Cardiac implantable electronic device and vascular access: Strategies to overcome problems

For arrhythmia treatment or sudden cardiac death prevention in hemodialysis patients, there is a frequent need for placement of a cardiac implantable electronic device (pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization device). Leads from a cardiac implantable electronic device can cause central vein stenosis and carry the risk of tricuspid regurgitation or contribute to infective endocarditis. In patients with end-stage kidney disease requiring vascular access and cardiac implantable electronic device, the best strategy is to create an arteriovenous fistula on the contralateral upper limb for a cardiac implantable electronic device and avoidance of central vein catheter. Fortunately, cardiac electrotherapy is moving toward miniaturization and less transvenous wires. Whenever feasible, one should avoid transvenous leads and choose alternative options such as subcutaneous implantable cardioverter defibrillator, epicardial leads, and leadless pacemaker. Based on recent reports on the leadless pacemaker/implantable cardioverter defibrillator effectiveness, in patients with rapid progression of chronic kidney disease (high risk of renal failure) or glomerular filtration rate <20 mL/min/1.73 m2, this option should be considered by the implanting cardiologist for future access protection.

Download Full-text

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature

The Journal of Vascular Access ◽

10.1177/1129729819894085 ◽

2019 ◽

pp. 112972981989408

Author(s):

Dawid Bednarczyk ◽

Wiktor Kuliczkowski ◽

Krzysztof Letachowicz ◽

Marcin Dzidowski ◽

Tomasz Witkowski ◽

...

Keyword(s):

Vascular Access ◽

Electronic Device ◽

Cardiac Pacemaker ◽

Cardiac Pacing ◽

Venous Access ◽

Cardiac Implantable Electronic Device ◽

Leadless Pacemaker ◽

Access Problem ◽

Arteriovenous Access

The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment with no possibility of arteriovenous access or in patients with cardiac implantable electronic device–related infection leading to the removal of cardiac implantable electronic device. We present a case report where both situations occur simultaneously. Using recent development in cardiac pacing—leadless cardiac pacemaker—we manage to overcome the vascular access problem. The described case emphasizes the necessity of multispecialty collaboration and gains of new pacing technology in patients who need placement of vascular access for hemodialysis and cardiac implantable electronic device where vascular access is scarce.

Download Full-text

682. Implantable Cardioverter-Defibrillator Lead Vegetation with Long-Standing Actinomyces neuii Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.879 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S444-S444

Author(s):

Mark Irwin ◽

Steven Tilem ◽

Charlie Ervin ◽

Fernando de la Serna ◽

Rahul Sampath

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Electronic Device ◽

Management Strategies ◽

Unknown Origin ◽

Blood Cultures ◽

Cardiac Resynchronization ◽

Transesophageal Echocardiogram ◽

Cardioverter Defibrillator ◽

Pyrexia Of Unknown Origin ◽

Ventricular Lead

Abstract Background Endocarditis caused by Actinomyces species is uncommon with only 30 cases reported in contemporary literature. Methods We present a novel case of cardiovascular implantable electronic device (CIED) endocarditis secondary to infection by Actinomyces neuii – a unique non-branching member of the species that grows in both anaerobic and aerobic media. Results Our patient, a 51-year-old female, with a history of implantable cardioverter-defibrillator (ICD) placement 17 years prior for heart failure, presented with six weeks of fevers and rigors. She was referred to the infectious disease clinic for evaluation of pyrexia of unknown origin. Her examination was unremarkable, and the ICD pocket was uninflamed. Her initial labs revealed mildly elevated inflammatory markers and renal insufficiency. Blood cultures were positive for slow-growing non-branching gram-positive rods in both aerobic and anaerobic media. These were identified as Actinomyces neuii by mass spectrometry. Review of outside records showed positive blood cultures with Actinomyces neuii at another facility two weeks prior to our evaluation which were not acted upon and thought to be bacterial contamination. The patient was further evaluated with a transesophageal echocardiogram that demonstrated a 3.3 x 2.2cm mobile vegetation attached to the ICD lead. She subsequently underwent removal of her Saint Jude cardiac resynchronization therapy defibrillator and leads using laser and snaring techniques, but the tail end of the ventricular lead fractured and could not be retrieved. The ICD pocket was also found to be infected. A planned 6-week course of IV ampicillin was interrupted by 2 weeks of ceftriaxone for treatment of an intercurrent lower respiratory tract infection. The patient regained her baseline health and was discharged 2 weeks after ICD removal with a LifeVest. She is to complete 12 months of oral amoxicillin therapy after completion of IV antibiotics in view of retained lead fragment, and long standing Actinomyces bacteremia - consistent with published management strategies. Figure 1. Transesophageal echocardiogram demonstrating size of vegetation. Figure 2. Three-dimensional view demonstrating vegetation on the ICD lead. Conclusion Here we describe the first known case of Actinomyces neuii CIED endocarditis with a large lead vegetation and long-standing bacteremia, presenting as pyrexia of unknown origin. Disclosures All Authors: No reported disclosures

