. The central veins were narrowed or occluded in 42% of patients, and thrombus was present in 2% of patients. Thirty-six percent of patients had incidental findings, and 4% of patients had unexpected findings requiring immediate inpatient attention. CONCLUSION MDCT performed before CIED lead extraction is able to identify major and moderately significant findings that can alter either percutaneous extraction or preprocedural planning. The use of dedicated preprocedural MDCT can help to stratify patient risk, guide decision making by the proceduralist, and identify non-catheter-related findings that affect patient management.
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Herzog A, Bogdan S, Glikson M, Ishaaya AA, Love C. Selective tissue ablation using laser radiation at 355 nm in lead extraction by a hybrid catheter; a preliminary report. Lasers Surg Med 2015; 48:281-7. [DOI: 10.1002/lsm.22451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Amir Herzog
- Department of Electrical and Computer EngineeringBen‐Gurion UniversityBeer‐Sheva 84105Israel
| | - Stefan Bogdan
- Leviev Heart CenterSheba Medical CenterTel‐Hashomer 52621Israel
| | - Michael Glikson
- Leviev Heart CenterSheba Medical CenterTel‐Hashomer 52621Israel
| | - Amiel Abraham Ishaaya
- Department of Electrical and Computer EngineeringBen‐Gurion UniversityBeer‐Sheva 84105Israel
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Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging with Cardiac Implantable Electronic Devices. Can Assoc Radiol J 2014; 65:290-300. [DOI: 10.1016/j.carj.2014.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI) has historically been considered contraindicated for individuals with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable defibrillators. Magnetic resonance scanners produce magnetic fields that can interact negatively with the metallic components of CIEDs. However, as CIED technology has advanced, newer MRI conditional devices have been developed that are now in clinical use and these systems have had demonstrated safety in the MRI environment. Despite the supportive data of such CIED systems, physicians remain reluctant to perform MRI scanning of conditional devices. This joint statement by the Canadian Heart Rhythm Society and the Canadian Association of Radiologists describes a collaborative process by which CIED specialists and clinics can work with radiology departments and specialists to safely perform MRI in patients with MRI conditional CIED systems. The steps required for patient and scanning preparation and the roles and responsibilities of the CIED and radiology departments are outlined. We also briefly outline the risks and a process by which patients with nonconditional CIEDs might also receive MRI in highly specialized centres. This document supports MRI in patients with MRI conditional CIEDs and offers recommendations on how this can be implemented safely and effectively.
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Verma A, Ha AC, Dennie C, Essebag V, Exner DV, Khan N, Lane C, Leipsic J, Philippon F, Sampaio M, Schieda N, Seifer C, Berthiaume A, Campbell D, Chakraborty S. Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging With Cardiac Implantable Electronic Devices. Can J Cardiol 2014; 30:1131-41. [DOI: 10.1016/j.cjca.2014.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022] Open
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Haines DE, Beheiry S, Akar JG, Baker JL, Beinborn D, Beshai JF, Brysiewicz N, Chiu-Man C, Collins KK, Dare M, Fetterly K, Fisher JD, Hongo R, Irefin S, Lopez J, Miller JM, Perry JC, Slotwiner DJ, Tomassoni GF, Weiss E. Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety. Heart Rhythm 2014; 11:e9-51. [PMID: 24814989 PMCID: PMC7106221 DOI: 10.1016/j.hrthm.2014.03.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Salwa Beheiry
- California Pacific Medical Center, San Francisco, California
| | - Joseph G. Akar
- Yale University School of Medicine, New Haven Connecticut
| | | | | | | | | | | | | | | | | | | | - Richard Hongo
- Sutter Pacific Medical Foundation, San Francisco, California
| | | | | | - John M. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - David J. Slotwiner
- Hofstra School of Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Catanzaro JN, Zviman M, Kolandaivelu A, Nazarian S, Halperin H, Berger RD, Brinker JA, Cheng A. Facilitation of transvenous lead extraction using site-specific delivery of electrosurgical energy. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:75-77. [PMID: 29450175 PMCID: PMC5801438 DOI: 10.1016/j.ijchv.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/14/2014] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alan Cheng
- Corresponding author at: 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, United States. Tel.: + 1 443 287 2939; fax: + 1 443 873 5019Corresponding author at:600 N. Wolfe Street, Carnegie 568Tel.: + 1 443 287 2939; fax: + 1 443 873 5019BaltimoreMD21287United States
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McCANTA ANTHONYC, TANEL RONNE, GRALLA JANE, RUNCIMAN DAVIDMARTIN, COLLINS KATHRYNK. The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:104-8. [DOI: 10.1111/pace.12282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/31/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ANTHONY C. McCANTA
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
| | - RONN E. TANEL
- Department of Pediatrics; University of California San Francisco/UCSF Benioff Children's Hospital; San Francisco California
| | - JANE GRALLA
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
- Department of Biostatistics and Informatics; University of Colorado Denver School of Public Health; Aurora Colorado
| | - DAVID MARTIN RUNCIMAN
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
| | - KATHRYN K. COLLINS
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
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Chu XM, Li XB, Zhang P, Wang L, Li D, Duan JB, Li B, Guo JH. Re-evaluation of transvenous lead extraction with modified standard technique: a prospective study in 229 patients. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2013; 33:650-655. [PMID: 24142715 DOI: 10.1007/s11596-013-1175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/22/2013] [Indexed: 11/28/2022]
Abstract
As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients (median, 66 years) who underwent lead extraction due to infection and lead malfunction were registered and followed up prospectively with respect to clinical features, reasons for lead extraction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted transvenously by using special tools from 229 patients (male, 72.1%). Vegetations ≥1 cm were detected in six patients. Locking Stylets were applied for 398 (90.5%) leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 (45.9%) leads due to lead adhesion, and the mean implant duration of the 202 leads was longer than the other 238 leads (48.9±22.6 vs. 26.6±17.8 months; P <0.01). In addition, modified isolation and snare techniques were used for 56 leads (12.7%). Minor and major procedure-related complications occurred in three (1.3%) and four (1.7%) cases respectively, including one death (0.4%). Severe lead residue occurred in one case. Complete procedural success rate was 96.1% (423/440), and clinical success rate was 98.9% (435/440). The median follow-up period was 18 (1-76) months. No infection- and procedure-related death occurred in our series. Our data demonstrated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.
