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Aman E, Atsina KB. Tricuspid Valve Transcatheter Edge-To-Edge Repair Guidance with Transesophageal Echocardiography and Intracardiac Echocardiography. Interv Cardiol Clin 2024; 13:1-10. [PMID: 37980059 DOI: 10.1016/j.iccl.2023.08.004] [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] [Indexed: 11/20/2023]
Abstract
As transcatheter tricuspid interventions have emerged, especially edge-to-edge repair, imaging has shown to be key in optimizing transcatheter outcomes. Given the location of the tricuspid valve relative to the esophagus, transesophageal echocardiography has proven difficult and utilization of three-dimensional (3D) multiplanar reconstruction has become essential. Three-dimensional intracardiac echocardiography is a useful imaging adjunct for tricuspid edge-to-edge repair. As 3D intracardiac echocardiography evolves, it may supplant transesophageal echocardiography as the imaging modality of choice in transcatheter tricuspid valve interventions.
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Affiliation(s)
- Edris Aman
- University of California, Davis Medical Center, 4860 Y Street, Suite 0200, Sacramento, CA 95817, USA.
| | - Kwame B Atsina
- University of California, Davis Medical Center, 4860 Y Street, Suite 0200, Sacramento, CA 95817, USA
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2
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Schiedat F, Fischer J, Aweimer A, Schöne D, El-Battrawy I, Hanefeld C, Mügge A, Kloppe A. Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis. Sci Rep 2023; 13:22964. [PMID: 38151554 PMCID: PMC10752869 DOI: 10.1038/s41598-023-50372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
There is a rising number in complications associated with more cardiac electrical devices implanted (CIED). Infection and lead dysfunction are reasons to perform transvenous lead extraction. An ideal anaesthetic approach has not been described yet. Most centres use general anaesthesia, but there is a lack in studies looking into deep sedation (DS) as an anaesthetic approach. We report our retrospective experience for a large number of procedures performed with deep sedation as a primary approach. Extraction procedures performed between 2011 and 2018 in our electrophysiology laboratory have been included retrospectively. We began by applying a bolus injection of piritramide followed by midazolam as primary medication and would add etomidate if necessary. For extraction of leads a stepwise approach with careful traction, locking stylets, dilator sheaths, mechanical rotating sheaths and if needed snares and baskets has been used. A total of 780 leads in 463 patients (age 69.9 ± 12.3, 31.3% female) were extracted. Deep sedation was successful in 97.8% of patients. Piritramide was used as the main analgesic medication (98.5%) and midazolam as the main sedative (94.2%). Additional etomidate was administered in 15.1% of cases. In 2.2% of patients a conversion to general anaesthesia was required as adequate level of DS was not achieved before starting the procedure. Sedation related complications occurred in 1.1% (n = 5) of patients without sequalae. Deep sedation with piritramide, midazolam and if needed additional etomidate is a safe and feasible strategy for transvenous lead extraction.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany.
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany.
| | - Julian Fischer
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
| | - Dominik Schöne
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut Für Forschung Und Lehre (IFL), Ruhr-University, Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology at Katholische Kliniken Bochum of the Ruhr University, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University, Bochum, Germany
- Department of Cardiology at Katholische Kliniken Bochum of the Ruhr University, Bochum, Germany
| | - Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Gelsenkirchen, Germany
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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 2-imaging after device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e33-e54. [PMID: 37861420 DOI: 10.1093/ehjci/jead273] [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: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
Cardiac implantable electronic devices (CIEDs) improve quality of life and prolong survival, but there are additional considerations for cardiovascular imaging after implantation-both for standard indications and for diagnosing and guiding management of device-related complications. This clinical consensus statement (part 2) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients after implantation of conventional pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices. The document summarizes the existing evidence regarding the role and optimal use of various cardiac imaging modalities in patients with suspected CIED-related complications and also discusses CRT optimization, the safety of magnetic resonance imaging in CIED carriers, and describes the role of chest radiography in assessing CIED type, position, and complications. The role of imaging before and during CIED implantation is discussed in a companion document (part 1).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- University of Baskent, Department of Cardiology, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
- Faculty of Medicine, Karolinska Institutet and Cardiovascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096-Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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Kloppe A, Fischer J, Aweimer A, Schöne D, El-Battrawy I, Hanefeld C, Mügge A, Schiedat F. Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort. J Clin Med 2023; 12:7613. [PMID: 38137682 PMCID: PMC10743728 DOI: 10.3390/jcm12247613] [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: 11/13/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths. METHODS Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares. RESULTS In 463 patients (age 69.9 ± 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 ± 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time (p < 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy (p = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time (p = 0.01) and uninterrupted acetylsalicylic acid (p < 0.05). CONCLUSION A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction.
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Affiliation(s)
- Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany; (A.K.); (J.F.); (D.S.)
