scholarly journals Endocardial lead extraction with transoesophageal echocardiography guidance for cardiovascular implantable electronic device (CIED) related infections: four cases report

2021 ◽  
Author(s):  
Qiaoyu Han ◽  
Yi Feng ◽  
Hui Ju ◽  
Yan Jiang ◽  
Feng Ze ◽  
...  
Keyword(s):  
Electronic Device ◽  
Complete Removal ◽  
Transoesophageal Echocardiography ◽  
Pericardial Tamponade ◽  
Lead Extraction ◽  
Monitoring Methods ◽  
Recommended Treatment ◽  
Routine Monitoring ◽  
Endocardial Lead ◽  
Older Populations

Abstract Background With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. The recommended treatment of which involves the complete removal of all hardware, followed by antibiotic therapy and re-implant. Application of transoesophageal echocardiography (TEE) helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Case presentation : We report four cases of CIED infections from single-centre, who were extracted endocardial leads with intra-op TEE monitoring and guidance. Three of them had three fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op TTE, which avoided intra-op embolism. Conclusions Continuously intra-op TEE should be one of the routine monitoring methods in these high-risk endocardial leads extraction procedures.

Submuscular reburial as an alternative to lead extraction in high risk patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Llewellyn ◽  
G Meda ◽  
DJ Wright ◽  
A Rao
Keyword(s):  
High Risk ◽  
Dwell Time ◽  
De Novo ◽  
Electronic Device ◽  
Significant Risk ◽  
Heart Rhythm ◽  
Complete Removal ◽  
High Volume ◽  
Lead Extraction ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background The Heart Rhythm Society (HRS) and European Heart Rhythm Association (EHRA) consensus states complete extraction is recommended for all patients with definite cardiac implantable electronic device (CIED) infection. Although complete removal of hardware is the best way to manage infections, lead extraction is a complex procedure with significant risk. As age and complexity of patients increase so too does extraction risk. In very high risk cases conservative management is cited, though little is known on outcomes. Purpose We are a high volume tertiary centre which serves a population of 2 million. 2 experienced operators perform 65 extraction procedures per year for the past 10 years. We report our experience of device reburial as initial management of CIED pre-erosion and erosion in cases deemed too high risk for extraction. Method We retrospectively reviewed all reburial procedures undertaken over 9 years. Patient and lead factors influencing decisions were assessed. Information on number of leads, dwell time, prior procedure, infective status and comorbidity was collated. The outcomes included morbidity, defined by repeat procedure (revision and/or extraction) and mortality.  Results 86 patients underwent 96 procedures from March 2013 until August 2020. All patients undergoing device reburial were included. 55.8% of patients were male, mean age was 73. 21 patients died, 7 of these deaths occurred within 12 months of the index reburial procedure. The mean follow up period was 39 months (range 5–90). 65.1% of patients had a procedure (de novo implant, upgrade or replacement) within 12 months prior to revision. We reviewed patients in 2 subgroups based on revision indication – erosion and pre-erosion. Erosion was defined as externalised lead/device. Pre-erosion was defined as superficial device with skin tethering but no exposure. The former is a definite indication for lead extraction, the latter a relative indication. All in the pre-erosion group were systemically well with no infection evident. One patient with erosion had a positive blood culture. The mean age in the erosion group was 85 years with a Clinical Frailty Score (CFS) 4.98 and lead dwell time 17.87 years compared to age 68 years, CFS 3.98 and dwell time 8.14 years in the pre-erosion group. Patients in this cohort with an eroded device were deemed too high risk to undergo transvenous lead extraction. A higher proportion of patients presenting with erosion died within 12 months of the index reburial procedure (16.67% vs 4.84%). 21% with an eroded device and 11% with a pre-eroding device undergoing reburial as first line management required future extraction. Conclusion Our 9 year data suggests less invasive intervention is a valid option in high risk groups such as older age, frailty, long lead dwell time, with an acceptable incidence of reintervention and/or extraction. This data can help guide informed consent in the future.

