scholarly journals 714 Effects of direct irradiation on cardiac implantable electronic devices

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gianfranco Mitacchione ◽  
Gianmarco Arabia ◽  
Luca Bontempi ◽  
Manuel Cerini ◽  
Francesca Salghetti ◽  
...  
Keyword(s):  
Pulse Generator ◽  
Electronic Devices ◽  
Lead Extraction ◽  
Radiation Doses ◽  
Electrical Parameters ◽  
Cardiac Implantable Electronic Devices ◽  
Direct Irradiation ◽  
Battery Capacity ◽  
Pacing Mode ◽  
Set Up

Abstract Aims Cardiac implantable electronic devices (CIEDs) may sustain damages during a course of radiation therapy, especially when the beam is directed onto the pulse generator, with device electrical reset and/or sudden battery drain. 2010 HRS/ASA expert consensus, and all CIEDs manufacturers, recommend to avoid devices direct irradiation with an accumulated dose that exceed five grays (Gy). In our prospective study, we tested the effects of direct irradiation on CIEDs with different radiation doses, also higher than 5 Gy. Methods and results Thirty-seven CIEDs of Medtronic, Abbott, Biotronik, and Boston Scientific were collected during system upgrading or lead extraction procedures. All devices were considered if they had at least 80% of residual battery capacity. All CIEDs were programmed with same default electrical parameters. Depending by CIED type, pacing mode was configured in VVI, VVIR, VDDR, or DDDR, and biventricular stimulation was activated, if present. ICDs electrical therapies were set-up with a pre-determined configuration. All devices were singularly placed in a 30 cm × 30 cm plastic bowl containing 2 l of deionized water that was placed over 5 cm Rockwool to simulate the backscatter and irradiated by a linear accelerator (Elekta Synergy®). CIEDs were divided into two groups depending on irradiation dose delivered: 5 Gy and 10 Gy. No significant differences in battery drainage were observed after irradiation respect to baseline in 5 Gy as well 10 Gy group [7.9 ± 3.1 vs. 7.5 ± 2.1 (years) battery longevity, P = 0.693; 7.7 ± 3.1 vs. 7.4 ± 2.1 (years) battery longevity, P = 0.677, respectively) (Figure). Moreover, all CIEDS saved the baseline program setting, without device reset events (Table). Conclusions Our data confirm that CIEDs direct irradiation of 5 Gy is safe, of note, direct irradiation up to 10 Gy seems to be similarly safe concerning the risk of CIEDs electrical reset and/or unexpected battery drain.

scholarly journals Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 566
Author(s):  
Nesterovics ◽  
Nesterovics ◽  
Stradins ◽  
Kalejs ◽  
Ansabergs ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Devices ◽  
Positive Culture ◽  
Major Complication ◽  
Heart Rhythm ◽  
University Hospital ◽  
Lead Extraction ◽  
Coagulase Negative Staphylococci ◽  
Cardiac Implantable Electronic Devices ◽  
Common Location

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal: an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1876-1889 ◽  
Author(s):  
Eyal Nof ◽  
Maria Grazia Bongiorni ◽  
Angelo Auricchio ◽  
Christian Butter ◽  
Nikolaos Dagres ◽  
...  
Keyword(s):  
Strong Predictor ◽  
Electronic Devices ◽  
Complete Removal ◽  
Lead Extraction ◽  
Lead Removal ◽  
Complication Rates ◽  
Failure Group ◽  
Cardiac Implantable Electronic Devices ◽  
Procedural Complications ◽  
Locking Stylet

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.

Abstract 13905: Gender Differences in Cardiac Implantable Electronic Devices (cieds) Among Systolic Heart Failure Hospitalizations: Aninsight From the National Inpatient Sample 2016 to 2017

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dinesh C Voruganti ◽  
Hafeez Hassan ◽  
Aman M Amanullah ◽  
Sushma Dugyala
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Pulse Generator ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample ◽  
Cardiac Implantable Electronic Devices ◽  
Icd 10 ◽  
Percutaneous Insertion

Background: Gender differences in systolic heart failure (HF) patients for the implantation of various cardiac implantable electronic devices (CIEDs) using ICD-10 have not been studied. We aim to explore the gender differences for each type of procedure. Methods: The National Inpatient Sample (NIS) 2016-2017 was used to obtain the hospitalizations with Systolic HF (ICD 10 CM codes I5020, I5021, I5022, I5023). Pacemaker/Defibrillator procedures were obtained using ICD 10 procedure codes. Demographic data were obtained using the variables provided in the NIS. All analysis was performed using SAS statistical software (9.4 Cary NC). Results: We identified 2,812,603 systolic HF hospitalizations from January 2016 to December 2017. Overall, two third of patients were male (62.9%). Table 1 elaborates on the demographics of these hospitalizations. Majority of hospitalizations were ascribed to white patient population (66% males were white & 63.2% females were white). Females were substantially higher Medicare beneficiaries (74.63% in females vs. 69.71% in males). Among the CIEDs, the males had a higher rates of procedure utilization compared to females (Table 2): Percutaneous insertion of defibrillator in right ventricle (1.6% in males vs. 1% in females); Insertion of defibrillator generator via sternotomy (1.1% in males vs. 0.7% in females); Percutaneous insertion of defibrillator lead in right atrium (1.1% in males vs. 0.7% in females); Cardiac resynchronization therapy-pulse generator via sternotomy (0.8% in males vs. 0.5% in females). Conclusion: Despite minimal differences in baseline characteristics, implantation of CIEDs appear to be underutilized in women. Further studies are required to confirm these findings and further explore gender differences.

Cardiac Implantable Electronic Device Lead Extractions

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.

scholarly journals Percutaneous Lead Extraction in Infection of Cardiac Implantable Electronic Devices: a Systematic Review

2018 ◽  
Vol 33 (2) ◽  
Author(s):  
Antônio da Silva Menezes Júnior ◽  
Thaís Rodrigues Magalhães ◽  
Alana de Oliveira Alarcão Morais
Keyword(s):  
Systematic Review ◽  
Electronic Devices ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices
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