scholarly journals Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients—A Post Mortem Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Jonas Keiler ◽  
Marko Schulze ◽  
Ronja Dreger ◽  
Armin Springer ◽  
Alper Öner ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Qualitative Assessment ◽  
Lead Extraction ◽  
Anatomical Landmarks ◽  
Leadless Pacemaker ◽  
Cardiac Implantable Electronic Devices ◽  
Icd Leads ◽  
The Right ◽  
Arrhythmia Therapy ◽  
Collagenous Fibers

The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1–2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.

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.

scholarly journals CIEDs (cardiac implantable electronic devices) error due to neutrons from X-ray therapy equipment

Impact ◽  
2021 ◽  
Vol 2021 (5) ◽  
pp. 31-33
Author(s):  
Hiroaki Matsubara ◽  
Hiroaki Matsubara
Keyword(s):  
Nuclear Physics ◽  
Interdisciplinary Collaboration ◽  
Electronic Devices ◽  
Assistant Professor ◽  
X Rays ◽  
Theoretical Understanding ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiac Devices ◽  
The Right ◽  
Key Techniques

Interdisciplinary collaboration is necessary for the advancement of medicine. A lack of collaboration can lead to misconceptions and a lack of theoretical understanding, which can affect the care afforded to patients. With the right collaborations between scientists in fields outside of medicine, misconceptions can be corrected and understanding improved. Assistant Professor Hiroaki Matsubara, Tokyo Women's Medical University, Japan, is a nuclear physicist who is applying his skills and expertise to advance the field of medicine. Nuclear physics is used in several key techniques and tools in medicine such as X-rays and radiotherapy. Matsubara is interested in the issues that can arise in patients with implanted cardiac devices that require radiotherapy. The radiation from radiotherapy can affect the proper functioning of cardiac implantable electronic devices (CIEDs), leading to dangerous malfunctions, even when the tumour being targeted is far from the heart. From gathering data from clinical settings and running tests in non-clinical environments Matsubara found that there was no correlation between photon exposure levels and device malfunction, which suggested another source of malfunction arising after radiotherapy. Using his nuclear expertise, he was able to uncover the source of CIED malfunction following radiotherapy.

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.

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