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Maclean E, Mahtani K, Honarbakhsh S, Butcher C, Ahluwalia N, Dennis AS, Creta A, Finlay M, Elliott M, Mehta V, Wijesuriya N, Shaikh O, Zaw Y, Ogbedeh C, Gautam V, Lambiase PD, Schilling RJ, Earley MJ, Moore P, Muthumala A, Sporton SC, Hunter RJ, Rinaldi CA, Behar J, Martin C, Monkhouse C, Chow A. The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. Circ Arrhythm Electrophysiol 2024; 17:e012446. [PMID: 38258308 PMCID: PMC10949977 DOI: 10.1161/circep.123.012446] [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: 09/07/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology. METHODS A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation. RESULTS In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9-6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4-6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6-17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6-4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446). CONCLUSIONS The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Karishma Mahtani
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Shohreh Honarbakhsh
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Charles Butcher
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Nikhil Ahluwalia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Adam S.C. Dennis
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Antonio Creta
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Malcolm Finlay
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Mark Elliott
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Vishal Mehta
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Nadeev Wijesuriya
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Omar Shaikh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Yom Zaw
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Chizute Ogbedeh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Vasu Gautam
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Pier D. Lambiase
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Richard J. Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Mark J. Earley
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Philip Moore
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Amal Muthumala
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Simon C.E. Sporton
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Ross J. Hunter
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Christopher A. Rinaldi
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Jonathan Behar
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Claire Martin
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Christopher Monkhouse
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Anthony Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
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Frazer M, Phan F, Przybylowicz R, Krebsbach A, Dornblaser J, Jessel PM, Bhamidipati C, Tibayan FA, Henrikson CA. Impact of fixation mechanism and helix retraction status on right ventricular lead extraction. Heart Rhythm O2 2023; 4:757-764. [PMID: 38204460 PMCID: PMC10774662 DOI: 10.1016/j.hroo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background The impact of lead fixation mechanism on extractability is poorly characterized. Objective We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads. Methods A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0-9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups. Results Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%. Conclusion TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.
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Affiliation(s)
| | - Francis Phan
- Oregon Health & Science University, Portland, Oregon
| | | | | | | | - Peter M. Jessel
- Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
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3
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Morton MB, Mariani JA, Kistler PM, Patel H, Voskoboinik A. Transvenous versus subcutaneous implantable cardioverter defibrillators in young cardiac arrest survivors. Intern Med J 2023; 53:1956-1962. [PMID: 37929818 DOI: 10.1111/imj.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Secondary prevention implantable cardioverter defibrillators (ICDs) are indicated in young patients presenting with aborted sudden cardiac death (SCD) because of ventricular arrhythmias. Transvenous-ICDs (TV-ICDs) are effective, established therapies supported by evidence. The significant morbidity associated with transvenous leads led to the development of the newer subcutaneous-ICD (S-ICD). This review discusses the clinical considerations when selecting an ICD for the young patient presenting with out-of-hospital cardiac arrest. The major benefits of TV-ICDs are their ability to pace (antitachycardia pacing [ATP], bradycardia support and cardiac resynchronisation therapy [CRT]) and the robust evidence base supporting their use. Other benefits include a longer battery life. Significant complications associated with transvenous leads include pneumothorax and tamponade during insertion and infection and lead failure in the long term. Comparatively, S-ICDs, by virtue of having no intravascular leads, prevent these complications. S-ICDs have been associated with a higher incidence of inappropriate shocks. Patients with an indication for bradycardia pacing, CRT or ATP (documented ventricular tachycardia) are seen as unsuitable for a S-ICD. If venous access is unsuitable or undesirable, S-ICDs should be considered given the patient is appropriately screened. There is a need for further randomised controlled trials to directly compare the two devices. TV-ICDs are an effective therapy for preventing SCD limited by significant lead-related complications. S-ICDs are an important development hindered largely by an inability to pace. Young patients stand to gain the most from a S-ICD as the cumulative risk of lead-related complications is high. A clinical framework to aid decision-making is presented.
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Affiliation(s)
- Matthew B Morton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Justin A Mariani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Hitesh Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
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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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Rexha E, Chung DU, Burger H, Ghaffari N, Madej T, Ziaukas V, Hassan K, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction-a GALLERY subgroup analysis. Front Cardiovasc Med 2023; 10:1251055. [PMID: 37745113 PMCID: PMC10511873 DOI: 10.3389/fcvm.2023.1251055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Background The prevalence of young patients with cardiac implantable electronic devices (CIED) is steadily increasing, accompanied by a rise in the occurrence of complications related to CIEDs. Consequently, transvenous lead extraction (TLE) has become a crucial treatment approach for such individuals. Objective The purpose of this study was to examine the characteristics and procedural outcomes of young patients who undergo TLE, with a specific focus on identifying independent risk factors associated with adverse events. Methods All patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) were categorized into two groups based on their age at the time of enrollment: 45 years or younger, and over 45 years. A subgroup analysis was conducted specifically for the younger population. In this analysis, predictor variables for all-cause mortality, procedural complications, and procedural failure were evaluated using multivariable analyses. Results We identified 160 patients aged 45 years or younger with a mean age of 35.3 ± 7.6 years and 42.5% (n = 68) female patients. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2 ± 1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. The all-cause in-hospital mortality rate was 2.5%, with septic shock identified as the primary cause of mortality. Multivariable analysis revealed CKD (OR: 19.0; 95% CI: 1.84-194.9; p = 0.018) and systemic infection (OR: 12.7; 95% CI: 1.14-142.8; p = 0.039) as independent predictor for all-cause mortality. Lead age ≥ 10 years (OR: 14.58, 95% CI: 1.36-156.2; p = 0.027) was identified as sole independent risk factor for procedural complication. Conclusion TLE in young patients is safe and effective with a procedure-related mortality rate of 0.0%. CKD and systemic infection are predictors for all-cause mortality, whereas lead age ≥ 10 years was identified as independent risk factor for procedural complications in young patients undergoing TLE.
