Venous Hemodialysis Catheters and Cardiac Implantable Electronic Devices: Avoiding a High-Risk Combination

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

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Risk Stratifying and Prognostic Analysis of Subclinical Cardiac Implantable Electronic Devices Infection: Insight From Traditional Bacterial Culture

Journal of the American Heart Association ◽

10.1161/jaha.121.022260 ◽

2021 ◽

Author(s):

Gaofeng Lin ◽

Tong Zou ◽

Min Dong ◽

Junpeng Liu ◽

Wen Cui ◽

...

Keyword(s):

High Risk ◽

Bacterial Culture ◽

Risk Group ◽

Electronic Devices ◽

Immunosuppressive Agents ◽

Subclinical Infection ◽

Infection Group ◽

Cardiac Implantable Electronic Devices ◽

Prognostic Analysis ◽

Composite Events

Background Subclinical infection of cardiac implantable electronic devices (CIEDs) is a common condition and increases the risk of clinical infection. However, there are limited studies focused on risk stratifying and prognostic analysis of subclinical CIED infection. Methods and Results Data from 418 consecutive patients undergoing CIED replacement or upgrade between January 2011 and December 2019 were used in the analysis. Among the patients included, 50 (12.0%) were detected as positive by bacterial culture of pocket tissues. The most frequently isolated bacteria were coagulase‐negative staphylococci (76.9%). Compared with the noninfection group, more patients in the subclinical infection group were taking immunosuppressive agents, received electrode replacement, or received CIED upgrade and temporary pacing. Patients in the subclinical infection group had a higher PADIT (Prevention of Arrhythmia Device Infection Trial) score. Univariable and multivariable logistic regression analysis found that use of immunosuppressive agents (odds ratio [OR], 6.95 [95% CI, 1.44–33.51]; P =0.02) and electrode replacement or CIED upgrade (OR, 6.73 [95% CI, 2.23–20.38]; P =0.001) were significantly associated with subclinical CIED infection. Meanwhile, compared with the low‐risk group, patients in the intermediate/high‐risk group had a higher risk of subclinical CIED infection (OR, 3.43 [95% CI, 1.58–7.41]; P =0.002). After a median follow‐up time of 36.5 months, the end points between the subclinical infection group and noninfection group were as follows: composite events (58.0% versus 41.8%, P =0.03), rehospitalization (54.0% versus 32.1%, P =0.002), cardiovascular rehospitalization (32.0% versus 13.9%, P =0.001), CIED infection (2.0% versus 0.5%, P =0.32), all‐cause mortality (28.0% versus 21.5%, P =0.30), and cardiovascular mortality (10.0% versus 7.6%, P =0.57). Conclusions Subclinical CIED infection was a common phenomenon. The PADIT score had significant value for stratifying patients at high risk of subclinical CIED infection. Subclinical CIED infection was associated with increased risks of composite events, rehospitalization, and cardiovascular rehospitalization.

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Combined Effect of Homocysteine and Uric Acid to Identify Patients With High Risk for Subclinical Atrial Fibrillation

Journal of the American Heart Association ◽

10.1161/jaha.121.021997 ◽

2021 ◽

Author(s):

