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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Transvenous lead extraction of implantable cardioverter-defibrillators: A comprehensive outcome-and risk factor analysis. Pacing Clin Electrophysiol 2023; 46:815-823. [PMID: 37461858 DOI: 10.1111/pace.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with transvenous implantable-cardioverter-defibrillator (ICD). OBJECTIVES Aim of this study was to characterize the procedural outcome and risk-factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE. METHODS We conducted a subgroup analysis of all ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed. RESULTS We identified 842 patients with an ICD undergoing TLE with the mean age of 62.8 ± 13.8 years. A total number of 1610 leads were treated with lead dysfunction (48.5%) as leading indication for extraction, followed by device-related infection (45.4%). Lead-per-patient ratio was 1.91 ± 0.88 and 60.0% of patients had dual-coil defibrillator leads. Additional extraction tools, such as mechanical rotating dilator sheaths and snares were utilized in 6.5% of cases. Overall procedural complications occurred in 4.3% with 2.0% major complications and a procedure-related mortality of 0.8%. Clinical success rate was 97.9%. All-cause in-hospital mortality was 3.4%, with sepsis being the leading cause for mortality. Multivariate analysis revealed lead-age ≥10 years (OR:5.82, 95%CI:2.1-16.6; p = .001) as independent predictor for procedural failure. Systemic infection (OR:9.57, 95%CI:2.2-42.4; p < .001) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p < .001) were identified as risk factors for all-cause mortality. CONCLUSIONS TLE is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Transvenous lead extraction in patients with systemic cardiac device-related infection-Procedural outcome and risk prediction: A GALLERY subgroup analysis. Heart Rhythm 2023; 20:181-189. [PMID: 36240993 DOI: 10.1016/j.hrthm.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) has evolved as one of the most crucial treatment options for patients with cardiac device-related systemic infection (CDRSI). OBJECTIVE The aim of this study was to characterize the procedural outcome and risk factors of patients with CDRSI undergoing TLE. METHODS A subgroup analysis of patients with CDRSI of the GALLERY (GermAn Laser Lead Extraction RegistrY) database was performed. Predictors for complications, procedural failure, and all-cause mortality were evaluated. RESULTS A total of 722 patients (28.6%) in the GALLERY had "systemic infection" as extraction indication. Patients with CDRSI were older (70.1 ± 12.2 years vs 67.3 ± 14.3 years; P < .001) and had more comorbidities than patients with local infections or noninfectious extraction indications. There were no differences in complete procedural success (90.6% vs 91.7%; P = .328) or major complications (2.5% vs 1.9%; P = .416) but increased procedure-related (1.4% vs 0.3%; P = .003) and all-cause in-hospital mortality (11.1% vs 0.6%; P < .001) for patients with CDRSI. Multivariate analyses revealed lead age ≥10 years as a predictor for procedural complications (odds ratio [OR] 3.23; 95% confidence interval [CI] 1.58-6.60; P = .001). Lead age ≥10 years (OR 2.57; 95% CI 1.03-6.46; P = .04) was also a predictor for procedural failure. We identified left ventricular ejection fraction <30% (OR 1.70; 95% CI 1.00-2.99; P = .049), age ≥75 years (OR 2.1; 95% CI 1.27-3.48; P = .004), chronic kidney disease (OR 1.92; 95% CI 1.17-3.14; P = .01), and overall procedural complications (OR 5.15; 95% CI 2.44-10.84; P < .001) as predictors for all-cause mortality. CONCLUSION Patients with CDRSI undergoing TLE demonstrate an increased rate of all-cause in-hospital, as well as procedure-related mortality, despite having comparable procedural success rates. Given these data, it seems paramount to develop preventive strategies to detect and treat CDRSI in its earliest stages.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | | | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at University Hospital Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at University Hospital Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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Giacomin E, Falzone PV, Dall'Aglio PB, Pittorru R, De Lazzari M, Vianello R, Bertaglia E, Tarzia V, Iliceto S, Gerosa G, Migliore F. Subcutaneous implantable cardioverter defibrillator after transvenous lead extraction: safety, efficacy and outcome. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01293-y. [PMID: 35831772 DOI: 10.1007/s10840-022-01293-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD. METHODS The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD. RESULTS Indications for TLE were infection (63.9%) and lead malfunction (36.1%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n = 4; 11.1%), isolated pocket erosion (n = 2; 5.5%), and ineffective therapy (n = 1; 2.8%). No lead/hardware dysfunction was reported. Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF). There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥ 2 (HR 5.05; 95% CI 1.00-26.38; p = 0.04), hypertension (HR 22.72; 95% CI 1.05-26.31; p = 0.02), diabetes (HR 10.64; 95% CI 2.05-55.60; p = 0.001) and ischemic heart disease (HR 5.92; 95% CI 1.17-30.30; p = 0.01). CONCLUSION Our study provides evidences on the use of S-ICD as an alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidities.
