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Moreau A, Pretet V, Kryza D. False-Positive Bone Pitfall Lesion and Collateral Circulation: Don't Miss the True-Positive Lesion. Clin Nucl Med 2024:00003072-990000000-01152. [PMID: 38861410 DOI: 10.1097/rlu.0000000000005304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT We report the case of a patient followed up for squamous cell carcinoma of the buccal floor with lymph node involvement. The initial staging PET/CT revealed bone foci that were not definitively pathological in the context of a regional collateral circulation secondary to a defibrillator. A new monitoring examination, conducted due to the rapid local progression, revealed a dissociated evolution of the bone uptake adjacent to the collateral circulation, some confirming false-positives, but one indicating a real metastasis. This case illustrates that bone uptakes without morphological lesions adjacent to a collateral circulation are not easily interpretable.
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Czajkowski M, Polewczyk A, Jacheć W, Kosior J, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. Multilevel Venous Obstruction in Patients with Cardiac Implantable Electronic Devices. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:336. [PMID: 38399623 PMCID: PMC10890105 DOI: 10.3390/medicina60020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The nature of multilevel lead-related venous stenosis/occlusion (MLVSO) and its influence on transvenous lead extraction (TLE) as well as long-term survival remains poorly understood. Materials and Methods: A total of 3002 venograms obtained before a TLE were analyzed to identify the risk factors for MLVSO, as well as the procedure effectiveness and long-term survival. Results: An older patient age at the first system implantation (OR = 1.015; p < 0.001), the number of leads in the heart (OR = 1.556; p < 0.001), the placement of the coronary sinus (CS) lead (OR = 1.270; p = 0.027), leads on both sides of the chest (OR = 7.203; p < 0.001), and a previous device upgrade or downgrade with lead abandonment (OR = 2.298; p < 0.001) were the strongest predictors of MLVSO. Conclusions: The presence of MLVSO predisposes patients with cardiac implantable electronic devices (CIED) to the development of infectious complications. Patients with multiple narrowed veins are likely to undergo longer and more complex procedures with complications, and the rates of clinical and procedural success are lower in this group. Long-term survival after a TLE is similar in patients with MLVSO and those without venous obstruction. MLVSO probably better depicts the severity of global venous obstruction than the degree of vein narrowing at only one point.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital of Radom, 26-617 Radom, Poland;
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland;
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
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Akhtar Z, Kontogiannis C, Elbatran AI, Leung LWM, Starck CT, Zuberi Z, Sohal M, Gallagher MM. Transvenous lead extraction: Experience of the Tandem approach. Europace 2023; 25:euad331. [PMID: 37936325 PMCID: PMC10903175 DOI: 10.1093/europace/euad331] [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: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with 'bail-out' support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach. METHOD The 'Tandem' procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive 'Tandem' procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics. RESULTS The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar. CONCLUSION The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christos Kontogiannis
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Ahmed I Elbatran
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Lisa W M Leung
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christoph T Starck
- Department of Cardiothoracic Surgery, German Heart Centre, Berlin, Germany
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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Miguelena Hycka J, López Menéndez J, Martín García M, Muñoz Pérez R, Castro Pinto M, Torres Terreros CB, García Chumbiray PF, Rodriguez-Roda J. Electrodos no funcionantes ¿Extracción o abandono? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Czajkowski M, Polewczyk A, Jacheć W, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies. Clin Physiol Funct Imaging 2023; 43:47-57. [PMID: 36251514 PMCID: PMC10092861 DOI: 10.1111/cpf.12792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/20/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Patients requiring temporal or permanent catheter or arterio-venous fistula (AVF) for haemodialysis may be in challenging situation, if they are cardiovascular implantable electronic devices (CIED) carriers. MATERIALS AND METHODS The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. RESULTS A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. CONCLUSION (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free-from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University , Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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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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8
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Milman A, Leshem E, Massalha E, Jia K, Meitus A, Kariv S, Shafir Y, Glikson M, Luria D, Sabbag A, Beinart R, Nof E. Occluded vein as a predictor for complications in non-infectious transvenous lead extraction. Front Cardiovasc Med 2022; 9:1016657. [PMID: 36312249 PMCID: PMC9601735 DOI: 10.3389/fcvm.2022.1016657] [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: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of cardiovascular implantable electronic device (CIED) is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous lead extraction (TLE) can facilitate the re-implantation of new leads. Aims This study aims to explore predictors and complications of non-infectious TLE. Methods This study involves a retrospective analysis and comparison of characteristics, complications, and outcomes of patients with and without occluded veins (OVs) undergoing TLE at our center. Results In total, eighty-eight patients underwent TLE for non-infectious reasons. Indications for TLE were lead malfunction (62; 70.5%) and need for CIED upgrade (22; 25%). Fourteen patients referred due to lead malfunction had an OV observed during venography. The OV group (36 patients) were significantly older (65.7 ± 14.1 vs. 53.8 ± 15.9, p = 0.001) and had more comorbidities. Ejection fraction (EF) was significantly lower for the OV group (27.5 vs. 57.5%, p = 0.001) and had a longer lead dwelling time (3,226 ± 2,324 vs. 2,191 ± 1,355 days, p = 0.012). Major complications were exclusive for the OV group (5.5% vs. none, p = 0.17), and most minor complications occurred in the OV group as well (33.3 vs. 4.1%, p < 0.001). Laser sheath and mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4 vs. 73.5%, respectively, p = 0.012). Procedure success was higher in the non-occluded group compared to the OV group (98 vs. 83.3%, respectively, p = 0.047). Despite these results, periprocedural mortality was similar between groups. Conclusion Among the TLE for non-infectious reasons, vein occlusion appears as a major predictor of complex TLE tool use, complications, and procedural success. Venography should be considered prior to non-infectious TLE to identify high-risk patients.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,*Correspondence: Anat Milman