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Affiliation(s)
- Xian-Ming Chu
- Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, 266100, China.,Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
| | - Xue-Bin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
| | - Ping Zhang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
| | - Long Wang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
| | - Ding Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
| | - Jiang-Bo Duan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
| | - Bing Li
- Department of Biology, Medical College of Qingdao University, Qingdao, 266021, China
| | - Ji-Hong Guo
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
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Lisy M, Kornberger A, Schmid E, Kalender G, Stock UA, Doernberger V, Steger V. Application of Intravascular Dissection Devices for Closed Chest Coronary Sinus Lead Extraction: An Interdisciplinary Approach. Ann Thorac Surg 2013; 95:1360-5. [DOI: 10.1016/j.athoracsur.2012.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/13/2012] [Accepted: 12/21/2012] [Indexed: 12/01/2022]
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Al-Bawardy R, Krishnaswamy A, Bhargava M, Dunn J, Wazni O, Tuzcu EM, Stewart W, Kapadia SR. Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249-54. [PMID: 23529935 DOI: 10.1002/clc.22104] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/06/2013] [Indexed: 11/06/2022] Open
Abstract
Implantable cardiac devices, including defibrillators and pacemakers, may be the cause of tricuspid regurgitation (TR) or may worsen existing TR. This review of the literature suggests that TR usually occurs over time after lead implantation. Diagnosis by clinical exam and 2-dimensional echocardiography may be augmented by 3-dimensional echocardiography and/or computed tomography. The mechanism may be mechanical perforation or laceration of leaflets, scarring and restriction of leaflets, or asynchronized activation of the right ventricle. Pacemaker-related TR might cause severe right-sided heart failure, but data regarding associated mortality are lacking. This comprehensive review summarizes the data regarding incidence, mechanism, and treatment of lead-related TR.
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Affiliation(s)
- Rasha Al-Bawardy
- Department Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Griksaitis MJ, Rosengarten JA, Gnanapragasam JP, Haw MP, Morgan JM. Implantable cardioverter defibrillator therapy in paediatric practice: a single-centre UK experience with focus on subcutaneous defibrillation. Europace 2013; 15:523-30. [PMID: 23333943 DOI: 10.1093/europace/eus388] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIMS Sudden cardiac death (SCD) risk can be managed by implantable cardioverter defibrillators (ICD). Defibrillation shocks can be delivered via ICD generator and/or intracardiac or subcutaneous coil configurations. We present our single-centre use of childhood ICDs. METHODS AND RESULTS Twenty-three patients had ICD implantation, with median age and weight of 12.96 years and 41.35 kg. Indications included eight long QT; four hypertrophic cardiomyopathy; three Brugada syndrome; two idiopathic ventricular fibrillation; two post-congenital heart repair; two family history of SCD with abnormal repolarization; one catecholaminergic polymorphic ventricular tachycardia; and one left ventricle non-compaction. Twelve had out of hospital cardiac arrests prior to implantation. Techniques included 13 conventional ICD implants (pre-pectoral device with endocardial leads), 7 with subcutaneous defibrillation coils (sensing via epicardial or endocardial leads tunnelled to the ICD), and 3 with exclusive subcutaneous ICD (sensing and defibrillation via the same subcutaneous lead). Satisfactory defibrillation efficacy and ventricular arrhythmia sensing was confirmed at implantation. Follow-up ranged from 0.17 to 11.08 years. One child died with the ICD in situ. Ten children received appropriate shocks; five on more than one occasion. Five received inappropriate shocks (for inappropriate recognition of sinus tachycardia or supraventricular tachycardia). Five children underwent six further interventions; all had intracardiac leads. CONCLUSION Innovative shock delivery systems can be used in children requiring an ICD. The insertion technique and device used need to accommodate the age and weight of the child, and concomitant need for pacing therapy. We have demonstrated effective defibrillation with shocks delivered via configurations employing subcutaneous coils in children.
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Affiliation(s)
- Michael J Griksaitis
- Department of Paediatric Cardiology & Cardiothoracic Surgery, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, Hampshire, UK
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DESIMONE CHRISTOPHERV, DESIMONE DANIELC, HAGLER DONALDJ, FRIEDMAN PAULA, ASIRVATHAM SAMUELJ. Cardioembolic Stroke in Patients with Patent Foramen Ovale and Implanted Cardiac Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:50-4. [DOI: 10.1111/pace.12014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/26/2012] [Accepted: 08/14/2012] [Indexed: 11/29/2022]
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Active fixation mechanism complicates coronary sinus lead extraction and limits subsequent reimplantation targets. J Interv Card Electrophysiol 2012; 36:81-6; discussion 86. [DOI: 10.1007/s10840-012-9704-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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Baranowski B, Wazni O, Chung R, Martin DO, Rickard J, Tanaka-Esposito C, Bassiouny M, Wilkoff BL. Percutaneous extraction of stented device leads. Heart Rhythm 2012; 9:723-7. [DOI: 10.1016/j.hrthm.2011.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 10/14/2022]
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