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Affiliation(s)
- Enrico Giacomin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Riccardo Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy.
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Ali H, Lupo P, Foresti S, De Ambroggi G, De Lucia C, Penela D, Turturiello D, Paganini EM, Cappato R. Air entrapment as a potential cause of early subcutaneous implantable cardioverter defibrillator malfunction: a systematic review of the literature. Europace 2022; 24:1608-1616. [PMID: 35639806 DOI: 10.1093/europace/euac046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Air entrapment (AE) has been reported as a potential cause of early inappropriate shocks (ISs) following subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, but a cause-effect relationship is not always evident. This systematic review aims to analyse this phenomenon concerning implantation techniques, electrogram (EGM) features, radiologic findings, and patient management. METHODS AND RESULTS A systematic search was conducted using PubMed, Embase, and Google Scholar databases following the PRISMA guidelines to obtain all available literature data since 2010 on S-ICD malfunctions possibly due to AE. The final analysis included 54 patients with AE as a potential cause of S-ICD malfunction. Overall, the aggregate incidence of this condition was 1.2%. Of ICD malfunctions possibly due to AE, 93% were ISs, and 95% were recorded within the first week following implantation. Radiologic diagnosis of AE was confirmed in 28% of the entire study cohort and in 68% of patients in whom this diagnostic examination was reported. At the time of device malfunction, EGMs showed artefacts, baseline drift, and QRS voltage reduction in 95, 76, and 67% of episodes, respectively. Management included ICD reprogramming or testing, no action (observation), and invasive implant revision in 57, 33, and 10% of patients, respectively. No recurrences occurred during follow-up, irrespective of management performed. CONCLUSIONS Device malfunction possibly due to AE may occur in ∼1% of S-ICD recipients. Diagnosis is strongly suggested by early occurrence, characteristic EGM features, and radiologic findings. Non-invasive management, principally device reprogramming, appears to be effective in most patients.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Carmine De Lucia
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Diego Penela
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Dario Turturiello
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Edoardo Maria Paganini
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS-MultiMedica Group, Via Milanese 300, 20099 Sesto San Giovanni, Milan, Italy
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Nso N, Nassar M, Lakhdar S, Enoru S, Guzman L, Rizzo V, Munira MS, Radparvar F, Thambidorai S. Comparative Assessment of Transvenous versus Subcutaneous Implantable Cardioverter-defibrillator Therapy Outcomes: An Updated Systematic Review and Meta-analysis. Int J Cardiol 2021; 349:62-78. [PMID: 34801615 DOI: 10.1016/j.ijcard.2021.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a high risk of ventricular arrhythmias. This study aimed to evaluate the safe replacement of TV-ICD with S-ICD based on updated recent evidence. METHODS We systematically searched EMBASE, JSTOR, PubMed/MEDLINE, and Cochrane Library on 30 July 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS We identified 26 studies that examined 7542 (58.27%) patients with S-ICD and 5400 (41.72%) with TV-ICD. The findings indicated that, compared to patients with TV-ICD, patients with S-ICD had a lower incidence of defibrillation lead failure (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.98; p = 0.05), lead displacement or fracture (OR, 0.25; 95% CI, 0.12-0.86; p = 0.0003), pneumothorax and/or hemothorax (OR: 0.22, 95% CI 0.05, 0.97, p = 0.05), device failure (OR: 0.70, 95% CI 0.51, 0.95, p = 0.02), all-cause mortality (OR: 0.44 [95% CI 0.32, 0.60], p < 0.001), and lead erosion (OR: 0.01, 95% CI 0.00, 0.05, p < 0.001). Patients with TV-ICD had a higher incidence of pocket complications than patients with S-ICD (OR, 2.13; 95% CI, 1.23-3.69; p = 0.007) and a higher but insignificant incidence of inappropriate sensing (OR, 3.53; 95% CI, 0.97-12.86; p = 0.06). CONCLUSIONS The S-ICD algorithm was safer and more effective than the TV-ICD system as it minimized the incidence of pocket complications, lead displacement or fracture, inappropriate sensing, defibrillation lead failure, pneumothorax/hemothorax, device failure, lead erosion, and all-cause mortality. Future studies should explore the scope of integrating novel algorithms with the current S-ICD systems to improve cardiovascular outcomes.
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Affiliation(s)
- Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA.
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Sostanie Enoru
- Division of Cardiovascular Disease, SUNY Downstate Medical Center, NY, USA
| | - Laura Guzman
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Most S Munira
- Division of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Farshid Radparvar
- Division of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA
| | - Senthil Thambidorai
- Cardiovascular Medicine Division, HCA Medical City of Fort Worth, TX/Medicine -TCU and UNTHSc School of Medicine, Fort Worth, TX, USA
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