| | - Eran Leshem
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Massalha
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Jia
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Meitus
- 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, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel,Hebrew University in Jerusalem Medical School, Jerusalem, Israel
| | - David Luria
- Hebrew University in Jerusalem Medical School, Jerusalem, Israel,Hadassah Medical Center, Heart Institute, Jerusalem, Israel
| | - Avi Sabbag
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Czajkowski M, Jacheć W, Polewczyk A, Kosior J, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction. Vasc Health Risk Manag 2022; 18:629-642. [PMID: 36003848 PMCID: PMC9393197 DOI: 10.2147/vhrm.s369342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO. Methods We performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO. Results Mild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees. Conclusion A total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Wojciech Jacheć
- Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Kielce, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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10
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Callahan TD. Looking for Lead Adhesions While Planning for Transvenous Lead Extraction. J Cardiovasc Electrophysiol 2022; 33:1041-1044. [PMID: 35245950 DOI: 10.1111/jce.15436] [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: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
The first implantable pacemaker was placed in the 1958, ushering in a new frontier of cardiovascular medicine. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas D Callahan
- Director, Inpatient Electrophysiology Service, Associate Program Director, Cardiovascular Medicine Fellowship.,Cleveland Clinic, Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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11
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Aboelhassan M, Bontempi L, Cerini M, Salghetti F, Arabia G, Giacopelli D, Fouad DA, F Abdelmegid MAK, Ahmed TAN, Dell'Aquila A, Curnis A. The Role of Preoperative Venography in Predicting the Difficulty of a Transvenous Lead Extraction Procedure. J Cardiovasc Electrophysiol 2022; 33:1034-1040. [PMID: 35243712 DOI: 10.1111/jce.15435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty. METHODS AND RESULTS A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age 71 years; 72% male) with a median of 2(1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31(30%), complete occlusion in 15(14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103(98%) patients. Fifty-five (52%) were advanced extractions as they required a power mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p<0.001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio 2.89[1.14-7.32], p=0.025). The fluoroscopy time was also significantly longer (14.0[8.2-18.7] vs. 5.1[2.1-10.0] min, p<0.001). The rate of complications did not differ based on the presence of venous lesions. CONCLUSION Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were 3 times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohamed Aboelhassan
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Luca Bontempi
- Cardiology Department, Spedali Civili, Brescia, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili, Brescia, Italy
| | | | | | - Daniele Giacopelli
- Clinical Research, Biotronik Italia, Milan, Italy.,Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Doaa A Fouad
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | | | - Tarek A N Ahmed
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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12
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Keyser A, Jungbauer C, Rennert J, Linnemann B, Schmid C, Schopka S. Assessment of Association Between Venous Occlusion and Infection of Cardiac Implantable Electronic Devices. Angiology 2022; 73:252-259. [PMID: 34362260 PMCID: PMC8873966 DOI: 10.1177/00033197211038376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increasing number of patients treated with cardiac implantable electronic devices (CIEDs) and indications for complex pacing requires system revisions. Currently, data on venous patency in repeat CIED surgery involving lead (re)placement or extraction are largely missing. This study aimed to assess venous patency and risk factors in patients referred for repeat CIED lead surgery, emphasizing CIED infection. All consecutive patients requiring extraction, exchange, or additional placement of ≥1 CIED leads during reoperative procedures from January 2015 to March 2020 were evaluated in this retrospective study. Venography was performed in 475 patients. Venous patency could be assessed in 387 patients (81.5%). CIED infection with venous occlusion was detected in 74 patients compared with venous occlusion without infection in 14 patients (P < .05). Concerning venous patency, novel oral anticoagulant medication appeared to be protective (P < .05; odds ratio [OR]: .35). Infection of the CIED appeared to be strongly associated with venous occlusion (OR: 16.0). The sensitivity was only 64.15%, but the specificity was 96.1%. Number of leads involved and previous CIED procedures were not associated with venous occlusion. In conclusion, in patients with CIED, venous occlusion was strongly associated with device infection, but not with the number of leads or previous CIED procedures.
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Affiliation(s)
- Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Cardiology, University Medical Center, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - Birgit Linnemann
- Department of Vascular Surgery and Angiology, University Medical Center, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
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13
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Fanous Y, Gula L, Skanes A, Tang A, Yee R, Khan HR. Safety of Lead Repair Compared to Lead Revision for Visible Lead Insulation Defects in Patients With Cardiac Implantable Electronic Devices. CJC Open 2021; 3:1490-1494. [PMID: 34993461 PMCID: PMC8712597 DOI: 10.1016/j.cjco.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | - Habib R. Khan
- Corresponding author: Dr Habib Khan, London Health Sciences Centre, University of Western Ontario, 339 Windermere Rd, Room C6-117A, London, Ontario N6A 5A5, Canada. Tel.: +1-519-663-3746, ext. 33746; fax: +1-519-663-3782.