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Affiliation(s)
- Enida Rexha
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - 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
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Tomas Madej
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Virgilijus Ziaukas
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Kambiz Hassan
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 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/Luebeck, 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/Luebeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Haeberlin A, Noti F, Breitenstein A, Auricchio A, Reichlin T, Conte G, Klersy C, Curti M, Pruvot E, Domenichini G, Schaer B, Kühne M, Gruszczynski M, Burri H, Kobza R, Grebmer C, Regoli FD. Transvenous Lead Extraction during Cardiac Implantable Device Upgrade: Results from the Multicenter Swiss Lead Extraction Registry. J Clin Med 2023; 12:5175. [PMID: 37629216 PMCID: PMC10455660 DOI: 10.3390/jcm12165175] [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: 07/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce. METHODS This is a post hoc analysis of the investigator-initiated multicenter Swiss TLE registry. The objectives were to assess patient and procedural factors influencing TLE outcomes at the time of device upgrades. RESULTS 941 patients were included, whereof 83 (8.8%) had TLE due to a device upgrade. Rotational mechanical sheaths were more often used in upgraded patients (59% vs. 42.7%, p = 0.015) and total median procedure time was longer in these patients (160 min vs. 105 min, p < 0.001). Clinical success rates of upgraded patients compared to those who received TLE due to other reasons were not different (97.6% vs. 93.0%, p = 0.569). Moreover, multivariable analysis showed that upgrade procedures were not associated with a greater risk for complications (HR 0.48, 95% confidence interval 0.14-1.57, p = 0.224; intraprocedural complication rate of upgraded patients 7.2% vs. 5.5%). Intraprocedural complications of upgraded patients were mostly associated with the implantation and not the extraction procedure (67% vs. 33% of complications). CONCLUSIONS TLE during device upgrade is effective and does not attribute a disproportionate risk to the upgrade procedure.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | | | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Moreno Curti
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Etienne Pruvot
- Department of Cardiology, CHUV, 1011 Lausanne, Switzerland
| | | | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | | | - Haran Burri
- Department of Cardiology, HUG, 1205 Geneva, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - François D. Regoli
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Cardiology Service, San Giovanni Hospital, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
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Frei C, Hofer D, Jan S, Grebmer C, Breitenstein A. Single center experience with the novel rotating dilator sheath TightRail TM Sub-C in transvenous lead extraction. J Cardiovasc Electrophysiol 2023; 34:1738-1743. [PMID: 37343057 DOI: 10.1111/jce.15970] [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: 07/14/2022] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) in transvenous lead extraction. METHODS For this retrospective single-center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at the University Heart Center Zurich. RESULTS A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45) occurred, but neither was directly related to the Sub-C. CONCLUSION This retrospective single-center analysis suggests that transvenous lead extraction with a routine use of the TightRailTM Sub-C extraction sheath is a safe strategy resulting in high success rates that may offer useful theoretical benefits. Future studies are needed to evaluate the incremental benefit of a routine use of short extraction sheaths including the Sub-C during TLE procedures.
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Affiliation(s)
- Celine Frei
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Steffel Jan
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
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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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Rotational mechanical dilator sheaths for effective transvenous lead extraction. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
An exponential rise in clinical demand for cardiac implantable electronic device (CIED) therapy is observed all over the world due to the rapidly expanding lifespan. Accordingly, appropriate lead management including lead extraction is becoming increasingly essential components for the comprehensive care of patients with various CIEDs.
Main body
With a high success rate and a low complication rate, transvenous lead extraction (TLE) has now been established as first-line therapy for lead extraction. However, TLE is often challenging when there are heavily calcified fibrous adhesions between leads and cardiovascular structures. Recently, rotational mechanical dilator (RMD) sheaths were introduced to resolve this issue and facilitate TLE procedure. There are two types of commercially available RMD sheaths, Evolution® systems and TightRail™. Thorough knowledge of the proper use of the RMD devices is essential to increase success rate and to reduce complications of TLE. In the present review, mechanical features, various techniques, and clinical data of RMD sheaths will be described.
Conclusion
According to recent advancement of device technology, the clinical outcomes of TLE using the RMD sheaths are continuously improving. However, as the RMD sheath is a potentially aggressive tool, special care should be taken when used in patients with longer lead ages.
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Hayashi T, Tobita K, Miyashita H, Moriyama N, Murakami M, Saito S. Rare Complications of Pseudoaneurysms of the Superior Vena Cava After Transvenous Lead Extraction. JACC Case Rep 2022; 4:443-448. [PMID: 35693895 PMCID: PMC9175205 DOI: 10.1016/j.jaccas.2022.03.001] [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: 11/23/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 10/27/2022]
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Contractor T, Kotak K, Cooper JM, Cooper K. Retrograde crossing and snaring technique to retain access after lead extraction in the setting of venous stenosis: Another tool in the toolbox. HeartRhythm Case Rep 2022; 8:36-39. [PMID: 35070705 PMCID: PMC8767168 DOI: 10.1016/j.hrcr.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Transvenous lead extraction using the TightRail mechanical rotating dilator sheath for Asian patients. Sci Rep 2021; 11:22251. [PMID: 35039566 PMCID: PMC8764071 DOI: 10.1038/s41598-021-99901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
The need for transvenous lead extraction (TLE) is increasing worldwide including in Asia–Pacific regions. However, supporting evidence for TightRail, a relatively new rotating mechanical dilator sheath, is still lacking in Asian patients. The efficacy and safety of TLE using TightRail performed between March 2018 and June 2021 were evaluated in 86 consecutive patients with 131 leads. The mean lead age was 11.7 ± 7.3 (range, 1.0–41.4) years. Clinical and complete procedural success using TightRail were achieved in 93.0% and 89.5% of 86 patients, respectively, with 6 min of median fluoroscopic time and 9.3% of major complication rate: death (1.2%), cardiac tamponade (3.5%), severe tricuspid regurgitation (3.5%), and stroke (1.2%). However, in 46 patients with longest lead age ≤ 10 years, clinical/complete success and major cardiac complication rates turned out better as 97.8%, 95.7%, and 2.2%, respectively. Additionally, when patients were divided into 3 groups: the first 28, second 29, and the last 29 patients, there was a clear trend toward better efficacy and safety outcomes with more experience with TightRail (Ptrend < 0.05). Longest lead age > 10 years was closely associated with TLE-related major cardiac complication (P = 0.046) with 85.7% sensitivity, 57.0% specificity, 15.0% positive predictive value, and 97.8% negative predictive values. In conclusion, TLE using TightRail may be effectively and safely performed by experienced operators for Asian patients with the longest lead age ≤ 10 years. However, as TightRail is a potentially aggressive tool, special attention should be paid to patients with longer lead dwelling times (e.g., > 10 years).