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (A.A.); (I.E.-B.); (A.M.)
| | - Julian Fischer
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany; (A.K.); (J.F.); (D.S.)
| | - Assem Aweimer
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (A.A.); (I.E.-B.); (A.M.)
| | - Dominik Schöne
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany; (A.K.); (J.F.); (D.S.)
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (A.A.); (I.E.-B.); (A.M.)
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, 44801 Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology at Katholische Kliniken Bochum, Ruhr University Bochum, 44791 Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (A.A.); (I.E.-B.); (A.M.)
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, 44801 Bochum, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany; (A.K.); (J.F.); (D.S.)
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany; (A.A.); (I.E.-B.); (A.M.)
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5
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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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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Chodór-Rozwadowska K, Sawicka M, Morawski S, Kalarus Z, Kukulski T. Tricuspid Regurgitation (TR) after Implantation of a Cardiac Implantable Electronic Device (CIED)-One-Year Observation of Patients with or without Left Ventricular Dysfunction. J Cardiovasc Dev Dis 2023; 10:353. [PMID: 37623367 PMCID: PMC10455858 DOI: 10.3390/jcdd10080353] [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: 07/24/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
The frequency of tricuspid regurgitation (TR) progression after cardiac implantable electronic devices (CIEDs) implantation varies from 7.2% to 44.7%. TR is associated with increased mortality and hospitalizations due to heart failure (HF) decompensation. The aim of this study was to assess the rate of early TR progression after CIED implantation and the frequency of HF decompensation and mortality. The 101 patients, who received a CIED between March 2020 and October 2021, before the procedure were divided into two groups-one with left ventricle ejection fraction (LVEF) ≥ 40% (n = 60) and one with LVEF < 40% (n = 41). Lead-related tricuspid regurgitation (LRTR) was defined as an increase of TR by at least one grade. The follow-up period was similar between both groups and was on average 13 (12-16) months. In the whole study group, TR progression by one grade was 34.6% and by two or more grades 15.8%. The significant changes in the dynamic of TR degree were as follows before and after implantation: none/trivial TR in group 1 (61.7% vs. 28.3%, p = 0.01) and severe/massive TR in group 2 (0.0% vs. 14.6%, p = 0.03). The groups did not differ from each other in terms of survival from decompensation of HF (18.3% vs. 36.6%, p = 0.70) and survival from death (1.7% vs. 4.9%, p = 0.16). At the one-year follow-up, the baseline LVEF did not affect the survival rate from death or HF decompensation among patients with a progression of TR after CIED implantation. In this study, a progression by one grade was more common in group 1, but the occurrence of severe/massive TR after implantation was more specific for group 2.
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Affiliation(s)
- Karolina Chodór-Rozwadowska
- Doctoral School, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Magdalena Sawicka
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Maria Skłodowska—Curie 9 Street, 41-800 Zabrze, Poland;
- Department of Cardiac Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Diseases, Maria Skłodowska—Curie 9 Street, 41-800 Zabrze, Poland
| | - Stanisław Morawski
- Department of Cardiology, Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Tomasz Kukulski
- 2nd Department of Cardiology, Medical University of Silesia, Katowice Poland, Spec. Hospital, 41-808 Zabrze, Poland;
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Affiliation(s)
- Rebecca T Hahn
- From the Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
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Budrejko S, Kempa M, Rohun J, Daniłowicz-Szymanowicz L, Zienciuk-Krajka A, Faran A, Raczak G. Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications. Diagnostics (Basel) 2023; 13:1584. [PMID: 37174974 PMCID: PMC10178181 DOI: 10.3390/diagnostics13091584] [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: 03/26/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Cardiac electrotherapy is developing quickly, which implies that it will face a higher number of complications, with cardiac device-related infective endocarditis (CDRIE) being the most frequent, but not the only one. (2) Methods: This is a retrospective case study followed by a literature review, which presents a patient with a rare but dangerous complication of electrotherapy, which could have been prevented if modern technology had been used. (3) Results: A 34-year-old female was admitted with suspicion of CDRIE based on an unclear echocardiographic presentation. However, with no signs of infection, that diagnosis was not confirmed, though an endocardial implantable cardioverter-defibrillator (ICD) lead was found folded into the pulmonary trunk. The final treatment included transvenous lead extraction (TLE) and subcutaneous ICD (S-ICD) implantation. (4) Conclusions: With the increasing number of implantations of cardiac electronic devices and their consequences, a high index of suspicion among clinicians is required. The entity of the clinical picture must be thoroughly considered, and various diagnostic tools should be applied. Lead dislocation into the pulmonary trunk is an extremely rare complication. Our findings align with the available literature data, where asymptomatic cases are usually effectively treated with TLE. Modern technologies, such as S-ICD, can effectively prevent lead-related problems and are indicated in young patients necessitating long-term ICD therapy.
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Affiliation(s)
| | | | | | - Ludmiła Daniłowicz-Szymanowicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland; (S.B.); (M.K.); (J.R.); (A.Z.-K.); (A.F.); (G.R.)
