Leadless Pacemaker Implantation after Lead Extraction for Cardiac Implanted Electronic Device Infection

2022 ◽  
Author(s):  
Li Bicong ◽  
John Carson Allen ◽  
Kelly Arps ◽  
Sana M. Al‐Khatib ◽  
Tristram D. Bahnson ◽  
...  
Keyword(s):  
Electronic Device ◽  
Pacemaker Implantation ◽  
Lead Extraction ◽  
Leadless Pacemaker ◽  
Device Infection

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.

Abstract 17088: In-Hospital Complications and Outcomes of Leadless Pacemaker Implantation: A Propensity-Score Matched Analysis From Nationwide Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Moghniuddin Mohammed ◽  
Amit Noheria ◽  
Seth Sheldon ◽  
Madhu Reddy
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Real World ◽  
Electronic Device ◽  
Artery Bypass ◽  
Pacemaker Implantation ◽  
Leadless Pacemaker ◽  
Ventricular Lead ◽  
Significant Difference ◽  
Before And After

Introduction: There are no randomized controlled trials that compared the outcomes of leadless pacemaker (L-PPM) implantation with transvenous pacemaker (TV-PPM) and there is scarcity of data on real world outcomes. Methods: We queried National Inpatient Sample to identify all adult patients who had primary discharge diagnosis of conduction disorders or tachy-arrhythmias and excluded patients who had a concomitant procedure for valve replacement, coronary artery bypass grafting, ablation and/or cardiac implantable electronic device removal so that complications can be attributed to the pacemaker implantation. We included only procedures from November 2016 to December 2017 as Micra was the only available L-PPM during that period. For the comparison cohort we selected patients, during the same time period, who had a procedure code for single chamber pacemaker implantation in conjunction with right ventricular lead placement. We performed 1:1 propensity score matching and the variables used for matching are marked with asterisk in Table 1. All the codes used to identify complications has been previously validated from the Micra Post-approval registry and Coverage with Evidence Study. Results: Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group were included. Baseline characteristics with standardized mean difference before and after matching are shown in Table 1. Briefly, patients in L-PPM group were younger but had higher co-morbidities compared to TV-PPM group. The complications before and after matching are shown in Table 2. Conclusions: In conclusion, we found no significant difference between in-hospital complications after propensity score matching, with the exception of deep venous thrombosis. There was no difference between length of stay but cost for L-PPM was significantly higher. In this real-world analysis, we found that the leadless PPM implantation is safe in comparison to transvenous PPM.

Concomitant leadless pacemaker implantation and lead extraction during an active infection

2020 ◽  
Vol 31 (4) ◽  
pp. 860-867 ◽  
Author(s):  
David Chang ◽  
James K. Gabriels ◽  
Beom Soo Kim ◽  
Haisam Ismail ◽  
Jonathan Willner ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Lead Extraction ◽  
Active Infection ◽  
Leadless Pacemaker

scholarly journals B-PO03-055 CONCOMITANT LEADLESS PACEMAKER IMPLANTATION AND LEAD EXTRACTION DURING AN ACTIVE INFECTION: A LONG-TERM FOLLOW UP

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S210-S211
Author(s):  
Evan Choi ◽  
David Chang ◽  
James K. Gabriels ◽  
Beom Soo Kim ◽  
Eric Pagan ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Lead Extraction ◽  
Active Infection ◽  
Leadless Pacemaker ◽  
Long Term Follow Up

scholarly journals Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads

EP Europace ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1378-1384 ◽  
Author(s):  
Frank Bracke ◽  
Niels Verberkmoes ◽  
Marcel van 't Veer ◽  
Berry van Gelder
Keyword(s):  
Multivariate Analysis ◽  
Primary Endpoint ◽  
Electronic Device ◽  
Independent Predictor ◽  
Lead Extraction ◽  
Complication Rates ◽  
Clinical Failure ◽  
Cardiac Implantable Electronic Device ◽  
Major Complications ◽  
Device Infection

Abstract Aims Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection. Methods and results All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6–38.2) and 11.6 (5.6–17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration. Conclusion Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.

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