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14
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Czajkowski M, Jacheć W, Polewczyk A, Kosior J, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. Risk Factors for Lead-Related Venous Obstruction: A Study of 2909 Candidates for Lead Extraction. J Clin Med 2021; 10:jcm10215158. [PMID: 34768676 PMCID: PMC8584439 DOI: 10.3390/jcm10215158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/10/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background: our knowledge of lead-related venous stenosis/occlusion (LRVSO) remains limited and there is still controversy regarding the risk factors for LRVSO. Venography is mandatory before transvenous lead extraction (TLE). Methods: we performed a retrospective analysis of venograms in 2909 patients (39.43% females, average age 66.90 years) who underwent TLE between 2008 and 2021 at high-volume centers. Results: the severity of LRVSO was likely to be dependent on the number of leads in the system (OR = 1.345; p = 0.003), the number of abandoned leads (OR = 1.965; p < 0.001), the presence of coronary sinus leads (OR = 1.184; p = 0.056), male gender (OR = 1.349; p = 0.003) and patient age at first CIED implantation (OR = 1.008; p = 0.021). The presence of permanent atrial fibrillation (OR = 0.666; p < 0.001) and right ventricular diastolic diameter (OR = 0.978; p = 0.006) showed an inverse correlation with the degree of LRVSO. The combined three-model multivariate analysis provided better prediction of LRSVO using the above-mentioned factors than the CHA2DS2-VASc score. Conclusions: the severity of LRVSO is probably dependent on the mechanical impact of the implanted/abandoned leads on the vein wall, therefore the study has demonstrated the central role of system-/procedure-related risk factors. The thrombotic mechanism may be less important, especially long after implantation, and for this reason the combined prediction model for LRVSO in this study was more effective than the CHA2DS2-VASc score.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-600024074
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland;
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland;
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland; (D.N.); (P.S.)
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-090 Lublin, Poland;
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15
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Ayvazyan SA, Gamzaev AB, Palagina AA, Gorshenin KG, Buslaeva SI, Seregin AA, Konovalov NS, Sapelnikov OV. The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications. Sovrem Tekhnologii Med 2021; 13:66-69. [PMID: 34513068 PMCID: PMC8353688 DOI: 10.17691/stm2021.13.1.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of the investigation was to study the issue of making challenging decisions concerning abandonment or removal of non-infected superfluous leads during lead revisions or cardiac implantable electronic device upgrades.
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Affiliation(s)
- S A Ayvazyan
- Cardiovascular Surgeon, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - A B Gamzaev
- Professor, Department of X-ray Surgical Methods of Diagnosis and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Palagina
- Resident, Department of X-ray Endovascular Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - K G Gorshenin
- Cardiologist, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - S I Buslaeva
- Cardiologist, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - A A Seregin
- Endovascular Surgeon, Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - N S Konovalov
- Resident, Department of X-ray Surgical Methods of Diagnosis and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - O V Sapelnikov
- Cardiovascular Surgeon, Department of Cardiovascular Surgery, National Medical Research Center of Cardiology, 15a, 3 Cherepkovskaya St., Moscow, 121552, Russia
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16
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The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189634. [PMID: 34574558 PMCID: PMC8465436 DOI: 10.3390/ijerph18189634] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival.
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17
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Tonko JB, Black SA, Rinaldi CA. "Inside-Out" Central Venous Access approach with infraclavicular exit for right-sided CRT-D Implantation in bilateral brachiocephalic and superior vena cava occlusion. Clin Case Rep 2021; 9:CCR33980. [PMID: 34136221 PMCID: PMC8190511 DOI: 10.1002/ccr3.3980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/09/2021] [Accepted: 02/08/2021] [Indexed: 11/08/2022] Open
Abstract
The use of the "inside-out" approach with an infraclavicular exit site with a dedicated system in the presence of complex central venous occlusion is feasible and safe for the implantation of complex cardiac devices.
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Affiliation(s)
- Johanna B. Tonko
- Department of CardiologySt. Thomas HospitalLondonUK
- Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | | | - Christopher A. Rinaldi
- Department of CardiologySt. Thomas HospitalLondonUK
- Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
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18
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Horlbeck FW, Eckerth C, Linhart M, Schaefer C, Jakob M, Pingel S, Klarmann-Schulz U, Nickenig G, Schwab JO. Long-term incidence of upper extremity venous obstruction in implantable cardioverter defibrillator patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1027-1032. [PMID: 33974720 DOI: 10.1111/pace.14266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Very little is known about the long-term prevalence of severe venous obstruction and occlusion in patients with transvenous implantable cardioverter-defibrillator leads. The objective of the current investigation was to elucidate the incidence and prevalence and to identify predisposing conditions in an ICD cohort over a long follow-up period. METHODS Based on a prospective database, we analyzed consecutive patients who received an ICD implantation in our hospital between 06/1988 and 2009 as well as all corresponding follow-up data until 02/2018. Cavographies were used for analysis, and all patients with at least one device replacement and one follow-up cavography were included. RESULTS Over a mean follow-up period of 94 ± 50 months, severe venous obstruction was found in 147 (33%) of 448 patients. Kaplan-Meier analysis shows a severe obstruction or occlusion in 50% of patients after a period of 14.3 years. The total number of leads (p < .001, HR 2.01, CI 2.000-2.022), an advanced age (p = .004, HR 1.023 per year, CI 1.022-1.024) and the presence of dilated cardiomyopathy (p = .035, HR 1.49, CI 1.47-1.51) were predictive of venous obstruction whereas the presence of anticoagulation was not. CONCLUSION Severe obstruction of the access veins after ICD implantation occurs frequently and its prevalence shows a nearly linear increase over long-time follow-up. Multiple leads, an advanced age and DCM as underlying disease are associated with an increased risk of venous obstruction while the role of anticoagulation to prevent venous obstruction in ICD patients is unclear.