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Clementy N, Bodin A, Ah-Fat V, Babuty D, Bisson A. Dual-chamber ICD for left bundle branch area pacing: the cardiac resynchronization and arrhythmia sensing via the left bundle (cross-left) pilot study. J Interv Card Electrophysiol 2022; 66:905-912. [PMID: 35970951 DOI: 10.1007/s10840-022-01342-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) has emerged as a promising technique to deliver cardiac resynchronization therapy (CRT). However, safety and efficacy of ventricular arrhythmia sensing via the left bundle in implantable cardioverter-defibrillator (ICD) recipients remain unclear. We sought to evaluate the feasibility of a single LBBAP lead connected to a dual-chamber ICD in patients indicated with a CRT-D implantation. METHODS The CROSS-LEFT pilot study prospectively included 10 consecutive patients with a reduced ejection fraction and a complete left bundle branch block, indicated with a prophylactic CRT-D. A DF-1 lead was implanted at the right ventricular (RV) apex, and an LBBAP lead through the interventricular septum. Ventricular fibrillation was induced at implantation in both conventional (RV) and left bundle branch area sensing configurations. The latter was the final sensing configuration, and patients were implanted with a dual-chamber DF-1 ICD connected to the atrial lead (RA port), the LBBAP lead (RV IS-1 port), and the defibrillation lead (RV DF-1 port), the IS-1 pin being capped. Atrioventricular delay was optimized to ensure fusion between LBBAP and native conduction from the right bundle. Patients were followed during 6 months. RESULTS No difference between both configurations was observed regarding R-wave sensing in sinus rhythm (p = 0.22), ventricular fibrillation median interval detection (p = 1.00), or total induced episode duration (p = 0.78). LBBAP resulted in a significant reduction of median QRS width from 164 to 126 ms (p = 0.002). Median ventricular sensing significantly improved from 9.7 at implantation to 18.8 mV at 6 months (p = 0.01). Median LVEF also significantly improved from 29 to 44% at 6 months (p = 0.002). CONCLUSION Ventricular arrhythmia sensing and defibrillation can be performed via a single LBBAP lead connected to a dual-chamber ICD, and is associated with significant electromechanical reverse remodeling. CLINICAL TRIAL REGISTRATION NUMBER NCT05102227 In patients presenting with left bundle branch block and left ventricular systolic dysfunction, a left bundle branch area pacing lead connected to a DF-1 dual-chamber implantable cardioverter-defibrillator provides safe ventricular arrhythmia sensing and efficient electro-mechanical resynchronization.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France.
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Vincent Ah-Fat
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
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11
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Khor L, Madan K, Lee CH, Ng MKC. Pacing lead extraction in the management of tricuspid regurgitation: a case report. Eur Heart J Case Rep 2022; 6:ytac170. [PMID: 35865227 PMCID: PMC9295692 DOI: 10.1093/ehjcr/ytac170] [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: 07/22/2021] [Revised: 08/24/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Background Patients with a cardiac implantable electronic device (CIED)-induced tricuspid regurgitation (TR) have an increased mortality and morbidity. However, the impact of CIED-lead extraction and its indications are not well-defined. Case summary A 69-year-old woman presented with recurrent hospital admissions for right heart failure refractory to medical therapy, on the background of a single-chamber permanent pacemaker (Biotronik) implanted 6 years ago for tachycardia–bradycardia syndrome. Transoesophageal echocardiography identified severe TR which was predominantly CIED-induced from a lead impingement of the posterior tricuspid valve (TV) leaflet preventing adequate leaflet coaptation. This had progressed to cause a degree of secondary functional TR. The patient underwent pacing lead extraction followed by epicardial lead placement via minithoracotomy, with significant symptomatic and echographic improvement of TR. Discussion CIED-induced TR from a lead impingement of TV leaflets carries the highest risk of TR and its consequences. This case illustrates the significance of the relationship between CIED-leads and the TV, which impacts management strategy. We recommend a mechanistic approach and incorporating CIED-lead interaction with the TV apparatus as the underlying principle in developing future management guidelines for CIED-induced TR.
