<b>A Complication of Pacemaker Lead Extraction:</b> Paradoxical Embolism of a Lead Fragment in a Leg Artery

Dieuzaide, Pierre; Savon, N.; Chalvidan, Thierry; LeTALLEC, L.; Deharo, Jean Claude; Djiane, P

doi:10.1111/j.1540-8159.1998.tb00053.x

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Although embolization of adherent bacterial vegetations to the pulmonary arteries has been reported, 12,13 intensive antimicrobial therapy allows for the rendering of noninvasive therapy. Asymptomatic embolization of a pacing electrode tip has been previously reported on two occasions—paradoxical embolism in the setting of a patent foramen ovale and a pulmonary artery 14,15 …”

Section: Discussionmentioning

confidence: 97%

Pulmonary Arterial Embolization of Pacemaker Lead Electrode Tip

Eckart

Hruczkowski

Landzberg

et al. 2006

Pacing Clinical Electrophis

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Complications with extraction of abundant endovascular systems increase with time since implantation. As the number of implanted devices increases, successful management of complications needs to be disseminated. We present a 46-year-old woman with endovascular leads placed 15 years previously requiring extraction. Using laser-assistance the leads were removed, although the passive lead tips were unable to be extracted, and were retained in the superior vena cava. One lead tip embolized to the distal pulmonary bed within 24 hours of her operative procedure. Computed tomography and pulmonary arteriography suggested a near immediate thrombogenic process. A multidisciplinary approach was utilized to identify management strategies that allowed for a satisfactory patient outcome.

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Section: Discussionmentioning

confidence: 97%

Pulmonary Arterial Embolization of Pacemaker Lead Electrode Tip

Eckart

Hruczkowski

Landzberg

et al. 2006

Pacing Clinical Electrophis

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“…Remaining lead fragments can cause serious complications, which have previously been described, for example, clinically relevant thrombus formation on the lead fragments or occult embolisms. A corresponding number of unreported asymptomatic complications, despite all potentially relevant damage to the body, is, therefore, to be assumed 17–19 . Furthermore, the remaining leads or lead fragments represent a significant risk for the future treatment of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…A corresponding number of unreported asymptomatic complications, despite all potentially relevant damage to the body, is, therefore, to be assumed. [17][18][19] Furthermore, the remaining leads or the detection of a subclinical acute cellular rejection without invasive examination by biopsies. 8,9 It can be assumed that there is a lower inhibition threshold for the examination by MRI than by a biopsy, which is why an earlier and thus more treatable diagnosis of rejection can be assumed.…”

mentioning

confidence: 99%

Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments

Hahnel

Pecha²,

Bernhardt³

et al. 2020

Cardiovasc electrophysiol

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Background Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX. Methods and Results Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X‐ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%. Conclusion Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance.

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“…In the general population, there are multiple reports of mechanical complications of transected abandoned pacemaker and ICD leads, including right ventricle perforation, perforation of the atrial septum, and subsequent cerebral embolization as well as paradoxic embolization of lead fragments. 5–7 …”

Section: Discussionmentioning

confidence: 99%

Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem

Holzhauser

Imamura

Nayak

et al. 2018

Journal of Cardiac Failure

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Background Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Methods We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). Results A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. Conclusion RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.

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A Complication of Pacemaker Lead Extraction: Paradoxical Embolism of a Lead Fragment in a Leg Artery

Cited by 7 publications

References 5 publications

Pulmonary Arterial Embolization of Pacemaker Lead Electrode Tip

Pulmonary Arterial Embolization of Pacemaker Lead Electrode Tip

Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments

Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem

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