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Affiliation(s)
- Fritz W Horlbeck
- Department of Medicine-Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Markus Linhart
- Department of Medicine-Cardiology, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Medicine-Angiology, University Hospital Bonn, Bonn, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, Ludwig Maximilian-University of Munich, Munich, Germany
| | - Simon Pingel
- Department of Medicine-Cardiology, University Hospital Bonn, Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine-Cardiology, University Hospital Bonn, Bonn, Germany
| | - Joerg O Schwab
- Department of Therapeutic and Interventional Cardiology, Beta Clinic Bonn, Bonn, Germany
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19
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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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20
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Efficacy and safety of transvenous lead extraction using a liberal combined superior and femoral approach. J Interv Card Electrophysiol 2020; 62:239-248. [PMID: 33029695 PMCID: PMC8536565 DOI: 10.1007/s10840-020-00889-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Purpose During transvenous lead extraction (TLE), the femoral snare has mainly been used as a bail-out procedure. The purpose of the present study is to evaluate the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach. Methods This is a single-center observational study including all TLE procedures between 2012 till 2019. Results A total of 264 procedures (median age 63 (51–71) years, 67.0% male) were performed in the study period. The main indications for TLE were lead malfunction (67.0%), isolated pocket infection (17.0%) and systemic infection (11.7%). The median dwelling time of the oldest targeted lead was 6.8 (4.0–9.7) years. The techniques used to perform the procedure were the use of a femoral snare only (30%), combined rotational powered sheath and femoral snare (25%), manual traction only (20%), rotational powered sheath only (17%) and locking stylet only (8%). The complete and clinical procedural success rate was 90.2% and 97.7%, respectively, and complete lead removal rate was 94.1% of all targeted leads. The major and minor procedure-related complication rates were 1.1% and 10.2%, respectively. There was one case (0.4%) of emergent sternotomy for management of cardiac avulsion. Furthermore, there were 5 in-hospital non-procedure-related deaths (1.9%), of whom 4 were related to septic shock due to a Staphylococcus aureus endocarditis after an uncomplicated TLE with complete removal of all leads. Conclusion An effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach.
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21
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Zucchelli G, Di Cori A, Segreti L, Laroche C, Blomstrom-Lundqvist C, Kutarski A, Regoli F, Butter C, Defaye P, Pasquié JL, Auricchio A, Maggioni AP, Bongiorni MG. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2020; 21:771-780. [PMID: 30590520 DOI: 10.1093/europace/euy300] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/01/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. METHODS AND RESULTS A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. CONCLUSIONS In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade.
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Affiliation(s)
- Giulio Zucchelli
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Andrea Di Cori
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Luca Segreti
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France
| | | | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland
| | - François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany
| | - Pascal Defaye
- Department of Arrhythmia and Cardiac Pacing, CHU Albert Michallon, University Hospital Grenoble-Alpes, BP 217, Grenoble Cedex 9, France
| | - Jean Luc Pasquié
- Département de Cardiologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France.,ANMCO Research Center, Via La Marmora 34, Firenze, Italy
| | - Maria Grazia Bongiorni
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
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22
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Eberhardt F, Bunck AC, Codjambopoulo P, Kalmbach K, Stöckigt F. Benign vena cava superior syndrome in patients with cardiac implantable electronic devices: Presentation and management. HeartRhythm Case Rep 2020; 6:549-553. [PMID: 32983865 PMCID: PMC7498635 DOI: 10.1016/j.hrcr.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Frank Eberhardt
- Department of Cardiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
- Address reprint requests and correspondence: PD Dr med Frank Eberhardt, Department of Cardiology, Evangelisches Krankenhaus Kalk, Buchforststr. 2, 51103 Cologne, Germany.
| | - Alexander C. Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Kilian Kalmbach
- Department of Anasthesiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Florian Stöckigt
- Department of Cardiology, Electrophysiology and Rhythmology, Krankenhaus Porz am Rhein, Cologne, Germany
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
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23
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Gomes S, Mamo AA, Cummins L, Kushwaha V. Is Venoplasty an Alternative to Lead Extraction for Patients With Venous Obstruction? Heart Lung Circ 2020; 30:419-422. [PMID: 32771385 DOI: 10.1016/j.hlc.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Indications for cardiovascular implantable electronic devices (CIEDs) have increased over time. Patients may require lead replacement or implantation due to lead failure or need for device upgrade. Venous obstruction is a common finding in these patients and often poses difficulties for operators. Venoplasty as an alternative to lead extraction emerges as an important intervention in the treatment of selected patients, particularly with a view to minimising procedural risk. METHODS Nine (9) patients with CIED related venous occlusion were treated with venoplasty at our institution between April 2006 and October 2019. Six (6) of nine patients were initially referred to our institution for consideration of transvenous lead extraction in the setting of venous occlusion. These patients are the subjects of the case series. Patient demographics, indication for venoplasty and procedural outcomes were examined. RESULTS We present a series of six patients in whom venoplasty has been performed at our centre as an alternative to lead extraction. Device and patient characteristics have been examined as well as radiation exposure and fluoroscopy time. The median age of our cohort was 64.5 years (range: 37-81 years) and 67% were female. Luminal calibre was improved in all patients allowing lead replacement, device upgrade or relief of symptoms. Procedural complications were not observed, and all patients remained free of symptoms related to venous occlusion at 3-month follow-up. CONCLUSIONS We present venoplasty as a viable alternative to lead extraction in high risk patients or in those who favour a less invasive approach.