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Affiliation(s)
- Lynn Khor
- Macquarie University Macquarie University Hospital, 3 Technology Place, , Sydney, NSW 2109 , Australia
- Cardiology Department, Nepean Hospital , Derby Street, Kingswood, NSW 2747 , Australia
| | - Kedar Madan
- Macquarie University Macquarie University Hospital, 3 Technology Place, , Sydney, NSW 2109 , Australia
- Cardiology Department, Nepean Hospital , Derby Street, Kingswood, NSW 2747 , Australia
| | - Choon Huat Lee
- Cardiology Department, Nepean Hospital , Derby Street, Kingswood, NSW 2747 , Australia
| | - Martin K C Ng
- Macquarie University Macquarie University Hospital, 3 Technology Place, , Sydney, NSW 2109 , Australia
- Cardiology Department, Royal Prince Alfred Hospital , Missenden Road, Camperdown, NSW 2050 , Australia
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Muraru D. 22nd Annual Feigenbaum Lecture Right Heart, Right Now: The Role of Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2022; 35:893-909. [DOI: 10.1016/j.echo.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Tułecki Ł, Czajkowski M, Targońska S, Polewczyk A, Jacheć W, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. The role of cardiac surgeon in transvenous lead extraction: experience from 3462 procedures. J Cardiovasc Electrophysiol 2022; 33:1357-1365. [PMID: 35474258 DOI: 10.1111/jce.15510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The professional society guidelines recommend that transvenous lead extraction (TLE) operating teams collaborate closely with cardiac surgeons in the management of life-threatening complications. METHODS AND RESULTS We assessed the role of cardiac surgeons participating in 3462 TLE procedures at a high-volume center between 2006 and 2021. The roles for cardiac surgery in TLE can be categorized into five areas: emergency surgical interventions for the management of cardiac laceration and severe bleeding (1.184%), cardiac surgery complementing partially successful TLE or vegetation removal (0.693%), delayed surgical treatment of TLE-related tricuspid valve dysfunction (0.751%), epicardial pacemaker implantation through sternotomy during emergency, complementing or delayed surgical interventions (0.607%) and delayed epicardial lead implantation (0.491%). Isolated damage to the wall of the right atrium was the most common cause of cardiac tamponade (53.66% of emergency surgeries) followed by injury to the right ventricle and vena cava (both 7.317%). CONCLUSIONS Emergency cardiac surgery for the management of severe hemorrhagic complications is still the most common treatment option. The remaining areas include surgery complementing partially successful TLE: repair of tricuspid valve or epicardial ventricular lead placement to achieve permanent cardiac resynchronization. The experience at a single high-volume TLE center indicates the necessity of close collaboration with the cardiac surgeons whose roles appear broader than the mere surgical standby. Mortality in patients who survived cardiac surgery during transvenous lead extraction does not differ from the survival of other patients after TLE without complications requiring surgical intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Sylwia Targońska
- Department of Cardiac Surgery Medical University of Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Centrum of Cardiology, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamość Poland
| | - Kamil Karpeta
- Department of Cardiac Surgery Masovian Specialistic Hospital of Radom, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
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14
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:913-929. [DOI: 10.1093/ehjci/jeac009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
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Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis. J Clin Med 2021; 11:jcm11010089. [PMID: 35011829 PMCID: PMC8745716 DOI: 10.3390/jcm11010089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. Methods: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008–2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. Results: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. Conclusions: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.
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Javed N, Iqbal R, Malik J, Rana G, Akhtar W, Zaidi SMJ. Tricuspid insufficiency after cardiac-implantable electronic device placement. J Community Hosp Intern Med Perspect 2021; 11:793-798. [PMID: 34804393 PMCID: PMC8604508 DOI: 10.1080/20009666.2021.1967569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Device-related estimates of incidence and significance of tricuspid regurgitation (TR) is mainly based on case reports and small observational studies. We sought to determine whether right-heart device implantation increased the risk of TR in this interventional study. Methods All patients who underwent permanent pacemaker (PPM) or other device implantation were assessed for degree of TR at one year. The data collected was analyzed on IBM SPSS version 26. Descriptive statistics were applied for qualitative variables. Mean and standard deviation were applied for quantitative variables. Regression analysis and paired t-tests were applied for the degree of change and predictors of TR. Results Out of 165 participants, 73.94% were male. The mean age of the participants was 59.86 ± 12.03 years. Dual-chamber pacemaker (DDDR) was the most common device implanted (78.18%) causing significant TR and drop in left ventricular ejection fraction as compared to other devices (p-value < 0.05). The paired t-test for changes in ejection fraction (LVEF) and TR were also significant (p-value < 0.05). A regression model predicted significant TR to depend on baseline LVEF (p-value < 0.05). Conclusion Device-related worsening of TR is related to mechanical mechanisms. It is significantly associated with DDDR pacemakers after a 1-year follow-up.
