2016
DOI: 10.1007/s10840-016-0110-0
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Cardiac implantable electronic device lead-based masses and atrial fibrillation ablation: a case-based illustration of periprocedural anticoagulation management strategies

Abstract: Introduction Cardiac implantable electronic device (CIED) leads frequently develop echogenic masses. However, the nature of these masses is not well understood. In patients in whom atrial fibrillation (AF) catheter ablation is planned, there is concern that transseptal puncture may result in cerebrovascular embolism of these masses. The optimal therapeutic strategy in this setting remains undefined. Methods We describe six patients identified over a 6-year period (2008–2014) with device lead-based masses pri… Show more

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Cited by 5 publications
(4 citation statements)
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References 22 publications
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“…It is essential to identify these masses in patients in whom AF catheter ablation is planned because there is a concern that transseptal puncture may result in cerebrovascular embolism. 54 Many questions remain unresolved regarding the relationships between PE and AF. Combination of AF and PE represents a vicious circle as these pathologies contribute to progression of each other.…”
Section: Right Atrial Thrombosis In Patients With Pulmonary Embolism mentioning
confidence: 99%
See 2 more Smart Citations
“…It is essential to identify these masses in patients in whom AF catheter ablation is planned because there is a concern that transseptal puncture may result in cerebrovascular embolism. 54 Many questions remain unresolved regarding the relationships between PE and AF. Combination of AF and PE represents a vicious circle as these pathologies contribute to progression of each other.…”
Section: Right Atrial Thrombosis In Patients With Pulmonary Embolism mentioning
confidence: 99%
“…It is important to identify the echogenic masses on device leads in patients in whom AF catheter ablation is planned to prevent transseptal puncture, which may result in cerebrovascular embolism. 54 The majority of such patients are already on anticoagulation and initiation of an intensified anticoagulation regimen (INR range of 2.0-3.0) in such cases allows for complete resolution of device lead masses in onethird of patients within 2 months. The remaining patients have persistent lead-based masses (average follow-up of approximately 11 months) decreasing in size.…”
Section: Management Of Patients With Right Atrial Thrombosismentioning
confidence: 99%
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“…For patients in atrial fibrillation undergoing transvenous cardiac implantable electronic device (CIED) insertion, continued warfarin therapy has been shown to be safer than interrupted warfarin with heparin bridging among patients with the highest thromboembolic risk (>5 percent per year). Safety data, however, are Special editions ANUBiH CLXXXI, OMN 54, p. 39-53 limited for patients treated with direct oral anticoagulants (DOACs) rather than warfarin (21). In BRUISE CONTROL-2, which included patients undergoing transvenous CIED insertion with CHA2DS2-VASc scores ≥2 who were taking a DOAC for chronic anticoagulation, the incidence of the primary outcome (clinically significant pocket hematoma requiring prolonged hospital stay, interruption of anticoagulation therapy, or surgery for hematoma removal) was the same (2.1 percent) for patients randomized to device insertion while on continued DOAC therapy and for those in whom the DOAC was stopped (22).…”
Section: Introductionmentioning
confidence: 99%