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Affiliation(s)
- Sean Gomes
- Eastern Heart Clinic, Prince of Wales Hospital, Prince of Wales Private Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Anthony Mamo
- St George & Sutherland Clinical School, University of New South Wales, Sutherland Heart Clinic, Sutherland Hospital, Sydney, NSW, Australia.
| | - Leigh Cummins
- Eastern Heart Clinic, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Virag Kushwaha
- Eastern Heart Clinic, Prince of Wales Hospital, Prince of Wales Private Hospital, University of New South Wales, Sydney, NSW, Australia
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24
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Isawa T, Honda T, Yamaya K, Taguri M. Predictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients. J Arrhythm 2020; 36:746-754. [PMID: 32782649 PMCID: PMC7411205 DOI: 10.1002/joa3.12395] [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: 03/26/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies on femoral approach during transvenous lead extraction (TLE) are limited. METHODS We retrospectively evaluated 75 patients undergoing TLE from September 2014 through November 2019 via supportive femoral approach (Femoral/Superior group; n = 22) and superior approach alone (Superior group; n = 53). RESULTS No significant between-group differences were observed regarding patients' baseline characteristics except for a higher incidence of access vein occlusion in the Femoral/Superior group (59.1% vs. 31.4%; P = .037). The Femoral/Superior group exhibited significantly longer dwell times of the oldest extracted lead (median: 13.4 years; interquartile range [IQR]: 8.8-21.2 years vs. median, 7.2 years; IQR: 3.7-10.8 years; P < .001) and a higher incidence of passive fixation ventricular pacemaker lead (81.8% vs. 39.6%; P = .001). Multivariate logistic analysis showed that access vein occlusion (odds ratio [OR]: 4.07, 95% confidence interval [CI]: 1.08-15.3; P < .001) and dwell time of the oldest extracted lead (per year) (OR: 1.22, 95% CI: 1.09-1.37; P = .038) were predictors of the need for supportive femoral approach. Receiver operating characteristic curve analysis revealed that 11.8 years from implant was the cutoff for the need for supportive femoral approach (sensitivity 68.2%, specificity of 81.1%, area under the curve 0.81). CONCLUSIONS Access vein occlusion and long dwell time of the oldest extracted lead predict a high probability of the need for supportive femoral approach. Supportive femoral approach may be necessary in patients with leads that are implanted for >11.8 years and whose access veins are occluded.
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Affiliation(s)
- Tsuyoshi Isawa
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Taku Honda
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Kazuhiro Yamaya
- Department of Cardiovascular SurgerySendai Kousei HospitalSendaiJapan
| | - Masataka Taguri
- Department of Data ScienceYokohama City University School of Data ScienceYokohamaJapan
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Coelho-Lima J, Chapman J, Lim HS, Neil DAH. Pathological changes secondary to pacing leads within the coronary veins. Cardiovasc Pathol 2020; 46:107197. [PMID: 32036174 DOI: 10.1016/j.carpath.2020.107197] [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: 09/11/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022] Open
Abstract
Changes within the Coronary veins secondary to pacing leads have not been described, this study assessed these changes in explanted hearts. Macroscopically fibrous sheaths formed around longstanding leads, leading to slit like channels for venous return in smaller veins. Histologically changes included bland fibrosis, a foreign body response to the lead, a chronic inflammatory response and inflammatory destruction of the media. Individuals responded in different ways with no clear relationship of changes to duration of the lead.
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Affiliation(s)
- Jose Coelho-Lima
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, UK
| | - Joanne Chapman
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, UK
| | - Hoong Sern Lim
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, UK
| | - Desley A H Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, UK.
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Safi M, Akbarzadeh MA, Azinfar A, Namazi MH, Khaheshi I. Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study. ACTA ACUST UNITED AC 2019; 55:139-144. [PMID: 28432849 DOI: 10.1515/rjim-2017-0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obstruction of the access vein following cardiac pacemaker and defibrillator implantation is a common complication. However, the exact incidence and contributing risk factors are unknown. The aim of this study is to determine the incidence and analyze the contribution of each risk factor. METHODS 57 consecutive patients candidate for their first transvenous pacemaker, implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy device implantation were enrolled. After implantation, venography of the ipsilateral peripheral arm was performed. Patients underwent their second venography after the follow-up period of 3 to 6 months. RESULTS 42 patients (13 females, mean age 59.71 ± 12.33) completed the study. The followup venography showed significant venous obstruction (more than 50%) in 9 (21%) patients, but in none of the individuals, venography revealed total occlusion of the veins. Patients with obstruction had more leads in their veins (2.56 ± 0.53 vs 1.58 ± 0.71, P = 0.001). Venous obstruction was significantly more prevalent in patients with implanted cardiac resynchronization therapy device compared with an ICD or pacemaker (p = 0. 01). Age, gender, diabetes mellitus, hypertension, ischemic heart disease and antiplatelet consumption did not reveal any other contribution to the risk of thrombosis. In multivariate analysis, total lead number was a positive predictor for venous occlusion (P = 0.015, OR:19.2, and CI: 1.7-207.1). CONCLUSION Venous obstruction is relatively frequent after pacemaker or ICD implantation. This study also shows that pacemaker and ICD leads have a similar risk for lead-related venous obstruction. However, patients with multiple leads are associated with an increased risk.