scholarly journals Transvenous lead extraction: procedural outcomes and in-hospital mortality in octogenarian patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Giannotti Santoro ◽  
L Segreti ◽  
G Zucchelli ◽  
V Barletta ◽  
A Di Cori ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Electronic Device ◽  
Clinical Success ◽  
Similar Efficacy ◽  
Lead Extraction ◽  
Tertiary Referral Center ◽  
Major Complications ◽  
Group 2 ◽  
Group 1

Abstract Background Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods Patients who had undergone TLE in single tertiary referral center were divided in two groups (Group 1: ≥80 years; group 2:<80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. Results Our analysis included 1316 patients (group 1: 202, group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities and more pacemakers, whereas the dwelling time of the oldest lead was similar, irrespectively of patient's age. In group 1 the radiological success rate for lead was higher (99.0% vs 95.9%; P<0.001) and the fluoroscopy time lower (13.0 vs 15.0 minutes; P=0.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P=0.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P=0.24). In the elderly group no in-hospital mortality occurred (0.0% vs 0.5%; P=0.42). Conclusions Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure and no procedural-related deaths. Funding Acknowledgement Type of funding source: None

scholarly journals A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

Hearts ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 202-212
Author(s):  
Giulia Massaro ◽  
Igor Diemberger ◽  
Matteo Ziacchi ◽  
Andrea Angeletti ◽  
Giovanni Statuto ◽  
...  
Keyword(s):  
Electronic Device ◽  
Positive Impact ◽  
Delayed Diagnosis ◽  
Implantation Rate ◽  
Major Complication ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices ◽  
Device Infection ◽  
New Perspective ◽  
Poor Outcomes

In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.

scholarly journals Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: Results from CRYSTAL AF

2015 ◽  
Vol 40 (1-2) ◽  
pp. 91-96 ◽  
Author(s):  
Richard A. Bernstein ◽  
Vincenzo Di Lazzaro ◽  
Marilyn M. Rymer ◽  
Rod S. Passman ◽  
Johannes Brachmann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Brain Infarction ◽  
Cryptogenic Stroke ◽  
Monitoring Methods ◽  
Brain Images ◽  
Kaplan Meier ◽  
Imaging Characteristics ◽  
Hazard Ratios ◽  
Routine Monitoring

Background: Insertable cardiac monitors (ICM) have been shown to detect atrial fibrillation (AF) at a higher rate than routine monitoring methods in patients with cryptogenic stroke (CS). However, it is unknown whether there are topographic patterns of brain infarction in patients with CS that are particularly associated with underlying AF. If such patterns exist, these could be used to help decide whether or not CS patients would benefit from long-term monitoring with an ICM. Methods: In this retrospective analysis, a neuro-radiologist blinded to clinical details reviewed brain images from 212 patients with CS who were enrolled in the ICM arm of the CRYptogenic STroke And underLying AF (CRYSTAL AF) trial. Kaplan-Meier estimates were used to describe rates of AF detection at 12 months in patients with and without pre-specified imaging characteristics. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were calculated using Cox regression. Results: We did not find any pattern of acute brain infarction that was significantly associated with AF detection after CS. However, the presence of chronic brain infarctions (15.8 vs. 7.0%, HR 2.84, 95% CI 1.13-7.15, p = 0.02) or leukoaraiosis (18.2 vs. 7.9%, HR 2.94, 95% CI 1.28-6.71, p < 0.01) was associated with AF detection. There was a borderline significant association of AF detection with the presence of chronic territorial (defined as within the territory of a first or second degree branch of the circle of Willis) infarcts (20.9 vs. 10.0%, HR 2.37, 95% CI 0.98-5.72, p = 0.05). Conclusions: We found no evidence for an association between brain infarction pattern and AF detection using an ICM in patients with CS, although patients with coexisting chronic, as well as acute, brain infarcts had a higher rate of AF detection. Acute brain infarction topography does not reliably predict or exclude detection of underlying AF in patients with CS and should not be used to select patients for ICM after cryptogenic stroke.

