Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

Álvarez, Paulino; Sperry, Brett W.; Pérez, Antonio L.; Varian, Kenneth D.; Raymond, Timothy; Tong, Michael Z.; Hussein, Ayman A.; Taylor, David O.

doi:10.1111/ajt.14755

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…In this study, 24% of the MRIs were thoracic. Similar data have been shown for MRIs of patients with CIED lead fragments . Our study adds to the accumulating safety data in patients with abandoned leads and represents the largest description thus far, including endocardial and epicardial PPM, ICD, subcutaneous high-voltage coils, and lead fragments.…”

Section: Discussionsupporting

confidence: 79%

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

et al. 2021

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IMPORTANCE Magnetic resonance imaging (MRI) is the modality of choice for many conditions. Conditional devices and novel protocols for imaging patients with legacy cardiac implantable electronic devices (CIEDs) have increased access to MRI in patients with devices. However, the presence of abandoned leads remains an absolute contraindication.OBJECTIVE To assess if the performance of an MRI in the presence of an abandoned CIED lead is safe and whether there are deleterious effects on concomitant active CIED leads. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included consecutive CIED recipients undergoing 1.5-T MRI with at least 1 abandoned lead between January 2013 and June 2020. MRI scans were performed at the Hospital of the University of Pennsylvania. No patients were excluded.EXPOSURES CIEDs were reprogrammed based on patient-specific pacing needs. Electrocardiography telemetry and pulse oximetry were monitored continuously, and live contact with the patient throughout the scan via visual and voice contact was performed if possible. After completion of the MRI, CIED evaluation was repeated and programming returned to baseline or to a clinically appropriate setting.MAIN OUTCOMES AND MEASURES Variation in pre-and post-MRI capture threshold of 50% or more, ventricular sensing 40% or more, and lead impedance 30% or more, as well as clinical sequelae such as pain and sustained tachyarrhythmia were considered significant. Long-term follow-up lead-related data were analyzed if available.RESULTS A total of 139 consecutive patients (110 men [79%]) with a mean (SD) age of 65.6 (13.4) years underwent 200 MRIs of various anatomic regions including the thorax. Repeat examinations were common with a maximum of 16 examinations for 1 patient. There was a total of 243 abandoned leads with a mean (SD) of 1.22 (0.45) per patient. The mean (SD) number of active leads was 2.04 (0.78) and 64 patients (46%) were pacemaker dependent. A transmit-receive radiofrequency coil was used in 41 patients (20.5%), all undergoing MRI of the brain. There were no abnormal vital signs or sustained tachyarrhythmias. No changes in battery voltage, power-on reset events, or changes of pacing rate were noted. CIED parameter changes including decreased right atrial sensing in 4 patients and decreased left ventricular R-wave amplitude in 1 patient were transiently noted. One patient with an abandoned subcutaneous array experienced sternal heating that subsided on premature cessation of the study. CONCLUSIONS AND RELEVANCEThe risk of MRI in patients with abandoned CIED leads was low in this large observational study, including patients who underwent examination of the thorax. The growing aggregate of data questions the absolute contraindication for MRI in patients with abandoned CIED leads.

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Section: Discussionsupporting

confidence: 79%

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

et al. 2021

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“…On the other hand, as heart failure therapies advance, prosthetic valves and implantable devices might become more common in cases of infective endocarditis amongst SOT recipients. For example, Alvarez et al [18] recently reported that up to 16% of heart transplant recipients might have retained cardiac devices.…”

Section: Risk Factorsmentioning

confidence: 99%

Infective endocarditis in solid organ transplant: a review

Suárez

Subramanian

2022

Current Opinion in Organ Transplantation

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Purpose of reviewInfective endocarditis remains an uncommon disease with significant morbidity and mortality. In the last two decades, progress has been made describing the unique aspects of infective endocarditis in solid organ transplant (SOT) recipients. Recent findingsIncidence of infective endocarditis in SOT is higher when compared with the general population. End-stage organ dysfunction, diabetes mellitus, older age, and prior intravenous lines have been identified as risk factors predisposing to infective endocarditis in SOT. Staphylococci and enterococci represent the most frequently isolated pathogens, whereas fungi are rarely isolated. Median time from transplantation to diagnosis ranges from 33 to 66 months. Nosocomial acquisition and mural endocarditis are more common in SOT recipients with infective endocarditis. Procurement of organs from patients with infective endocarditis might be well tolerated so long as close monitoring and targeted antibiotics are given. Selected patients might benefit from heart transplantation as definitive or salvage therapy for infective endocarditis. Outcomes of infective endocarditis in SOT recipients compared with the general population might be similar; however, patient survival and graft function are reduced when recipients suffer from infective endocarditis.

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Complications of retained pacemaker hardware in heart transplant recipients: case series and review of the literature

et al. 2020

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Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

Cited by 6 publications

References 18 publications

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

Infective endocarditis in solid organ transplant: a review

Complications of retained pacemaker hardware in heart transplant recipients: case series and review of the literature

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