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Affiliation(s)
- Nismat Javed
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Raafe Iqbal
- Department of Cardiology, Pakistan Ordinances Factory Hospital, Wah Cantt, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Ghazanfar Rana
- Department of Cardiology, St. Lukes General Hospital, Kilkenny, Ireland
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
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17
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Guella E, Devereux F, Ahmed FZ, Scott P, Cunnington C, Zaidi A. Novel atrioventricular sequential pacing approach using a transvenous atrial pacemaker and a leadless pacemaker: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab219. [PMID: 34377899 PMCID: PMC8343438 DOI: 10.1093/ehjcr/ytab219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/11/2020] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
Background The use of transvenous pacing leads is associated with the risk of developing tricuspid valve (TV) dysfunction. This develops through several mechanisms including the failure of leaflet coaptation or direct damage to the TV or to its sub-valvular apparatus and can result in significant tricuspid regurgitation (TR). Multiple approaches to pacemaker implantation after transvenous lead extraction (TLE) or surgical TV repair have been described. Placement of pacing leads across the TV is generally avoided in such circumstances. Case summary A 66-year-old woman presented with a year-long history of exertional dyspnoea, peripheral oedema, and postural neck pulsations. Her medical history included a dual-chamber pacemaker implantation for sinus node dysfunction 14 years ago. Echocardiography revealed severe lead-related TR. Her case was discussed in our multi-disciplinary team meeting. A decision was made to perform a TLE and implant a leadless pacemaker in an attempt to avoid open-heart surgery if possible. This was reserved as an option in the event of persistent severe TR. Transvenous extraction of the right ventricular lead was performed. The atrial lead was preserved and connected to and AAI device. A Micra AV was implanted allowing for atrioventricular (AV) synchronous pacing. Discussion We present the first case of successful implementation of AV sequential pacing using a dual-pacemaker approach involving the use of an AAI pacemaker and a Micra AV device. This was performed after TLE for severe lead-related TR.
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Affiliation(s)
- Elhosseyn Guella
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Frances Devereux
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Fozia Zahir Ahmed
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Peter Scott
- Cardiology Department, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton BL4 0JR, UK
| | - Colin Cunnington
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Amir Zaidi
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Lee WC, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Liu WH, Chen MC. Progressive tricuspid regurgitation and elevated pressure gradient after transvenous permanent pacemaker implantation. Clin Cardiol 2021; 44:1098-1105. [PMID: 34036612 PMCID: PMC8364716 DOI: 10.1002/clc.23656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background The association of postimplant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. Hypothesis This study aimed to explore the clinical outcomes of progressive postimplant TR after permanent pacemaker (PPM) implantation. Methods A total of 1670 patients who underwent a single ventricular or dual‐chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, history of HF, and baseline abnormal TR and TRPG were excluded. Finally, a total of 1075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and TRPG of >30 mmHg after implant. Results In 198 (18.4%) patients (group 1) experienced progressive postimplant TR and elevated TRPG, whereas 877 patients (group 2) did not have progressive postimplant TR. Group 1 had larger change in postimplant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < .001) than group 2. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < .001). Preimplant TRPG (HR: 1.075; 95% confidence interval [CI]: 1.032–1.121; p = .001) was an independent predictor of progressive postimplant TR. Conclusions After a transvenous ventricular‐based PPM implantation, 18.4% of patients experienced progressive postimplant TR and elevated TRPG. Higher preimplant TRPG was an independent predictor of progressive postimplant TR.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Nowosielecka D, Jacheć W, Polewczyk A, Kleinrok A, Tułecki Ł, Kutarski A. The prognostic value of transesophageal echocardiography after transvenous lead extraction: landscape after battle. Cardiovasc Diagn Ther 2021; 11:394-410. [PMID: 33968618 DOI: 10.21037/cdt-20-871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure. Methods We analyzed data from 936 TEE performed in patients undergoing TLE between 2015 and 2019 (mean follow-up 566.23±224.47 days) and assessed the role of echocardiographic phenomena after procedure. Results Increment in tricuspid regurgitation (TR) was observed in 9% of patients after TLE. Factors increasing the risk of TR were: binding sites between lead and right ventricle (RV) (OR: 5.429), tricuspid valve (TV) (OR: 3.42), superior vena cava (SVC) (OR: 3.30) and lead-to-lead adhesions (OR: 2.88). Predisposing factors of residual structures after TLE were: asymptomatic masses on the leads (AMEL) (OR: 1.68), binding sites between SVC and cardiac structures (OR: 1.72), and multiple leads (OR: 1.30). Probability of vegetation remnants increased in the presence of abandoned leads (OR: 7.91). The risk factors of tamponade were: dwell time of the oldest lead (OR: 1.17), lead-to-lead adhesion (OR: 22.47), binding sites between lead and TV (OR: 6.08), RA (OR: 11.50), SVC (OR: 4.47), higher LVEF (OR: 2.35; P=0.006), female gender (OR: 5.43), multiple leads (OR: 2.11), looped leads (OR: 4.90) and AMEL (OR: 6.42). The risk of lead fracture was increased by: lead-to-lead adhesion (OR: 5.69), fibrosis binding the lead to RV (OR: 5.16), RA (OR: 2.39) and dwell time of the oldest lead (OR: 1.068). The mortality rate was 11.97% during follow-up. The risk of death was increased by: severe TR and vegetation remnants. Conclusions The most important phenomena evaluated after TLE are: tricuspid valve function, residual fibrosis and vegetation remnants, progression of pericardial effusion and retained lead fragments. Postoperative TEE provides information about the results of TLE and helps establish further management.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland
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20
