Transvenous Lead Extraction for Cardiac Implantable Electronic Devices

2015 ◽  
Vol 26 (4) ◽  
pp. 320-328
Author(s):  
Julie B. Shea
Keyword(s):  
Electronic Devices ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices

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.

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

scholarly journals Influence of the type of pathogen on the clinical course of infectious complications related to cardiac implantable electronic devices

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Polewczyk ◽  
Wojciech Jacheć ◽  
Luca Segreti ◽  
Maria Grazia Bongiorni ◽  
Andrzej Kutarski
Keyword(s):  
Clinical Course ◽  
Electronic Devices ◽  
High Volume ◽  
Infectious Complications ◽  
Lead Extraction ◽  
Gram Positive ◽  
Cardiac Implantable Electronic Devices ◽  
Long Term Prognosis

AbstractThe specific role of the various pathogens causing cardiac implantable electronic devices-(CIEDs)-related infections requires further understanding. The data of 1241 patients undergoing transvenous lead extraction because of lead-related infective endocarditis (LRIE-773 patients) and pocket infection (PI-468 patients) in two high-volume centers were analyzed. Clinical course and long-term prognosis according to the pathogen were assessed. Blood and generator pocket cultures were most often positive for methicillin-sensitive Staphylococcus aureus (MSSA: 22.19% and 18.13% respectively), methicillin-sensitive Staphylococcus epidermidis (MSSE: 17.39% and 15.63%) and other staphylococci (11.59% and 6.46%). The worst long-term prognosis both in LRIE and PI subgroup was in patients with infection caused by Gram-positive microorganisms, other than staphylococci. The most common pathogens causing CIED infection are MSSA and MSSE, however, the role of other Gram-positive bacteria and Gram-negative organisms is also important. Comparable, high mortality in patients with LRIE and PI requires further studies.

scholarly journals Risk Factors Predicting Complications of Transvenous Lead Extraction

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Maciej Polewczyk ◽  
Andrzej Tomasik ◽  
Marianna Janion ◽  
...  
Keyword(s):  
Risk Factors ◽  
Electronic Devices ◽  
Technical Problem ◽  
Female Gender ◽  
Lead Extraction ◽  
Efficacy And Safety ◽  
Clinical Factors ◽  
Short Term ◽  
Related Factors ◽  
Cardiac Implantable Electronic Devices

Objective. Transvenous lead extraction (TLE) is the gold standard in the management of patients with cardiac implantable electronic devices (CIED)-related complications. Knowledge of TLE risk factors is very important.Methods. Clinical data from 1915 patients undergoing TLE at the Reference Center between 2006 and 2015 were analyzed. The effects of clinical and procedure-related factors on the development of major (MJC) and minor (MIC) complications and survival after TLE were evaluated.Results. MJC were caused mainly by lead implant duration, presence of abandoned leads, multiple procedures preceding TLE, and any technical problem during TLE. Of clinical factors female gender and anemia increased the risk of MJC. MIC were reported in patients with the first implantation of CIED under the age of 30 and after sternotomy analysis of 30-day survival after procedure demonstrated a significant effect of clinical factors and lead dwell times, previous unsuccessful TLE, and MIC.Conclusions. Efficacy and safety of TLE depend mainly on procedure-related factors. This knowledge is essential for preventing MJC and MIC. Mortality at 30 days following TLE is mainly associated with the clinical factors; however, there was also a significant effect of lead dwell time and periprocedural complications on the short-term prognosis of patients undergoing TLE.

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