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13
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Efficacy and mortality of rotating sheaths versus laser sheaths for transvenous lead extraction: a meta-analysis. J Interv Card Electrophysiol 2021:10.1007/s10840-021-01076-x. [PMID: 34839431 DOI: 10.1007/s10840-021-01076-x] [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: 04/06/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rotating and laser sheaths are both routinely used in transvenous lead extraction (TLE) which can lead to catastrophic complications including death. The efficacy and risk of each approach are uncertain. To perform a meta-analysis to compare success and mortality rates associated with rotating and laser sheaths. METHODS We searched electronic academic databases for case series of consecutive patients and randomized controlled trials published 1998-2017 describing the use of rotating and laser sheaths for TLE. Among 48 studies identified, rotating sheaths included 1,094 patients with 1,955 leads in 14 studies, and laser sheaths included 7,775 patients with 12,339 leads in 34 studies. Patients receiving rotating sheaths were older (63 versus 60 years old) and were more often male (74% versus 72%); CRT-P/Ds were more commonly extracted using rotating sheaths (12% versus 7%), whereas ICDs were less common (37% versus 42%), p > 0.05 for all. Infection as an indication for lead extraction was higher in the rotating sheath group (59.8% versus 52.9%, p = 0.002). The mean time from initial lead implantation was 7.2 years for rotating sheaths and 6.3 years for laser sheaths (p > 0.05). RESULTS Success rates for complete removal of transvenous leads were 95.1% in rotating sheaths and 93.4% in laser sheaths (p < 0.05). There was one death among 1,094 patients (0.09%) in rotating sheaths and 66 deaths among 7,775 patients (0.85%) in laser sheaths, translating to a 9.3-fold higher risk of death with laser sheaths (95% CI 1.3 to 66.9, p = 0.01). CONCLUSIONS Laser sheaths were associated with lower complete lead removal rate and a 9.3-fold higher risk of death.
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Cioffi GM, Gasperetti A, Tersalvi G, Schiavone M, Compagnucci P, Sozzi FB, Casella M, Guerra F, Dello Russo A, Forleo GB. Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives. J Cardiovasc Electrophysiol 2021; 32:3082-3094. [PMID: 34570400 DOI: 10.1111/jce.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives.
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Affiliation(s)
- Giacomo M Cioffi
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy.,Department of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Fabiola B Sozzi
- Department of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Wei Z, Xue Z, Guo Q. Recent Progress on Bioresorbable Passive Electronic Devices and Systems. MICROMACHINES 2021; 12:mi12060600. [PMID: 34067419 PMCID: PMC8224698 DOI: 10.3390/mi12060600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022]
Abstract
Bioresorbable electronic devices and/or systems are of great appeal in the field of biomedical engineering due to their unique characteristics that can be dissolved and resorbed after a predefined period, thus eliminating the costs and risks associated with the secondary surgery for retrieval. Among them, passive electronic components or systems are attractive for the clear structure design, simple fabrication process, and ease of data extraction. This work reviews the recent progress on bioresorbable passive electronic devices and systems, with an emphasis on their applications in biomedical engineering. Materials strategies, device architectures, integration approaches, and applications of bioresorbable passive devices are discussed. Furthermore, this work also overviews wireless passive systems fabricated with the combination of various passive components for vital sign monitoring, drug delivering, and nerve regeneration. Finally, we conclude with some perspectives on future fundamental studies, application opportunities, and remaining challenges of bioresorbable passive electronics.
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Affiliation(s)
- Zhihuan Wei
- School of Microelectronics, Shandong University, Jinan 250100, China;
| | - Zhongying Xue
- State Key Laboratory of Functional Materials for Informatics, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai 200050, China
- Correspondence: (Z.X.); (Q.G.)
| | - Qinglei Guo
- School of Microelectronics, Shandong University, Jinan 250100, China;
- State Key Laboratory of ASIC and Systems, Fudan University, Shanghai 200433, China
- Correspondence: (Z.X.); (Q.G.)
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Schaller RD, Sadek MM. Intracardiac Echocardiography During Transvenous Lead Extraction. Card Electrophysiol Clin 2021; 13:409-418. [PMID: 33990279 DOI: 10.1016/j.ccep.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transvenous lead extraction is an invaluable procedure within the contemporary management of cardiac implantable electronic devices. Transvenous lead extraction has traditionally been guided by fluoroscopy. Complementary imaging with intracardiac echocardiography can provide valuable additional information, such as identification of complications, lead-adherent echodensities, and sites of lead-tissue adherence. As such, it can be used to aid in risk stratification before lead removal, help to choose tools or techniques, and provide visual monitoring throughout the procedure. Intracardiac echocardiography can be incorporated into the lead extraction workflow of the contemporary electrophysiologist and provide valuable information supporting safety and efficacy.
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Affiliation(s)
- Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mouhannad M Sadek
- Arrhythmia Service, Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Costa R, Silva KRD, Crevelari ES, Nascimento WTJ, Nagumo MM, Martinelli Filho M, Jatene FB. Effectiveness and Safety of Transvenous Removal of Cardiac Pacing and Implantable Cardioverter-defibrillator Leads in the Real Clinical Scenario. Arq Bras Cardiol 2021; 115:1114-1124. [PMID: 33470310 PMCID: PMC8133723 DOI: 10.36660/abc.20200476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Fundamento Remoção de cabos-eletrodos de dispositivos cardíacos eletrônicos implantáveis (DCEI) é procedimento pouco frequente e sua realização exige longo treinamento profissional e infraestrutura adequada. Objetivos Avaliar a efetividade e a segurança da remoção de cabos-eletrodos de DCEI e determinar fatores de risco para complicações cirúrgicas e mortalidade em 30 dias. Métodos Estudo prospectivo com dados derivados da prática clínica. De janeiro/2014 a abril/2020, foram incluídos, consecutivamente, 365 pacientes submetidos à remoção de cabos-eletrodos, independentemente da indicação e técnica cirúrgica utilizada. Os desfechos primários foram: taxa de sucesso do procedimento, taxa combinada de complicações maiores e morte intraoperatória. Os desfechos secundários foram: fatores de risco para complicações intraoperatórias maiores e morte em 30 dias. Empregou-se análise univariada e multivariada, com nível de significância de 5%. Resultados A taxa de sucesso do procedimento foi de 96,7%, sendo 90,1% de sucesso completo e 6,6% de sucesso clínico. Complicações maiores intraoperatórias ocorreram em 15 (4,1%) pacientes. Fatores preditores de complicações maiores foram: tempo de implante dos cabos-eletrodos ≥ 7 anos (OR= 3,78, p= 0,046) e mudança de estratégia cirúrgica (OR= 5,30, p= 0,023). Classe funcional III-IV (OR= 6,98, p<0,001), insuficiência renal (OR= 5,75, p=0,001), infecção no DCEI (OR= 13,30, p<0,001), número de procedimentos realizados (OR= 77,32, p<0,001) e complicações maiores intraoperatórias (OR= 38,84, p<0,001) foram fatores preditores para mortalidade em 30 dias. Conclusões Os resultados desse estudo, que é o maior registro prospectivo de remoção de cabos-eletrodos da América Latina, confirmam a segurança e a efetividade desse procedimento no cenário da prática clínica real. (Arq Bras Cardiol. 2020; 115(6):1114-1124)
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Affiliation(s)
- Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Katia Regina da Silva
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Elizabeth Sartori Crevelari
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Marcia Mitie Nagumo
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Keiler J, Schulze M, Dreger R, Springer A, Öner A, Wree A. Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients-A Post Mortem Study. Front Cardiovasc Med 2020; 7:602179. [PMID: 33330664 PMCID: PMC7734031 DOI: 10.3389/fcvm.2020.602179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1-2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.