Shihao Wang ◽

Yushan Wei ◽

Tesfaldet Habtemariam Hidru ◽

Daobo Li ◽

Nan Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Uric Acid ◽

High Risk ◽

European Society ◽

Electronic Devices ◽

Hazard Ratio ◽

Blood Samples ◽

Cardiac Implantable Electronic Devices ◽

Increased Risk ◽

European Society Of Cardiology

Background Subclinical atrial fibrillation (SCAF) is often asymptomatic nonetheless harmful. In patients with cardiac implantable electronic devices, we evaluated the combined performance of homocysteine and uric acid (UA) biomarkers to discriminate high‐risk patients for SCAF. Methods and Results We enrolled 1224 consecutive patients for evaluation of SCAF in patients with cardiac implantable electronic devices in Dalian, China, between January 2013 and December 2019. Clinical data and blood samples were obtained from patients selected according to the absence or presence of atrial high‐rate episodes >6 minutes. Blood samples were obtained, and homocysteine and UA biomarkers were tested in all patients to distinguish their prognostic performance for SCAF. Homocysteine and UA biomarkers were significantly different in SCAF versus no SCAF. On multivariable Cox regression analysis with potential confounders, elevated homocysteine and UA biomarkers were significantly associated with an increased risk of SCAF. A rise of 1 SD in homocysteine (5.7 μmol/L) was associated with an increased risk of SCAF in men and women regardless of their UA levels. Similarly, a 1‐SD increase in UA (91 μmol/L) was associated with an increased risk of SCAF among the patients with high levels of homocysteine in men (hazard ratio, 1.81; 95% CI, 1.43–2.30) and women (hazard ratio, 2.11; 95% CI, 1.69–2.62). The addition of homocysteine and UA to the atrial fibrillation risk factors recommended by the 2020 European Society of Cardiology Guidelines significantly improved risk discrimination for SCAF. Conclusions Homocysteine and UA biomarkers were strongly associated with SCAF. The prediction performance of the European Society of Cardiology model for SCAF was increased by the addition of the selected biomarkers. Registration URL: https://www.chictr.org.cn ; Unique identifier: Chi‐CTR200003837.

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COSTS OF INFECTIONS RELATED TO TREATMENT WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES

In a good rythm ◽

10.5604/01.3001.0013.7383 ◽

2019 ◽

Vol 3 (52) ◽

pp. 24-28

Author(s):

Przemysław Mitkowski

Keyword(s):

Renal Failure ◽

High Risk ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Cardiac Device ◽

Oral Anticoagulant Treatment ◽

Term Outcome ◽

Healthcare Budget ◽

Long Term Outcome ◽

Cardiac Implantable Electronic Devices

Treatment with cardiac implantable electronic devices is not free from complications, including infections, which not only influence long term outcome, but also significantly impact healthcare budget. The costs of management of cardiac device related infections ranged from several to tens or even hundreds of thousands euro. A risk of infection varies from 0,5 to 5,0 and more percent and depends on: type of procedure, complexity of system, number of previous procedures performed, renal failure, immunosuppression, heart failure, malignancies, oral anticoagulant treatment, use of temporary pacing before procedure. Based on PADIT trial results infection risk score was established based on 5 parameters (age, type of procedure, renal failure, immunodeficiency, number of previous procedure). This score allows to define population of patients with low, intermediate and high risk to develop infection. In high risk group, despite standard preparation to the procedure, some additional tools should be considered to reduce infection rate. It relates mainly, but is not limited to, device exchange, revisions, up-grades of cardiac resynchronization systems.

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A Novel Video-Assisted Approach to Excimer Laser-Guided Cardiac Implantable Electronic Devices Lead Extraction

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000277 ◽

2016 ◽

Vol 11 (3) ◽

pp. 210-213

Author(s):

Patrick Zardo ◽

Henning Busk ◽

Johannes Hadem ◽

Hassina Baraki ◽

George Kensah ◽

...

Keyword(s):

High Risk ◽

Real Time ◽

Laser Sheet ◽

Electronic Devices ◽

Lead Extraction ◽

Clinical Value ◽

High Risk Patients ◽

Video Assisted ◽

Cardiac Implantable Electronic Devices ◽

Risk Patients

Objective Even though roughly 90% of all implanted cardiac implantable electronic devices leads can be removed through conventional techniques, presence of large vegetations or thrombi, fractured leads, previous failed extraction, or long duration from implantation often impede classical transvenous extraction. In these cases, laser-assisted procedures represent a highly successful alternative and have a low procedural complication rate with major adverse events in less than 2% of cases. Unfortunately, most encountered complications are potentially fatal, which prompted us to develop a novel approach that adds additional safety measures by allowing for real-time intrathoracic visualization and intervention. Methods Five consecutive patients classified as high-risk patients received concomitant laser sheet extraction and right-sided uniportal video-assisted thoracic surgery for real-time intrathoracic visualization. Results Complete extraction was achieved in all cases without observing major intraoperative events, and on-table extubation was feasible in all cases. No chest tube-associated or incision-related complications were encountered. Conclusions Concomitant laser sheet extraction and video-assisted thoracoscopy are feasible and may offer benefits in high-risk patients. Further studies to document the actual safety and clinical value of our procedure are warranted.

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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.

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