Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices

Abstract Aims The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved. Methods and results ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08–1.19), P < 0.0001 and OR 2.68 (1.22–5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04–0.95), P = 0.03 and OR 0.32 (0.13–0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01–4.16), P = 0.046]. Conclusion A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.

Download Full-text

Cardiac Implantable Electronic Device Lead Extractions

Cardiac Anesthesia: A Problem-Based Learning Approach ◽

10.1093/med/9780190884512.003.0022 ◽

2019 ◽

pp. 207-214

Author(s):

Kevin Fitzmartin ◽

Aalok Kacha

Keyword(s):

Standard Method ◽

Gold Standard ◽

Older Patients ◽

Electronic Device ◽

Electronic Devices ◽

Lead Extraction ◽

Lead Removal ◽

Gold Standard Method ◽

Cardiac Implantable Electronic Devices ◽

Device Extraction

Cardiac implantable electronic devices (CIEDs) are used for an increasing range of indications. With a broader range of indications, CIEDs are being implanted in increasing numbers. They are being used in older patients as well as patients with more comorbidities. As expected with these trends, the need for device extraction for a variety of reasons has steadily grown as well. These leads can often be removed via simple traction, but other techniques have been developed for circumstances where removal is more complex. To perform this procedure safely, a team-based approach is required, as is the ability to anticipate consequences of complications for each of the different methods of removal. A gold standard method has not been identified for transvenous lead extraction, but rather one has a toolbox of methods at their disposal. In this chapter, indications for lead removal, extraction techniques and devices, as well as potential complications are reviewed.

Download Full-text

Transvenous Extraction and Removal of Pacing Leads Placed after Cardiac Transplantation

Case Reports in Cardiology ◽

10.1155/2019/6270950 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Caleb Norton ◽

Benjamin Holmes ◽

Asad Al Aboud ◽

Eun-Jeong Kim ◽

Holly Gonzales ◽

...

Keyword(s):

Cardiac Transplantation ◽

Electronic Devices ◽

Extraction Procedure ◽

Adverse Outcomes ◽

Lead Extraction ◽

Lead Removal ◽

Cardiac Implantable Electronic Devices ◽

Life Saving ◽

One Year ◽

Pacing Leads

There is an increasing prevalence of cardiac implantable electronic devices (CIEDs) due to expanding adoption and availability of these evidence-based therapies. With the increased prevalence of these life-saving devices, there has also been an increased demand for lead removal and lead extraction. Understanding the specific subgroups of patients at high risk for complications during and after lead extraction has become imperative to properly manage endovascular CIED leads. There have been multiple published studies describing clinical variables that predict adverse outcomes in CIED system extractions; however, the risk of complications in leads placed after cardiac transplantation has not specifically been addressed to date. We present four cases of transvenous extraction and removal of pacing leads placed after cardiac transplantation. There were no major complications related to extraction in these four cases; however, three of the four patients died within one year after the procedure. While the etiology of death in these cases seemed to be unrelated to the extraction procedure, the indications for extraction (infection in the setting of immunosuppression and calcineurin-associated ESRD and poor sensing/capture possibly secondary to chronic rejection and/or frequent right heart biopsies) likely contributed at least indirectly to the subsequent death.

Download Full-text

Recent Advances in Pacing and Defibrillation

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:74 ◽

2011 ◽

Vol 3 (1) ◽

pp. 74

Author(s):

Kathy L Lee ◽

Keyword(s):

Cardiac Death ◽

Electronic Devices ◽

Implantable Defibrillators ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Treatment And Prevention ◽

Recent Advances ◽

Pacing Lead ◽

Leadless Pacing ◽

Device Complications

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

Download Full-text