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Sidhu BS, Gould J, Sieniewicz B, Porter B, Rinaldi CA. The role of transvenous lead extraction in the management of redundant or malfunctioning pacemaker and defibrillator leads post ELECTRa. Europace 2019; 20:1733-1740. [PMID: 29452360 DOI: 10.1093/europace/euy018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
Cardiac implantable electronic devices implantation rates have increased over the past decade due to broader indications and an ageing population. Similarly, device and lead complications have also risen. The management of pacemaker/defibrillator leads that are no longer required (redundant) or malfunctioning, can be contentious. There is a need to balance the risk of transvenous lead extraction (TLE) against those of lead abandonment. The recently published European Lead Extraction ConTRolled Registry (ELECTRa) study provides contemporary outcomes for TLE across Europe with important implications for the management of redundant and/or malfunctioning leads. This review article discusses the potential complications for each interventional approach when managing redundant or malfunctioning pacemaker leads.
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Affiliation(s)
- Baldeep S Sidhu
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Justin Gould
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Benjamin Sieniewicz
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Bradley Porter
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
| | - Christopher A Rinaldi
- Cardiology Department, Basement Floor South Wing, Guy's & St Thomas' Hospitals, Westminster Bridge Rd, London, UK
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Abstract
Lead extraction procedures have a low but real risk of major complications, such as superior vena cava tear and cardiac tamponade. Complications during lead removal are commonly related to lead binding sites, lead malposition, and lead perforation. Lead extraction imaging may indicate lead vascular binding sites, lead position, and perforation. Several imaging modalities are available, including chest radiograph, cardiac computed tomography, and echocardiography. The information provided by various imaging modalities will help assess the challenges of each lead extraction procedure and allows for better preprocedure planning.
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Affiliation(s)
- Pierce J Vatterott
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA.
| | - Imran S Syed
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
| | - Akbar H Khan
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
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Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin 2019; 10:17-29. [PMID: 29428139 DOI: 10.1016/j.ccep.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA.
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Cacko A, Kozyra-Pydyś E, Gawałko M, Opolski G, Grabowski M. Predictors of venous stenosis or occlusion following first transvenous cardiac device implantation: Prospective observational study. J Vasc Access 2018; 20:495-500. [PMID: 30537896 PMCID: PMC6699062 DOI: 10.1177/1129729818815135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Venous stenosis or occlusion related to an intracardiac device is a well-known complication of that procedure. There are numerous studies tried to determine predictors of venous stenosis or occlusion; however, most of them investigate the venous system prior to device upgrade, generator replacement, or transvenous lead extraction. Therefore, we aimed to assess the prevalence and determine the predictors of venous stenosis or occlusion following first transevnous cardiac device implantation. METHODS Observational, prospective study included 71 consecutive patients admitted for first transvenous cardiac device implantation. All patients were followed up for 6 months after operation. RESULTS Implanted device systems comprised cardioverter defibrillator (n = 26), single-chamber or dual-chamber pacemakers (n = 34), and biventricular pacemakers (n = 11); 88.5% of implantable cardioverter defibrillator leads were single-coils and 11.5% were dual-coils. The incidence of venous stenosis or occlusion within 6-month follow-up was 21.1%. Multivariate logistic regression showed that only diabetes or prediabetes (p = 0.033, odds ratio: 0.17, 95% confidence interval: 0.04-0.87), prolonged procedure time (p = 0.046, odds ratio: 4.54, 95% confidence interval: 1.01-20.12), and perioperative complications (p = 0.021, odds ratio: 7.04, 95% confidence interval: 1.35-36.85) were predictors of venous stenosis or occlusion. CONCLUSION Prolonged implantation time (>60 min) and perioperative complications are associated with an increased risk of venous stenosis or occlusion, whereas diabetes and prediabetes significantly reduce the risk of venous stenosis or occlusion.
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Affiliation(s)
- Andrzej Cacko
- 1 Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Eliza Kozyra-Pydyś
- 2 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Gawałko
- 2 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 2 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 2 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Albertini CMDM, Silva KRD, Leal Filho JMDM, Crevelari ES, Martinelli Filho M, Carnevale FC, Costa R. Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures. Arq Bras Cardiol 2018; 111:686-696. [PMID: 30281686 PMCID: PMC6248256 DOI: 10.5935/abc.20180164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 06/12/2018] [Indexed: 01/06/2023] Open
Abstract
Background Venous obstructions are common in patients with transvenous cardiac
implantable electronic devices, but they rarely cause immediate clinical
problems. The main consequence of these lesions is the difficulty in
obtaining venous access for additional leads implantation. Objectives We aimed to assess the prevalence and predictor factors of venous lesions in
patients referred to lead reoperations, and to define the role of
preoperative venography in the planning of these procedures. Methods From April 2013 to July 2016, contrast venography was performed in 100
patients referred to device upgrade, revision and lead extraction. Venous
lesions were classified as non-significant (< 50%), moderate stenosis
(51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral
circulation was classified as absent, discrete, moderate or accentuated. The
surgical strategy was defined according to the result of the preoperative
venography. Univariate analysis was used to investigate predictor factors
related to the occurrence of these lesions, with 5% of significance
level. Results Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in
11%. There were no significant differences in relation to the device side or
the venous segment. The usefulness of the preoperative venography to define
the operative tactic was proven, and in 99% of the cases, the established
surgical strategy could be performed according to plan. Conclusions The prevalence of venous obstruction is high in CIED recipients referred to
reoperations. Venography is highly indicated as a preoperative examination
for allowing the adequate surgical planning of procedures involving previous
transvenous leads.