Impacted Permanent Incisor Associated With Compound Odontoma: Case Report and Literature Review

2021 ◽  
pp. 1-3
Author(s):  
Aicha Ibourk ◽  
◽  
Ihsane Ben Yahya ◽  
Keyword(s):  
Complete Removal ◽  
Odontogenic Tumor ◽  
Permanent Teeth ◽  
Radiographic Examination ◽  
Central Incisor ◽  
Impacted Tooth ◽  
Anterior Maxilla ◽  
Jaw Bones ◽  
Recommended Treatment ◽  
Compound Odontoma

Odontoma is defined as calcifying benign odontogenic tumor composed of various tooth tissues such as enamel, dentin, pulp, and cementum and representing the second most common odontogenic tumor of the jaw bones. These lesions are often associated with impacted permanent teeth. They are usually small, asymptomatic and diagnosed after routine radiographic examination. The aim of this work was to report a case of a compound odontoma in the anterior maxilla of a 35-year-old woman, which was causing the impaction of the maxillary left central incisor. A removal of the tumor was planned. An orthodontic approach was proposed as a surgical procedure for orthodontic traction of the impacted tooth. After 12 months, the clinical and radiographic examination revealed the eruption of the impacted incisor. The recommended treatment of compound odontoma is the complete removal of the tumour. An orthodontic approach may be indicated to correct any malocclusion or to perform the traction of the tooth, due to a possible impaction.

Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes

Heart Rhythm ◽  
2017 ◽  
Vol 14 (12) ◽  
pp. 1807-1811 ◽  
Author(s):  
Amr F. Barakat ◽  
Oussama M. Wazni ◽  
Khaldoun Tarakji ◽  
Walid I. Saliba ◽  
Nayef Nimri ◽  
...  
Keyword(s):  
Electronic Device ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Device

scholarly journals Rescue transoesophageal echocardiography for refractory haemodynamic instability during transvenous lead extraction

2014 ◽  
Vol 15 (8) ◽  
pp. 926-932 ◽  
Author(s):  
J. N. Hilberath ◽  
P. S. Burrage ◽  
S. K. Shernan ◽  
D. J. Varelmann ◽  
K. Wilusz ◽  
...  
Keyword(s):  
Transoesophageal Echocardiography ◽  
Lead Extraction ◽  
Haemodynamic Instability

Predictors of success and complications in laser lead extraction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Madej ◽  
K Matschke ◽  
M Knaut
Keyword(s):  
Adverse Events ◽  
Electronic Device ◽  
Clinical Success ◽  
Multivariable Analysis ◽  
Lead Extraction ◽  
Predictors Of Success ◽  
Funding Sources ◽  
Icd Leads ◽  
Short Term Mortality ◽  
Major Adverse Events