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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
| | - Ronja Dreger
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Armin Springer
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
| | - Alper Öner
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Choi YS, Hsueh YY, Koo J, Yang Q, Avila R, Hu B, Xie Z, Lee G, Ning Z, Liu C, Xu Y, Lee YJ, Zhao W, Fang J, Deng Y, Lee SM, Vázquez-Guardado A, Stepien I, Yan Y, Song JW, Haney C, Oh YS, Liu W, Yoon HJ, Banks A, MacEwan MR, Ameer GA, Ray WZ, Huang Y, Xie T, Franz CK, Li S, Rogers JA. Stretchable, dynamic covalent polymers for soft, long-lived bioresorbable electronic stimulators designed to facilitate neuromuscular regeneration. Nat Commun 2020; 11:5990. [PMID: 33239608 PMCID: PMC7688647 DOI: 10.1038/s41467-020-19660-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022] Open
Abstract
Bioresorbable electronic stimulators are of rapidly growing interest as unusual therapeutic platforms, i.e., bioelectronic medicines, for treating disease states, accelerating wound healing processes and eliminating infections. Here, we present advanced materials that support operation in these systems over clinically relevant timeframes, ultimately bioresorbing harmlessly to benign products without residues, to eliminate the need for surgical extraction. Our findings overcome key challenges of bioresorbable electronic devices by realizing lifetimes that match clinical needs. The devices exploit a bioresorbable dynamic covalent polymer that facilitates tight bonding to itself and other surfaces, as a soft, elastic substrate and encapsulation coating for wireless electronic components. We describe the underlying features and chemical design considerations for this polymer, and the biocompatibility of its constituent materials. In devices with optimized, wireless designs, these polymers enable stable, long-lived operation as distal stimulators in a rat model of peripheral nerve injuries, thereby demonstrating the potential of programmable long-term electrical stimulation for maintaining muscle receptivity and enhancing functional recovery.
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Affiliation(s)
- Yeon Sik Choi
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Yuan-Yu Hsueh
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70456, Taiwan
- International Research Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, 70456, Taiwan
| | - Jahyun Koo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- School of Biomedical Engineering, Korea University, Seoul, 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Republic of Korea
| | - Quansan Yang
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Buwei Hu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian, University of Technology, 116024, Dalian, China
- Department of Engineering Mechanics, Dalian University of Technology, 116024, Dalian, China
- International Research Center for Computational Mechanics, Dalian University of Technology, 116024, Dalian, China
| | - Geumbee Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - Zheng Ning
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Claire Liu
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Yameng Xu
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Young Joong Lee
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - Weikang Zhao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Fang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yujun Deng
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, 200240, Shanghai, China
| | - Seung Min Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - Abraham Vázquez-Guardado
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Iwona Stepien
- Center for Developmental Therapeutics, Chemistry Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
| | - Ying Yan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Joseph W Song
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Chad Haney
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, 60208, USA
| | - Yong Suk Oh
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - Wentai Liu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Hong-Joon Yoon
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Anthony Banks
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - Matthew R MacEwan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Guillermo A Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Tao Xie
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Colin K Franz
- Regenerative Neurorehabilitation Laboratory, Biologics, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Song Li
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
| | - John A Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, 60208, USA.
- Querrey Simpson Institute for Biotechnology, Northwestern University, Evanston, IL, 60208, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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20
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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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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: 46] [Impact Index Per Article: 11.5] [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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Lead-related superior vena cava syndrome: Management and outcomes. Heart Rhythm 2020; 18:207-214. [PMID: 32920177 DOI: 10.1016/j.hrthm.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Superior vena cava (SVC) syndrome includes the clinical sequalae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important nonmalignant causes of this syndrome. There are little data on the effectiveness of venoplasty and lead extraction in the management of these patients. OBJECTIVE The objective of this study was to report the findings associated with the use of balloon angioplasty and lead extraction in the management of 17 patients with lead induced SVC syndrome. METHODS Data collected from January 2003 to July 2019 identified 17 cases of SVC syndrome at our tertiary center. Their outcomes were compared to a control group of patients without SVC syndrome. A P value of <.05 was considered statistically significant. RESULTS Of the 17 patients, 13 (76%) underwent transvenous lead extraction and venoplasty. Three patients (18%) were treated with venoplasty alone, and 1 patient (6%) underwent surgical SVC reconstruction. In 10 patients (59%), transvenous reimplantation was necessary. Symptom resolution was achieved in all 17 patients and confirmed at both 6 and 12 months' follow-up. There was no significant difference in the rate of complications associated with transvenous lead extraction for SVC syndrome vs control. CONCLUSION In patients with SVC syndrome, venoplasty and lead extraction are safe and effective for resolution of symptoms and maintaining SVC patency.
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23
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Rizal A, Ruspiono E, Putri DH. Intermittent Pacemaker Malfunction Caused by Continuous Compression of the Lead by the Clavicle (Subclavian Crush Syndrome). Eur J Case Rep Intern Med 2020; 7:001684. [PMID: 32789137 PMCID: PMC7417038 DOI: 10.12890/2020_001684] [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: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Abstract
Subclavian vein access is still one of the most favoured access options for cardiac implantable electronic device (CIED) implantation. For the physician, the technique is reasonably familiar and easy to carry out. However, this has several potential complications. In this case, we present a late complication of subclavian access. The patient presented with intermittent loss of pacemaker output, which caused him to experience several syncopal events. In the acute setting, we changed the lead polarity and achieved a good outcome. Further management of this situation consisted of removal and replacement of the damaged lead.