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Affiliation(s)
| | - Katia Regina da Silva
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | | | - Martino Martinelli Filho
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Roberto Costa
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Sotiriadis C, Volpi S, Douek P, Chouiter A, Muller O, Qanadli SD. Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective? Front Surg 2018; 5:49. [PMID: 30105227 PMCID: PMC6077194 DOI: 10.3389/fsurg.2018.00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs. Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed. Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty. Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.
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Affiliation(s)
- Charalampos Sotiriadis
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Stephanie Volpi
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Pauline Douek
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Amine Chouiter
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Salah D Qanadli
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
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Perez AA, Woo FW, Tsang DC, Carrillo RG. Transvenous Lead Extractions: Current Approaches and Future Trends. Arrhythm Electrophysiol Rev 2018; 7:210-217. [PMID: 30416735 PMCID: PMC6141917 DOI: 10.15420/aer.2018.33.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
The use of cardiac implantable electronic devices (CIEDs) has continued to rise along with indications for their removal. When confronted with challenging clinical scenarios such as device infection, malfunction or vessel occlusion, patients often require the prompt removal of CIED hardware, including associated leads. Recent advancements in percutaneous methods have enabled physicians to face a myriad of complex lead extractions with efficiency and safety. Looking ahead, emerging technologies hold great promise in making extractions safer and more accessible for patients worldwide. This review will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this novel field.
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Affiliation(s)
- Adryan A Perez
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Frank W Woo
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Darren C Tsang
- University of Miami Miller School of Medicine Miami, FL, USA
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Fermin L, Gebhard RE, Azarrafiy R, Carrillo R. Pearls of Wisdom for High-Risk Laser Lead Extractions: A Focused Review. Anesth Analg 2017; 126:406-412. [PMID: 28991113 DOI: 10.1213/ane.0000000000002540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Due to new indications and improved technology, the incidence of laser lead extraction (LLE) has significantly increased over the past years. While LLE has been well studied and proven to be safe and effective, only few studies are geared toward the anesthesiologist's role during high-risk LLEs. This article utilized both a focused review and authors' experience to investigate anesthetic protocols during LLEs. Through this review, we recommend best practices for the anesthesiologist including appropriate procedure location, onsite availability of a cardiac surgeon, availability of a cardiopulmonary bypass machine, and intraoperative use of echocardiography to detect and address potential complications during high-risk LLEs.
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Affiliation(s)
- Lilibeth Fermin
- From the Department of Anesthesiology, Cleveland Clinic Florida, Weston, Florida
| | - Ralf E Gebhard
- Department of Anesthesiology, Perioperative Medicine and Pain Management
| | - Ryan Azarrafiy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Roger Carrillo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 703] [Impact Index Per Article: 100.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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37
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Boczar K, Zabek A, Haberka K, Debski M, Rydlewska A, Musial R, Lelakowski J, Malecka B. Venous stenosis and occlusion in the presence of endocardial leads in patients referred for transvenous lead extraction. Acta Cardiol 2017; 72:61-67. [PMID: 28597736 DOI: 10.1080/00015385.2017.1281545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures. Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO. Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients - subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts-75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites. Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.
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Affiliation(s)
- Krzysztof Boczar
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Andrzej Zabek
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Kazimierz Haberka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Maciej Debski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Robert Musial
- Department of Medical Intensive Care Unit, John Paul II Hospital, Cracow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Barbara Malecka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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Da Costa A, Axiotis A, Romeyer-Bouchard C, Abdellaoui L, Afif Z, Guichard JB, Gerbay A, Isaaz K. Transcatheter leadless cardiac pacing. Int J Cardiol 2017; 227:122-126. [DOI: 10.1016/j.ijcard.2016.11.196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022]
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Boczar K, Ząbek A, Dębski M, Haberka K, Rydlewska A, Lelakowski J, Małecka B. The utility of a CHA2DS2-VASc score in predicting the presence of significant stenosis and occlusion of veins with indwelling endocardial leads. Int J Cardiol 2016; 218:164-169. [PMID: 27236109 DOI: 10.1016/j.ijcard.2016.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, there are no studies in which a CHA2DS2-VASc score has been used to predict the risk of venous stenosis and occlusion (VSO) in patients after the implantation of a cardiac implantable electronic device (CIED). METHODS The material consists of the records of 223 consecutive patients qualified for transvenous lead extraction, generator change and system revisions or upgrades in whom we assessed the utility of a CHA2DS2-VASc score in the prediction of VSO. The CHA2DS2-VASc score was calculated retrospectively based on the clinical data. The whole study population was divided into two groups, based on the presence (group I) or absence (group II) of VSO. Using the receiver operating characteristic (ROC) curve, we identified the optimal cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO. RESULTS The venography was performed in 223 consecutive patients aged on average 68.2years (25.7-95.3), 77 females (34.5%). The presence of VSO was detected in 79 (35.4%) patients aged 68.3±14.1years, 30 female (40%) patients-group I. The level of the cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO was 3.0. CONCLUSION In the whole population the incidence of VSO amounted to 35.4%. The result of the CHA2DS2-VASc score was a destimulant of VSO occurrence and was characterized by moderate sensitivity (73.4%) and specificity (42.4%) in predicting the absence of VSO. The most significant factor, which prevented VSO development was diabetes.