Abstract Funding Acknowledgements Type of funding sources: None. Background Extraction of cardiac implantable electronic device (CIED) leads using excimer laser is in use since &gt; 20 years, but the predictors of success, all-cause complications and mortality are not yet sufficiently statistically evaluated.  Method All consecutive laser extractions performed at our institution between September 2011 and March 2020 with lead age &gt; 12 months were included and retrospectively analysed. Results 792 leads (mean age 75 months) were extracted during 335 procedures. The indication for extraction was pocket infection in 59%, CIED endocarditis in 25%, lead dysfunction or upgrade in 14% and others in 2%. 94.6% of leads were extracted complete, 4.2% partial (&lt; 4 cm rest) and the extraction failed in 1.3% of the leads (retention of ≥ 4 cm rest). Multivariable analysis identified lead age &gt; 7.5 years (odds ratio [OR] 6.5; p = 0.0281), broken leads (OR 28.0; p = 0.0009) and implantable cardioverter-defibrillator (ICD) leads (OR 6.5; p = 0.0010) as independent predictors of failed extraction. CIED-endocarditis was independently associated with complete extraction (OR 3.3; p = 0.0218). Complete procedural success or clinical success was achieved in 330 of 335 procedures (98.6%). The lead extraction failed in five cases (1.5%). Major procedure-associated adverse events (injuries of the great vessels or heart) occurred in four cases (1.2%). Two patients died perioperatively (0.6%). Minor complications occurred in 13 cases (3.9%). Major adverse events (MAE) causally not related to the procedure occurred in 18 (5.4%) of the patients. The most frequent MAE was postoperative aggravation of the sepsis (10 patients; 3.0%).  Independent predictors of major adverse events were CIED-endocarditis (OR 6.0; p = 0.0175), preoperative C-reactive-protein (CRP) &gt; 35 mg/l (OR 3.8; p = 0.0412) and body mass index (BMI) ≥ 25 kg/m2 (OR 5.0; p = 0.0489). Ten patients (3%) died during the hospital stay.  CIED-endocarditis with preoperative CRP &gt; 35 mg/l was independently associated with hospital mortality in multivariable analysis (OR 10.7; p = 0.0020). The Kaplan-Meyer analysis of 30-day mortality showed a significantly worse survival of patients with endocarditis (Log-Rank p = 0.0102). Conclusion Leads &gt; 7.5 years, broken leads and ICD leads are independent predictors of failed extraction. CIED endocarditis, CRP &gt; 35 and BMI ≥ 25 are associated with MAE. CIED endocarditis is related to higher short-term mortality despite successful lead extraction. Abstract Figure. Predictors of major adverse events

The pericardium and pericardial disease

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Transoesophageal Echocardiography ◽  
Pericardial Tamponade ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Mechanically Ventilated ◽  
Spectral Doppler ◽  
Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

1260Transvenous lead extraction: efficacy and safety of the procedure in octogenarian patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Giannotti Santoro ◽  
L Segreti ◽  
G Zucchelli ◽  
V Barletta ◽  
F Fiorentini ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Electronic Device ◽  
Clinical Success ◽  
Lead Extraction ◽  
Efficacy And Safety ◽  
Cardiac Implantable Electronic Device ◽  
Major Complications ◽  
Group 2 ◽  
Manual Traction ◽  
Group 1

Abstract Introduction the management of patients with infection or malfunction of a cardiac implantable electronic device (CIED) may be challenging. Purpose The aim of the study is to evaluate the safety and efficacy of transvenous lead extraction (TLE) in elderly patients. Methods a retrospective analysis of patients who underwent to TLE in our center was performed. Patients were divided in two groups: 1) patients 80 years of age or older, 2) patients younger than 80 years. All patients were treated with manual traction or mechanical dilatation. Results our analysis included 1316 patients, with a total of 2513 leads extracted. Group 1 (≥80 years) counted 202 patients and group 2 (&lt;80 years) 1114 patients. The group of elderly patients presented more comorbidities, as hypertension, chronic kidney disease, atrial fibrillation and pulmonary disease. Patients 80 years of age or older had more pacemakers than ICDs, whereas the dwelling time of the oldest lead, the number of leads and the presence of abandoned leads was similar despite patients age. In group 1 the rate of radiological success for lead was higher than in group 2 (99.0% vs 95.9%; P &lt; 0.001). The clinical success was obtained in 1273 patients (96.7%), without significative differences between groups (98.0% vs 96.4%; P = 0.36). Major complications occurred in 10 patients (0.7%), without significative differences (1.5% vs 0.6%; P = 0.24) (figure 1). Conclusion TLE in elderly patients is a safe and effective procedure. In patients older than 80 years there are not more major complications than in younger patients, and the efficacy of the procedure seems to be superior. Abstract Figure 1

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