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Affiliation(s)
- Ardian Rizal
- Arrhythmia and Pacing Division, Cardiology and Vascular Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Indonesia
| | - Evit Ruspiono
- Catheterization Laboratory, Dr Iskak Tulungagung General Hospital, Indonesia
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Mazzone P, Melillo F, Radinovic A, Marzi A, Paglino G, Della Bella P, Mascioli G. Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience. J Arrhythm 2020; 36:343-350. [PMID: 32256885 PMCID: PMC7132215 DOI: 10.1002/joa3.12310] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of this study is to assess the safety and efficacy of the new bidirectional rotational mechanical sheath TightRail™ (Spectranetics) for lead extraction. METHODS AND RESULTS This is a bicentric prospective study that included patients who underwent a transvenous lead extraction (TLE) in two Italian centers (San Raffaele Hospital and Humanitas Gavazzeni Hospital). From November 2016 to December 2018, 26 patients underwent a TLE procedure in which the TightRail™ was used. The new TightRail Sub-C was used in 20 (76%) patients to overcome the fibrosis between the vessel and the first rib. Median age was 69 (IQR 60.7-79.5) years. The indication for TLE were infection (57.7%) or lead dysfunction (42.3%). A total of 57 leads (range 1-4), 40 of which using the TightRail (range 1-4), were extracted. Overall mean implant duration was 98.2.0 ± 66.5 months. Mean age of the lead extracted with the TightRail sheath was 99.1 ± 70.2 months and was higher compared to that of the leads extracted manually (84.4 ± 60.3 months, P = .001). The overall clinical success was 100% and complete procedural success without the use of a snare was achieved in 98.3%. There were no cases of death or major complications and only two minor complications occurred. All patients were event-free at 6-month follow-up. CONCLUSION This initial experience using the TightRail™ suggests a high safety and efficacy profile for extractions in a wide range of lead age.
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Affiliation(s)
- Patrizio Mazzone
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Francesco Melillo
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Andrea Radinovic
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Alessandra Marzi
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Gabriele Paglino
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology LaboratoriesDepartment of Cardiology and Cardiothoracic SurgeryOspedale San RaffaeleMilanItaly
| | - Giosuè Mascioli
- Electrophysiology UnitCardiovascular DepartmentHumanitas Gavazzeni HospitalBergamoItaly
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25
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Safety and In-Hospital Outcomes of Transvenous Lead Extraction for Cardiac Implantable Device-Related Infections: Analysis of 13 Years of Inpatient Data in the United States. JACC Clin Electrophysiol 2019; 5:1450-1458. [PMID: 31857046 DOI: 10.1016/j.jacep.2019.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the safety and in-hospital outcomes of transcutaneous lead extraction (TLE) associated with device-related infection (DRI) in the United States from 2003 to 2015. BACKGROUND DRI remains the most serious complication and the most common indication for lead extraction in patients with cardiac implantable electronic devices. The rates of DRI and associated lead extraction have been growing in line with the increasing number of cardiac implantable electronic device implantations worldwide. METHODS Data for this study were drawn from the National (Nationwide) Inpatient Sample. The International Classification of Diseases-9th Revision-Clinical Modification coding system was used to identify hospitalizations with TLE for DRI and to investigate the rates of major adverse events. RESULTS From a total of approximately 100 million unweighted hospitalizations over the 13-year study period, 12,257 unweighted observations were identified. This represents 59,082 (95% confidence interval [CI]: 58,982 to 59,182) patients who underwent TLE for DRI during the study period. A large majority of patients (75%) were older than 60 years. Patients were predominantly male (70%) and Caucasian (76%), and 80% had at least 1 comorbidity. The median length of stay was 8 days (interquartile range 5 to 14 days). At least 1 major adverse event occurred in 10.42% of procedures. The all-cause in-hospital mortality rate was 4.11%. Independent predictors of mortality were weight loss (adjusted odds ratio [aOR]: 4.02; 95% CI: 3.13 to 5.17), congestive heart failure (aOR: 3.28; 95% CI: 2.48 to 4.34), chronic kidney disease (aOR: 2.09; 95% CI: 1.70 to 2.56), pericardial complications (aOR: 2.87; 95% CI: 1.79 to 4.61), and procedure-related pulmonary injury (aOR: 2.06; 95% CI: 1.25 to 3.40). CONCLUSIONS These results reflect the high rate of complications and mortality for TLE due to DRI in real-world experience, highlighting the importance of comorbidities, especially congestive heart failure and chronic kidney disease, as significant predictors of mortality in these patients.
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26
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Döring M, Richter S, Hindricks G. The Diagnosis and Treatment of Pacemaker-Associated Infection. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:445-452. [PMID: 30017027 DOI: 10.3238/arztebl.2018.0445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/28/2017] [Accepted: 03/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Approximately 105 000 cardiac electronic devices are newly implanted in Germany each year. Germany has the highest implantation rate with respect to population of any European country. Infections in cardiac implants are serious complications, with an associated in-hospital mortality of 5-15%. It is thus very important to optimize the diagnostic and therapeutic strategies by which such infections can be detected early and treated effectively. METHODS This review is based on pertinent publications retrieved by a search in PubMed, with special attention to the current recommendations of international medical specialty societies. RESULTS According to the international literature, the incidence of device-associated infection is 1.7% (in six months) for implanted defibrillators and 9.5% (in two years) for resynchronization devices. No absolute figures on infection rates are available for Germany. Infection can involve either the site where the impulse generator is implanted or the intravascular portion of the electrodes. The most important elements of the diagnostic evaluation are: assessment of the local findings; pathogen identification by culture of peripheral blood, swabs of the infected site, or material recovered at surgery; and transesophageal echocardiography to detect endocarditic deposits on the electrodes or cardiac valves. The treatment consists of appropriate antibiotic administration and the complete removal of all foreign material. These special extractions are generally performed via the transvenous route. With the aid of various sheath systems, the procedure can be carried out safely and effectively, with a success rate above 95% and a complication rate below 3%. The indications for the implantation of a new device after eradication of the infection should be critically reassessed. CONCLUSION Untreated infection carries a high mortality. Evaluation and treatment according to a standardized clinical algorithm facilitate correct and timely diagnosis and the choice of an appropriate therapeutic strategy.
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Affiliation(s)
- Michael Döring
- Clinic for Cardiology, Department of Rhythmology, Heart Center Leipzig
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27
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Alqarawi W, Coppens J, Aldawood W, Ramirez FD, Redpath CJ, Nair GM, Nery PB, Davis DR, Abu Shama R, Aydin A, Klein A, Golian M, Schaller RD, Green MS, Birnie DH, Sadek MM. A Strategy of Lead Abandonment in a Large Cohort of Patients With Sprint Fidelis Leads. JACC Clin Electrophysiol 2019; 5:1059-1067. [DOI: 10.1016/j.jacep.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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28
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Xu K, Li S, Dong S, Zhang S, Pan G, Wang G, Shi L, Guo W, Yu C, Luo J. Bioresorbable Electrode Array for Electrophysiological and Pressure Signal Recording in the Brain. Adv Healthc Mater 2019; 8:e1801649. [PMID: 31168937 DOI: 10.1002/adhm.201801649] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/29/2019] [Indexed: 01/29/2023]
Abstract
Medical implantation of an electrocorticography (ECoG) recording system for brain monitoring is an effective clinical tool for seizure focus location and brain disease diagnosis. Planar and flexible ECoG electrodes can minimize the risks of infection and serious inflammatory response, and their good shape adaptability allows the device to fit complex cortex shape and structure to record brain signals with high spatial and temporal resolution. However, these ECoG electrodes require an additional surgery to remove the implant, which imposes potential medical risks. Here, a novel flexible and bioresorbable ECoG device integrated with an intracortical pressure sensor for monitoring swelling of the cortex during operation is reported. The ECoG device is fabricated with poly(l-lactide) and polycaprolactone composite and transient metal molybdenum. In vivo tests on rats show that the ECoG system can record the dynamic changes in brain signals for the different epilepsy stages with high resolution, while the malleable pressure sensor shows a linear relationship between the pressure and resistance in in vitro tests. In vitro degradation experiments show that the ECoG system can work stably for about five days before loss of efficacy, and the whole ECoG system degrades completely in a phosphate buffer solution in about 100 days.