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Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Kleinrok A, Kutarski A. Echocardiographic findings in patients with cardiac implantable electronic devices-analysis of factors predisposing to lead-associated changes. Clin Physiol Funct Imaging 2020; 41:25-41. [PMID: 32949059 DOI: 10.1111/cpf.12662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined. METHODS We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high-volume centre between 2015 and 2019. RESULTS The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead-to-lead adhesions, excessive lead loops, lead-dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR = 1.771; p < .01) and lead dwell time (OR = 1.111; p < .001). Women were more likely to have excessive lead loops (OR = 1.639; p < .01), and the occurrence of loops increase with the number of implanted leads (OR = 2.557; p < .001). Heart failure (OR = 4.016; p < .001), lead looping (OR = 2.603; p < .01) and longer cumulative lead dwell time (OR = 1.017; p < .05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR = 1.043; p < .001). CONCLUSIONS Lead dwell time is the main factor predisposing to the occurrence of most lead-associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead-associated masses.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland
| | - Anna Polewczyk
- Department of Physiology and Patophysiology, Collegium Medicum The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamosc, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland.,University of Information Technology and Management, Rzeszow, Poland
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21
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Moving the Bar for Transcatheter Tricuspid Valve Repair. JACC Cardiovasc Interv 2020; 13:565-566. [DOI: 10.1016/j.jcin.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
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22
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol 2019; 42:1006-1017. [DOI: 10.1111/pace.13715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Jacheć
- 2nd Department of CardiologyMedical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze Zabrze Poland
| | - Anna Polewczyk
- Faculty of Medicine and Health Sciences KielceThe Jan Kochanowski University Kielce Poland
- Swietokrzyskie Cardiology Center Kielce Poland
| | - Luca Segreti
- Department of CardiologyUniversity Hospital of Pisa Pisa Italy
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23
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Fu H, Ho G, Yang M, Huang X, Fender EA, Mulpuru S, Asirvatham R, Pretorius VG, Friedman PA, Birgersdotter-Green U, Cha YM. Outcomes of repeated transvenous lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1321-1328. [PMID: 30058073 DOI: 10.1111/pace.13464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The outcomes of repeated cardiovascular implantable electronic device (CIED) lead extraction have not been well studied. We sought to determine the indications, outcomes, and safety of repeated lead extraction procedures. METHODS This retrospective study was conducted using data from two medical centers, including 38 patients who had undergone two or more lead extraction procedures compared to 439 patients who had a single procedure. The electronic medical records and procedural databases were reviewed to determine the indications, procedural characteristics, and outcomes. The outcomes of the first procedure were compared to the outcomes of subsequent procedures. RESULTS The 5-year cumulative probability of a repeated extraction procedure was 11% (95% confidence interval, 7%-15%). In 439 patients who underwent single lead extractions, 72% had device and lead related infections as the procedure indication compared to 39% for 38 patients who underwent repeated extraction (P < 0.001). The mean duration from device reimplant to repeated extraction procedures was 63 ± 48 months. Ninety-eight percent of the leads were removed completely in repeated procedures, similar to the 95% success rate of the first procedure (P = 0.51). There was no significant difference in major complication rate in the first or repeated extractions (2.6% vs 5.2%, P = 0.79). CONCLUSIONS Repeated transvenous lead extraction is not uncommon. It had a high success rate comparable to that of the initial procedure and was not associated with an increased incidence of adverse events.
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Affiliation(s)
- Haixia Fu
- Department of Cardiovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Henan, China.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Gordon Ho
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mei Yang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinmiao Huang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Erin A Fender
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Victor G Pretorius
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Lacour P, Parwani A, Huemer M, Attanasio P, Dang PL, Luebcke J, Schleussner L, Blaschke D, Boldt LH, Pieske B, Haverkamp W, Blaschke F. What physicians do in case of a failure of the pace-sense part of a defibrillation lead : Survey in Germany, Austria and Switzerland. Herz 2018; 45:362-368. [PMID: 30054714 DOI: 10.1007/s00059-018-4736-9] [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: 04/03/2018] [Revised: 06/14/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. METHODS We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. RESULTS The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. CONCLUSION Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.
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Affiliation(s)
- P Lacour
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Parwani
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Huemer
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Attanasio
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P L Dang
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Luebcke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Schleussner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L-H Boldt
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - B Pieske
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Haverkamp
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Schleifer JW, Pislaru SV, Lin G, Powell BD, Espinosa R, Koestler C, Thome T, Polk L, Li Z, Asirvatham SJ, Cha YM. Effect of ventricular pacing lead position on tricuspid regurgitation: A randomized prospective trial. Heart Rhythm 2018; 15:1009-1016. [DOI: 10.1016/j.hrthm.2018.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 11/25/2022]
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26
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Lau EW. Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease. Indian Pacing Electrophysiol J 2017; 17:156-159. [PMID: 29192594 PMCID: PMC5652279 DOI: 10.1016/j.ipej.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/26/2022] Open
Abstract
Multi-site multi-polar left ventricular pacing through the coronary sinus (CS) may be preferred over endocardial right ventricular or surgical epicardial pacing in the presence of tricuspid valve disease. However, the required lead placement can be difficult through a persistent left superior vena cava (PLSVC), as the CS tends to be hugely dilated and side branches tend to have sharp angulations (>90°) when approached from the PLSVC. Pre-shaped angiography catheters and techniques used for finding venous grafts from the ascending aorta post coronary bypass surgery may help with lead placement in such a situation.