Download Full-text

Radiotherapy in patients with cardiac implantable electronic device either a permanent pacemaker or an implantable cardioverter defibrillator

La radiologia medica ◽

10.1007/s11547-017-0749-3 ◽

2017 ◽

Vol 122 (7) ◽

pp. 538-539

Author(s):

Yasemin Benderli Cihan

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Electronic Device ◽

Permanent Pacemaker ◽

Cardiac Implantable Electronic Device ◽

Cardioverter Defibrillator

Download Full-text

Remote heart failure management using a multiparameter implantable cardioverter-defibrillator alert: the multicentric RE-HEART registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.3465 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J De Juan Baguda ◽

J.J Gavira Gomez ◽

M Pachon Iglesias ◽

L Pena Conde ◽

J.M Rubin Lopez ◽

...

Keyword(s):

Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Median Duration ◽

Office Visit ◽

Active Phase ◽

Cardiac Resynchronization ◽

Office Visits ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Clinical Events

Abstract Background The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator (ICD)-based sensors into an index for prediction of impending heart failure (HF) decompensation. In patients with ICD and cardiac resynchronization therapy ICD remotely monitored at 13 Spanish centers, we analyzed the association between clinical events and HeartLogic alerts and we described the use of the algorithm for the remote management of HF. Methods The association between clinical events and HeartLogic alerts was studied in the blinded phase (from ICD implantation to alert activation – no clinical actions taken in response to alerts) and in the following active phase (after alert activation – clinicians automatically notified in case of alert). Results We enrolled a total of 215 patients (67±13 years old, 77% male, 53% with ischemic cardiomyopathy) with ICD (19%) or CRT-D (81%). The median duration of the blinded phase was 8 [3–12] months. In this phase, the HeartLogic index crossed the threshold value (set by default to 16) 34 times in 20 patients. HeartLogic alerts were associated with 6 HF hospitalizations and 5 unplanned in-office visits for HF. Five additional HeartLogic threshold crossings were not associated with overt HF events, but occurred at the time of changes in drug therapy or of other clinical events. The rate of unexplained alerts was 0.25 alert-patient/year. The median time spent in alert was longer in the case of HF hospitalizations than of in-office visits (75 [min-max: 30–155] days versus 39 [min-max: 5–105] days). The maximum HeartLogic index value was 38±15 in the case of hospitalizations and 24±7 in that of minor HF events. The median duration of the following active phase was 5 [2–10] months. After HeartLogic activation, 40 alerts were reported in 26 patients. Twenty-seven (68%) alerts were associated with multiple HF- or non-HF related conditions or changes in prescribed HF therapy. Multiple actions were triggered by these alerts: HF hospitalization (4), unscheduled in-office visits (8), diuretics increase (8), change in other cardiovascular drugs (5), device reprogramming (2), atrial fibrillation ablation (1), patient education on therapy adherence (2). The rate of unexplained alerts not followed by any clinical action was 0.13 alert-patient/year. These alerts were managed remotely (device data review and phone contact), except for one alert that generated an unscheduled in-office visit. Conclusions HeartLogic index was frequently associated with HF-related clinical events. The activation of the associated alert allowed to remotely detect relevant clinical conditions and to implement clinical actions. The rate of unexplained alerts was low, and the work required in order to exclude any impending decompensation did not constitute a significant burden for the centers. Funding Acknowledgement Type of funding source: None

Download Full-text