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Affiliation(s)
- Kedi Xu
- Key Laboratory of Biomedical Engineering of Education MinistryQiushi Academy for Advanced StudiesDepartment of Biomedical EngineeringZhejiang University Hangzhou 310027 China
| | - Shijian Li
- College of Computer ScienceZhejiang University Hangzhou 310027 China
| | - Shurong Dong
- College of Information Science and Electronic EngineeringZhejiang University Hangzhou 310027 China
| | - Shaomin Zhang
- Key Laboratory of Biomedical Engineering of Education MinistryQiushi Academy for Advanced StudiesDepartment of Biomedical EngineeringZhejiang University Hangzhou 310027 China
| | - Gang Pan
- College of Computer ScienceZhejiang University Hangzhou 310027 China
| | - Guangming Wang
- College of Information Science and Electronic EngineeringZhejiang University Hangzhou 310027 China
| | - Lin Shi
- College of Information Science and Electronic EngineeringZhejiang University Hangzhou 310027 China
| | - Wei Guo
- College of Information Science and Electronic EngineeringZhejiang University Hangzhou 310027 China
| | - Chaonan Yu
- Key Laboratory of Biomedical Engineering of Education MinistryQiushi Academy for Advanced StudiesDepartment of Biomedical EngineeringZhejiang University Hangzhou 310027 China
| | - Jikui Luo
- Institute of Renewable Energy and Environmental TechnologyBolton University Deane Road Bolton BL3 5AB UK
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Sherk WM, Khaja MS, Good ED, Cunnane RT, Dasika NL, Williams DM. Hybrid venous recanalization and cardiac implantable electronic device lead revision procedures: A single-center retrospective analysis of 38 patients. Clin Imaging 2019; 58:145-151. [PMID: 31336361 DOI: 10.1016/j.clinimag.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the safety and efficacy of hybrid recanalization procedures in a series of patients with obstructed central veins requiring cardiac implantable electronic device (CIED) revision. METHODS Between 2008 and 2016, 38 consecutive patients (24 M; age 60.5 ± 16.2 years; range 25-87 years) with central venous obstruction underwent 42 recanalization interventions performed in conjunction with CIED revision or extraction. Fifty percent of patients (19/38) presented with veno-occlusive symptoms, and 13% (5/38) of patients had CIED leads with an ipsilateral upper extremity dialysis conduit. RESULTS Ninety-one percent (38/42) of all procedures resulted in successful recanalization and CIED revision. Twenty-four percent (9/38) of all patients required secondary procedures due to recurrent stenosis, and 78% (7/9) of those requiring secondary procedures had indwelling dialysis conduits and/or clinical symptoms related to venous occlusion before the initial procedure. There were complications in 2 patients related to recanalization, and in 3 related to CIED revision. CONCLUSIONS Recanalization of central venous stenosis/occlusion in patients with CIED can be technically challenging but is successful in most patients. Symptomatic patients and those with dialysis conduits often require more aggressive revascularization interventions and may be at increased risk of complication or need for secondary interventions.
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Affiliation(s)
- William M Sherk
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Minhaj S Khaja
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Eric D Good
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America
| | - Ryan T Cunnane
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America.
| | - Narasimham L Dasika
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - David M Williams
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
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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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Migliore F, Testolina M, Sagone A, Carretta D, Agricola T, Rovaris G, Piazzi E, Facchin D, Lazzari M, Zorzi A, Melillo F, Cataldi C, Marzi A, Bottio T, Tarzia V, Gerosa G, Iliceto S, Bertaglia E, Mazzone P. Multicenter experience with the Evolution RL mechanical sheath for lead extraction using a stepwise approach: Safety, effectiveness, and outcome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:989-997. [DOI: 10.1111/pace.13700] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Martina Testolina
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Antonio Sagone
- Policlinico IRCCS Multimedica Sesto San Giovanni Milano Italy
| | - Domenico Carretta
- Unit of Cardiovascular Diseases, Azienda Ospedaliera UniversitariaOspedale Policlinico Consorziale Bari Italy
| | - Tullio Agricola
- Electrophysiology Unit“Spirito Santo” Hospital Pescara Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology UnitSan Gerardo Hospital Monza Italy
| | - Elena Piazzi
- Interventional Electrophysiology UnitSan Gerardo Hospital Monza Italy
| | | | - Manuel Lazzari
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Francesco Melillo
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
| | - Claudia Cataldi
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Alessandra Marzi
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Patrizio Mazzone
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
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Segreti L, Rinaldi CA, Claridge S, Svendsen JH, Blomstrom-Lundqvist C, Auricchio A, Butter C, Dagres N, Deharo JC, Maggioni AP, Kutarski A, Kennergren C, Laroche C, Kempa M, Magnani A, Casteigt B, Bongiorni MG. Procedural outcomes associated with transvenous lead extraction in patients with abandoned leads: an ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) Registry Sub-Analysis. Europace 2019; 21:645-654. [DOI: 10.1093/europace/euy307] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luca Segreti
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | | | - Simon Claridge
- Cardiology Department, Guy’s & St Thomas’ Hospitals, London, UK
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carina Blomstrom-Lundqvist
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Angelo Auricchio
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Christian Butter
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Nikolaos Dagres
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Germany
| | | | - Aldo P Maggioni
- CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, Marseille, France
- ANMCO Research Center, Florence, Italy
| | - Andrzej Kutarski
- Scientific Division, European Society of Cardiology, EURObservational Research Programme (EORP), 2035 Route des colles, CS 80179 Biot, Sophia-Antipolis Cedex, France
| | - Charles Kennergren
- Department of Cardiology, Medical University of Lublin, 20-090 Lublin Str., Jaczewskiego 8, Lublin, Poland
| | | | - Maciej Kempa
- Sahlgrenska University Hospital, Cardiothoracic Surgery, Sahlgrenska/SU, Goteborg, Sweden
| | - Andrea Magnani
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Debinki 7 Str., Gdansk, Poland
| | - Benjamin Casteigt
- Cardiology Department, University Hospital Maggiore della Carità, Corso Mazzini 18, Novara, Italy
| | - Maria Grazia Bongiorni
- Clinique Pasteur, Management of Cardiac Arrhythmias, 45 Avenue de Lombez, Toulouse, France
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Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:233-235. [PMID: 29894362 DOI: 10.1097/imi.0000000000000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.