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Affiliation(s)
- Krzysztof Boczar
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland.
| | - Andrzej Ząbek
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Maciej Dębski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Kazimierz Haberka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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Calvagna GM, Patanè S, Vasquez L. Closure access leading venous advanced gain new ability: A new technique to overcome implantable device venous occlusion. Int J Cardiol 2016; 202:911-3. [PMID: 26479957 DOI: 10.1016/j.ijcard.2015.10.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/04/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, (Messina), Italy
| | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo, Taormina (Me) and Cardiologia Presidio Ospedaliero "G. Fogliani", Milazzo (Me) Azienda Sanitaria Provinciale di Messina, Italy
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41
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Santini M, Di Fusco SA, Santini A, Magris B, Pignalberi C, Aquilani S, Colivicchi F, Gargaro A, Ricci RP. Prevalence and predictor factors of severe venous obstruction after cardiovascular electronic device implantation. Europace 2015; 18:1220-6. [PMID: 26705557 DOI: 10.1093/europace/euv391] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/26/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Despite not being uncommon, limited evidence exists about predisposing factors for venous obstruction in patients with implantable electronic devices. We aimed to assess the prevalence of severe venous obstruction in patients with intravenous devices and identify predictor factors. METHODS AND RESULTS A total of 184 patients underwent venography to detect venous obstruction associated with the inserted lead. Vessel obstruction was graded as venous occlusion (complete flow interruption), severe obstruction (narrowing >90%), or mild-moderate obstruction (narrowing 50-90%). Severe venous obstruction/occlusion prevalence was 11.4% (n = 21) and was always asymptomatic. Collateral circulation was found in 80.9% of patients with severe obstruction/occlusion. Twelve patients (6.5%) had 3 leads. The rates of patients with secondary prevention of sudden cardiac death as indication for implantable devices and of those of patients with 3 leads were significantly greater in the group with severe obstruction/occlusion than in the non-severe obstruction/occlusion group (respectively, P = 0.004 and P = 0.03). Logistic analysis adjusted for venous thromboembolic risk factors confirmed that secondary prevention of sudden cardiac death as indication for implantable devices [odds ratio (OR), 7.1; 95% confidence interval (CI): 1.4-35.3; P = 0.017] and the presence of 3 leads (OR, 8.5; 95% CI: 1.75-41.35; P = 0.008) were predictors of severe obstruction/occlusion. CONCLUSION In patients with implantable devices, severe venous obstruction prevalence is not negligible and the lack of symptoms does not exclude it. The presence of three leads and sudden cardiac death as indication for implantable devices seem to be associated with the presence of severe venous obstruction/occlusion.
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Affiliation(s)
- Massimo Santini
- Cardiovascular Department, San Filippo Neri Hospital, via Martinotti 20, Rome 00135, Italy
| | | | - Andrea Santini
- Radiology and Diagnostic Imaging Unit, Dermopathic Institute of the Immaculate, via Monti Creta 104, Rome 00167, Italy
| | - Barbara Magris
- Cardiovascular Department, San Filippo Neri Hospital, via Martinotti 20, Rome 00135, Italy
| | - Carlo Pignalberi
- Cardiovascular Department, San Filippo Neri Hospital, via Martinotti 20, Rome 00135, Italy
| | - Stefano Aquilani
- Cardiovascular Department, San Filippo Neri Hospital, via Martinotti 20, Rome 00135, Italy
| | | | - Alessio Gargaro
- Department of Clinical Research, Biotronik Italy S.p.A, viale delle industrie 11, Vimodrone (Mi) 20090, Italy
| | - Renato Pietro Ricci
- Cardiovascular Department, San Filippo Neri Hospital, via Martinotti 20, Rome 00135, Italy
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Trucco E, Mont L. Extraction of sterile leads is the preferred approach rather than implanting a new lead: the con perspective. Card Electrophysiol Clin 2015; 7:427-431. [PMID: 26304522 DOI: 10.1016/j.ccep.2015.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.
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Affiliation(s)
- Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic Universitari de Barcelona, Carrer Villarroel, 270, Barcelona 08036, Spain.
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Calvagna GM, Patanè S. Cardiac rehabilitation in pacing venous occlusions. Int J Cardiol 2015; 179:248-51. [PMID: 25464458 DOI: 10.1016/j.ijcard.2014.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
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Calvagna GM, Patanè S. Venous occlusion after transvenous pacemaker implantation--is there a role for new oral anticoagulants? Cardiovasc Drugs Ther 2014; 29:99-100. [PMID: 25435495 DOI: 10.1007/s10557-014-6564-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo-Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039, Taormina, Messina, Italy,
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