A devices’ game of thrones: cardiac resynchronization therapy vs. pacemaker

Moura‐Ferreira, Sara; Gonçalves, Helena; Oliveira, Marco; Primo, João; Fonseca, Paulo; Ribeiro, José; Santos, Emanuel; Pelicano, Nuno; Martins, Dinis; Gama, Vasco

doi:10.1093/europace/eux081

Cited by 2 publications

(1 citation statement)

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“…There is a growing population of patients with CIEDs (cardiac implantable electronic devices) with a long or very long-life expectancy [ 1 , 2 , 3 , 4 ]. The limited, yet extending the average duration of intracardiac leads functionality (pacemaker—PM—about 20 years, implantable cardioverter-defibrillator—ICD—about 10 years) [ 3 , 4 , 5 , 6 , 7 ] and changes in the health status of patients requiring device upgrade [ 8 , 9 ] result in the abandonment of inactive or redundant intracardiac leads [ 10 , 11 ], which is accepted by successive editions of guidelines on cardiac implantable devices [ 12 , 13 , 14 ]. As a result, the population of patients with intracardiac leads, who have an expected longevity of more than 30–40 years, is growing.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Kutarski

Główniak

Kosior

et al. 2022

IJERPH

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Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Kutarski

Główniak

Kosior

et al. 2022

IJERPH

View full text Add to dashboard Cite

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Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

Stefańczyk

Nowosielecka

Polewczyk

et al. 2022

IJERPH

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Background: Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. Methods: We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. Results: The need for an upgrade was the leading indication for TLE in only 36–66% of patients. In 42.0–57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1–76.4% of patients, functional leads were retained in 20.2–31.9%, non-functional leads were left in place in 0.0–1.1%, and non-functional superfluous leads were extracted in 3.6–8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Conclusions: Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.

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A devices’ game of thrones: cardiac resynchronization therapy vs. pacemaker

Cited by 2 publications

References 1 publication

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

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