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Dai M, Joyce DL, Blackmon S, Friedman MPHPA, Espinosa R, Osborn MJ, Huang C, Cha YM. Outcomes of video-assisted thoracoscopic surgery for transvenous lead extraction. J Cardiovasc Electrophysiol 2018; 29:1032-1037. [PMID: 29858883 DOI: 10.1111/jce.13643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/02/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To evaluate the outcomes of video-assisted thoracoscopic surgery (VATS) during transvenous lead extractions (TLEs). METHODS AND RESULTS Ninety-one high-risk patients who underwent TLE in the operating room from January 1, 2015, to March 31, 2017, were included in the study. Of these, 9 patients underwent VATS during TLE. Their clinical characteristics, indications for lead extraction, and complications associated with TLE in the 9 patients who had VATS were compared with those for the 82 patients who did not have VATS. The mean (SD) age of the study patients was 61 (17) years (64.8% were male). The lead dwell time, number of leads extracted, and clinical comorbidities were similar between the 2 groups. Superior vena cava (SVC) tear occurred in 2 of the 9 patients in VATS group and in 1 of the 82 in the non-VATS group (22.2% vs. 1.2%, P = 0.03). Of the 2 patients in the VATS group who had SVC tears, in 1 the tear was visualized immediately and there was no hemodynamic compromise. In the other patient, the SVC tear was within the pericardium; the blood pressure recovered quickly after sternotomy and repair. Both patients had complete lead extraction and survived hospitalization. The patient in the non-VATS group who had an SVC tear had a successful repair but died of postoperative complications. CONCLUSIONS Utilization of VATS to facilitate TLE is beneficial for early recognition of SVC tear and timely surgical repair in select high-risk patients.
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Affiliation(s)
- Mingyan Dai
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David L Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shanda Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Raul Espinosa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael J Osborn
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Merchant FM, Tejada T, Patel A, El-Khalil J, Desai Y, Keeling B, Lattouf OM, Leon AR, El-Chami MF. Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads. Heart Rhythm 2018; 15:855-859. [DOI: 10.1016/j.hrthm.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 10/18/2022]
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Kang SK, Koo J, Lee YK, Rogers JA. Advanced Materials and Devices for Bioresorbable Electronics. Acc Chem Res 2018; 51:988-998. [PMID: 29664613 DOI: 10.1021/acs.accounts.7b00548] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent advances in materials chemistry establish the foundations for unusual classes of electronic systems, characterized by their ability to fully or partially dissolve, disintegrate, or otherwise physically or chemically decompose in a controlled fashion after some defined period of stable operation. Such types of "transient" technologies may enable consumer gadgets that minimize waste streams associated with disposal, implantable sensors that disappear harmlessly in the body, and hardware-secure platforms that prevent unwanted recovery of sensitive data. This second area of opportunity, sometimes referred to as bioresorbable electronics, is of particular interest due to its ability to provide diagnostic or therapeutic function in a manner that can enhance or monitor transient biological processes, such as wound healing, while bypassing risks associated with extended device load on the body or with secondary surgical procedures for removal. Early chemistry research established sets of bioresorbable materials for substrates, encapsulation layers, and dielectrics, along with several options in organic and bio-organic semiconductors. The subsequent realization that nanoscale forms of device-grade monocrystalline silicon, such as silicon nanomembranes (m-Si NMs, or Si NMs) undergo hydrolysis in biofluids to yield biocompatible byproducts over biologically relevant time scales advanced the field by providing immediate routes to high performance operation and versatile, sophisticated levels of function. When combined with bioresorbable conductors, dielectrics, substrates, and encapsulation layers, Si NMs provide the basis for a broad, general class of bioresorbable electronics. Other properties of Si, such as its piezoresistivity and photovoltaic properties, allow other types of bioresorbable devices such as solar cells, strain gauges, pH sensors, and photodetectors. The most advanced bioresorbable devices now exist as complete systems with successful demonstrations of clinically relevant modes of operation in animal models. This Account highlights the foundational materials concepts for this area of technology, starting with the dissolution chemistry and reaction kinetics associated with hydrolysis of Si NMs as a function of temperature, pH, and ion and protein concentration. A following discussion focuses on key supporting materials, including a range of dielectrics, metals, and substrates. As comparatively low performance alternatives to Si NMs, bioresorbable organic semiconductors are also presented, where interest derives from their intrinsic flexibility, low-temperature processability, and ease of chemical modification. Representative examples of encapsulation materials and strategies in passive and active control of device lifetime are then discussed, with various device illustrations. A final section outlines bioresorbable electronics for sensing of various biophysical parameters, monitoring electrophysiological activity, and delivering drugs in a programmed manner. Fundamental research in chemistry remains essential to the development of this emerging field, where continued advances will increase the range of possibilities in sensing, actuation, and power harvesting. Materials for encapsulation layers that can delay water-diffusion and dissolution of active electronics in passively or actively triggered modes are particularly important in addressing areas of opportunity in clinical medicine, and in secure systems for envisioned military and industrial uses. The deep scientific content and the broad range of application opportunities suggest that research in transient electronic materials will remain a growing area of interest to the chemistry community.