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Affiliation(s)
- Ernest W Lau
- Department of Cardiology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
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27
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Zha K, Cui K, Liu X, Fang Y. Clinical investigation of left ventricular pacing using coronary sinus in patients with mechanical prosthetic tricuspid valve replacement. Clin Cardiol 2017; 40:1139-1144. [PMID: 29166536 DOI: 10.1002/clc.22800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although transvenous right ventricular (RV) endocardial lead placement is routine practice in clinical pacing, RV inaccessibility in certain clinical situations mandates the search for other sites. HYPOTHESIS This study is aimed to verify whether left ventricular lead through coronary sinus is safe and efficient. METHODS Based on a retrospective analysis of a single-center series of 4 patients with inaccessibility for RV pacing, we report on the feasibility and reliability of coronary sinus (CS) pacing via left ventricular (LV) lead, which usually is used in cardiac resynchronization therapy. Four patients with valvular heart disease and bradycardias post-mechanical prosthetic tricuspid valve replacement were studied. The LV leads were implanted into the lateral vein or great cardiac vein of the CS, and all parameters were programmed postprocedure. RESULTS In all cases procedures yielded favorable parameters, with 1 CS dissection. At long-term follow-up, there was no threshold increase or lead dislocation. CONCLUSIONS LV lead implantation through the CS appears safe and efficacious in patients with inaccessibility for RV pacing.
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Affiliation(s)
- Kelan Zha
- Department of Cardiology, West China School of Medicine, Sichuan University, Chengdu, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingbin Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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28
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 703] [Impact Index Per Article: 100.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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29
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Soydan E, Engin Ç, Zoghi M. Uncommon but life threatening complication of the left ventricle pacemaker lead: Coronary sinus perforation. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2017. [DOI: 10.1016/j.ijcac.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Ramirez FD, Almutairi A, Stadnick E, Nair GM, Sadek MM, Birnie DH. Late resolution of pacemaker lead-related severe tricuspid regurgitation and right ventricular dysfunction after percutaneous lead extraction: A case report and review of the literature. HeartRhythm Case Rep 2017; 2:324-327. [PMID: 28491702 PMCID: PMC5419887 DOI: 10.1016/j.hrcr.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Abdullah Almutairi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ellamae Stadnick
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad M Sadek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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31
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Montgomery JA, Ellis CR, Crossley GH. Extraction of looped transvenous pacing leads to reduce tricuspid regurgitation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:644-647. [PMID: 28369957 DOI: 10.1111/pace.13085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/27/2017] [Accepted: 03/26/2017] [Indexed: 11/27/2022]
Abstract
Transvenous leads are a known source of iatrogenic tricuspid regurgitation. It is commonly held that extraction of chronic pacing and defibrillator leads will not reduce this, due to the inevitable trauma to the valve associated with the procedure. We demonstrate three cases of clinically significant reductions in tricuspid regurgitation after extraction of leads that were looped across the tricuspid valve.
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Affiliation(s)
- Jay A Montgomery
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher R Ellis
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - George H Crossley
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
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Husain A, Raja FT, Fatallah A, Fadel B, Alsanei A, Raja FT, AlGhamdi B. Tricuspid stenosis: An emerging disease in cardiac implantable electronic devices era. Case report and literature review. J Cardiol Cases 2017; 15:190-193. [PMID: 30279777 DOI: 10.1016/j.jccase.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/05/2017] [Accepted: 02/13/2017] [Indexed: 11/18/2022] Open
Abstract
Tricuspid valve dysfunction and in particular tricuspid stenosis has recently been described secondary to cardiac implantable electronic devices. The valve is subjected to different mechanisms of injury related to the endocardial lead passing through its plane. The lead can form a loop or perforate one of the leaflets and initiate inflammatory response and fibrotic changes. Multimodality cardiac imaging is required to diagnose this clinical entity and decide on the best treatment plan. Here we present a case of a young female who developed tricuspid stenosis secondary to permanent pacemaker lead that was implanted 24 years before. We performed a review for all cases reported in the literature with a similar condition and various treatment approaches. <Learning objectives: 1. Tricuspid valve dysfunction can develop secondary to cardiac implantable electronic devices. Tricuspid regurgitation is the most common valve lesion however, tricuspid stenosis is reported as well. 2. Endocardial leads can cause injury to the valve initiating a cascade of inflammatory response and fibrosis. 3. Trans-thoracic echocardiography is the initial diagnostic modality but visualization of lead injury requires further cardiac imaging such as cardiac computed tomography and trans-esophageal echocardiography. 4. Various treatment modalities are reported in the literature; medical therapy, percutaneous valvoplasty; and surgery.>.