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Affiliation(s)
- Seung-Kyun Kang
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Jahyun Koo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, Illinois 60208, United States
| | - Yoon Kyeung Lee
- Department of Chemistry, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - John A. Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, Illinois 60208, United States
- Department of Chemistry, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
- Departments of Materials Science & Engineering and Mechanical Engineering, Northwestern University, Evanston, Illinois 60208, United States
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Lau CP, Tse HF. An Unpleasant Legacy: Infected Abandoned Leads. JACC Clin Electrophysiol 2018; 4:209-211. [PMID: 29749939 DOI: 10.1016/j.jacep.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China; Shenzhen Institutes of Research and Innovation, University of Hong Kong, Hong Kong SAR, China
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Bontempi L, Vassanelli F, Cerini M, Inama L, Mitacchione G, Giacopelli D, Curnis A. Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | - Lorenza Inama
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | | | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
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Tarakji KG, Saliba W, Markabawi D, Rodriguez ER, Krauthammer Y, Brunner MP, Hussein AA, Baranowski B, Cantillon DJ, Kanj M, Niebauer M, Rickard J, Callahan T, Shao M, Martin DO, Wazni OM, Wilkoff BL, Tan CD. Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction. Heart Rhythm 2018; 15:318-325. [DOI: 10.1016/j.hrthm.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 11/28/2022]
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Sood N, Martin DT, Lampert R, Curtis JP, Parzynski C, Clancy J. Incidence and Predictors of Perioperative Complications With Transvenous Lead Extractions. Circ Arrhythm Electrophysiol 2018; 11:e004768. [DOI: 10.1161/circep.116.004768] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nitesh Sood
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - David T. Martin
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Rachel Lampert
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jeptha P. Curtis
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Craig Parzynski
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jude Clancy
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
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Barakat AF, Wazni OM, Tarakji K, Saliba WI, Nimri N, Rickard J, Brunner M, Bhargava M, Kanj M, Baranowski B, Martin DO, Cantillon D, Callahan T, Dresing T, Niebauer M, Chung M, Lindsay BD, Wilkoff B, Hussein AA. Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes. Heart Rhythm 2017; 14:1807-1811. [DOI: 10.1016/j.hrthm.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 10/19/2022]
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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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Fender EA, Killu AM, Cannon BC, Friedman PA, Mcleod CJ, Hodge DO, Broberg CS, Henrikson CA, Cha YM. Lead extraction outcomes in patients with congenital heart disease. Europace 2017; 19:441-446. [PMID: 27738059 DOI: 10.1093/europace/euw049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/06/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Patients with congenital heart disease (CHD) are at increased risk for intracardiac device malfunction and infection that may necessitate extraction; however, the risk of extraction is poorly understood. This study addresses the safety of extraction in patients with structural heart disease and previous cardiac surgery. Methods and results This retrospective study included 40 CHD and 80 matched control patients, who underwent transvenous lead extractions between 2001 and 2014. Only leads >12 months were included. There were 77 leads in CHD patients and 146 in controls. The mean age was 38 ± 16 years in CHD patients. Ninety per cent of CHD patients had ≥1 cardiac surgeries when compared with 21% of controls (P < 0.001). The number of abandoned leads was significantly different (17 vs. 3, P < 0.001). Lead age was similar with an average duration of 83 ± 87 months in CHD patients and 62 ± 65 months in controls (P = 0.24). There was no significant difference in extraction techniques. Manual traction was successful in 40% of CHD patients and 47% of controls, and advanced techniques were used in 60 and 53% of CHD patients and controls, respectively. Complete extraction was achieved in 94% of the patients in both groups. There was no significant difference in complications. Conclusion Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and longer implantation times, the difficulty of lead extraction in patients with CHD is comparable with controls.
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Affiliation(s)
- Erin A Fender
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Ammar M Killu
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Bryan C Cannon
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Paul A Friedman
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Christopher J Mcleod
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - David O Hodge
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Craig S Broberg
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Charles A Henrikson
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Yong-Mei Cha
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
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Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, Zeitler EP, Al-Khatib SM, Hegland DD, Piccini JP. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation 2017; 136:1387-1395. [DOI: 10.1161/circulationaha.117.027636] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Abstract
Background:
Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.
Methods:
Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.
Results:
Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years;
P
<0.0001), were less likely to be male (65% versus 68%;
P
=0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years;
P
<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7–14.4) and 54.3% (95% CI, 52.8–55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62–0.97;
P
=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.
Conclusions:
Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.
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Affiliation(s)
- Sean D. Pokorney
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Xiaojuan Mi
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Robert K. Lewis
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Melissa Greiner
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Laurence M. Epstein
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Roger G. Carrillo
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Emily P. Zeitler
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Sana M. Al-Khatib
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Donald D. Hegland
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
| | - Jonathan P. Piccini
- From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women’s Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.)
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Kalb B, Indik JH, Ott P, Martin DR. MRI of patients with implanted cardiac devices. J Magn Reson Imaging 2017; 47:595-603. [PMID: 28776823 DOI: 10.1002/jmri.25824] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022] Open
Abstract
Cardiac implanted electronic devices (CIEDs) have historically been regarded as a contraindication for performing magnetic resonance imaging (MRI), limiting the availability of this exam for large numbers of patients who may have otherwise benefited from the unique diagnostic capabilities of MRI. Interactions between CIEDs and the magnetic field associated with MRI systems have been documented, and include potential effects on CIED function, lead heating, and force/torque on the generator. Several device manufacturers have developed "MR-Conditional" CIEDs with specific hardware and software design changes to optimize the device for the MR environment. However, a substantial body of evidence has been accumulating that suggests that MRI may be safely performed in patients with either conditional or nonconditional CIEDs. Institutional policies and procedures, including preexam screening and assessment by skilled electrophysiology personnel and intraexam monitoring, allow MRI to be safely performed in CIED patients, as evidenced by at least two, large multicenter prospective studies and multiple smaller, single-institution studies. Cross-departmental collaboration and a robust safety infrastructure at sites that perform MRI should allow for the safe imaging of CIED patients who have a clinical indication for the study, regardless of the conditionality status of the device. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:595-603.
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Affiliation(s)
- Bobby Kalb
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Julia H Indik
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Peter Ott
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Diego R Martin
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
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47
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Bontempi L, Vassanelli F, Cerini M, Inama L, Salghetti F, Giacopelli D, Gargaro A, Raweh A, Curnis A. Predicting the difficulty of a transvenous lead extraction procedure: Validation of the LED index. J Cardiovasc Electrophysiol 2017; 28:811-818. [DOI: 10.1111/jce.13223] [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: 01/17/2017] [Revised: 03/09/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Luca Bontempi
- Division of Cardiology; Spedali Civili Hospital; Brescia Italy
| | | | - Manuel Cerini
- Division of Cardiology; Spedali Civili Hospital; Brescia Italy
| | - Lorenza Inama
- Division of Cardiology; Spedali Civili Hospital; Brescia Italy
| | | | | | | | - Abdallah Raweh
- Cardiac surgery department; L.U.de.S. University; Lugano Switzerland
| | - Antonio Curnis
- Division of Cardiology; Spedali Civili Hospital; Brescia Italy
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48
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El-Chami MF, Sayegh MN, Patel A, El-Khalil J, Desai Y, Leon AR, Merchant FM. Outcomes of lead extraction in young adults. Heart Rhythm 2017; 14:537-540. [DOI: 10.1016/j.hrthm.2017.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 10/20/2022]
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49
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Lead Abandonment or Lead Extraction?: Weighing the Risks. JACC Clin Electrophysiol 2017; 3:10-11. [PMID: 29759688 DOI: 10.1016/j.jacep.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/22/2022]
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50
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Manolis AS, Melita H. Managing infected cardiovascular implantable electronic devices. ACTA ACUST UNITED AC 2016. [DOI: 10.1002/cce2.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - H. Melita
- Onassis Cardiac Surgery Center; Athens Greece
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