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Affiliation(s)
- Aysha Husain
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Faris Tufail Raja
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Fatallah
- Radiology Department, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bahaa Fadel
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Aly Alsanei
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Tufail Raja
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bandar AlGhamdi
- Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
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Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:348-354. [PMID: 27980549 PMCID: PMC5133324 DOI: 10.5114/aic.2016.63636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Spontaneous lead dislodgement into the pulmonary circulation is a rare complication of permanent pacing with unproven harmfulness and an indication of controversial class for transvenous lead extraction (TLE). AIM To assess TLE safety in patients with leads dislodged into the pulmonary artery. MATERIAL AND METHODS A retrospective analysis of a 9-year-old database of transvenous lead extraction procedures comprising 1767 TLEs was carried out, including a group of 19 (1.1%) patients with leads dislodged into the pulmonary artery (LDPA). RESULTS Under univariate analysis the factors that increased the likelihood of the presence of an electrode in the pulmonary artery were mean lead dwelling time (increase of risk by 9% per year), total number of leads in the heart before TLE (increase of risk by 66% for one lead) and the number of abandoned leads (increase of risk by 119%). The presence of LDPA was associated with frequent occurrence of intracardiac lead abrasion (increase by 316%) and isolated lead-related infective endocarditis (LRIE) (increase by 500%). There were no statistically significant differences in clinical (p = 0.3), procedural (p = 0.94) or radiological (p = 0.31) success rates in compared (LDPA and non-LDPA) groups. Long-term mortality after TLE was comparable in both groups. CONCLUSIONS As the effectiveness and safety of TLE in patients with LDPA are comparable to those in standard TLE procedures, in our opinion, such patients should be considered TLE candidates.
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Sideris S, Drakopoulou M, Oikonomopoulos G, Gatzoulis K, Stavropoulos G, Limperiadis D, Toutouzas K, Tousoulis D, Kallikazaros I. Left Ventricular Pacing through Coronary Sinus Is Feasible and Safe for Patients with Prior Tricuspid Valve Intervention. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:378-81. [PMID: 26769172 DOI: 10.1111/pace.12815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the presence of tricuspid valve intervention, right ventricular lead implantation is associated with the potential risk of tricuspid valve malfunction leading to a tricuspid regurgitation. Few cases have been reported with successful left ventricular pacing via the coronary sinus (CS) after tricuspid valve replacement or repair. In this retrospective study, we present the long-term clinical outcomes of 17 patients who underwent CS lead implantation and left ventricular pacing. METHODS Seventeen consecutive patients referred to our institution with an indication of postprocedural pacemaker (PM) implantation after tricuspid valve intervention were retrospectively included in the study. The indication for device implantation in all patients was atrial fibrillation with a symptomatic pause ≥ 3.0 seconds. Thus, all devices implanted were ventricular rate responsive (VVIR). RESULTS All device implantations were successful and uncomplicated. Mean operation time was 60 ± 8 minutes. Mean fluoroscopy time was 8.3 ± 2.1 minutes. Mean R-wave sensing was 7.5 ± 2.0 mV with a mean slew rate of 2.2 V/s. A mean pacing threshold of 1.9 ± 0.3 V/0.4 ms was accepted as patients were not PM-dependent. The pacing impedance was 743.5 ± 109.71 Ohm. At 2-year follow-up, pacing sensing, threshold, and impedance values were unchanged and no lead dislodgement has been noted. CONCLUSIONS In patients with tricuspid valve intervention, left ventricular pacing might be the treatment of choice for permanent ventricular pacing, with all the advantages of the endovenous route as a minimally invasive approach.
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Affiliation(s)
- Skevos Sideris
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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35
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Failed laser extraction of a fractured right ventricle defibrillator lead in a patient with persistent left superior vena cava. J Vasc Access 2016; 17:e10-1. [PMID: 26450083 DOI: 10.5301/jva.5000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 11/20/2022] Open
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Abstract
Decision-making regarding extracting or abandoning sterile but nonfunctioning ICD leads has to be individualized. Providing recommendations to patients and their families requires a careful weighing of pros and cons and understanding of the availability of local expertise. Decision models to help with these clinical scenarios have started to become available but remain in their infancy.
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Affiliation(s)
- Samir Saba
- Cardiac Electrophysiology Section, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-535, Pittsburgh, PA 15213-2582, USA.
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Domenichini G, Diab I, Campbell NG, Dhinoja M, Hunter RJ, Sporton S, Earley MJ, Schilling RJ. A highly effective technique for transseptal endocardial left ventricular lead placement for delivery of cardiac resynchronization therapy. Heart Rhythm 2015; 12:943-9. [DOI: 10.1016/j.hrthm.2015.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Indexed: 11/24/2022]
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