Late complications of electrotherapy — a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience

Polewczyk, Anna; Kutarski, Andrzej; Tomaszewski, A.; Janion, Marianna

doi:10.5603/kp.2013.0064

Cited by 5 publications

(27 citation statements)

References 22 publications

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“…Our study has implications for both lead manufacturers and lead implanters. Smaller diameter leads have, as a group, resulted in greater risk of significant complications such as perforation or lead failure, with a decrease in venous stenosis as a potential benefit. With that in mind, implanters need to consider whether an individual patient would benefit from a larger lead with proven durability at initial implant.…”

Section: Resultsmentioning

confidence: 99%

Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients

Abu-El-Haija

Bhave

Campbell

et al. 2015

JAHA

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BackgroundVenous stenosis is a common complication of transvenous lead implantation, but the risk factors for venous stenosis have not been well defined to date. This study was designed to evaluate the incidence of and risk factors for venous stenosis in a large consecutive cohort.Methods and ResultsA total of 212 consecutive patients (136 male, 76 female; mean age 69 years) with existing pacing or implantable cardioverter-defibrillator systems presented for generator replacement, lead revision, or device upgrade with a mean time since implantation of 6.2 years. Venograms were performed and percentage of stenosis was determined. Variables studied included age, sex, number of leads, lead diameter, implant duration, insulation material, side of implant, and anticoagulant use. Overall, 56 of 212 patients had total occlusion of the subclavian or innominate vein (26%). There was a significant association between the number of leads implanted and percentage of venous stenosis (P =0.012). Lead diameter, as an independent variable, was not a risk factor; however, greater sum of the lead diameters implanted was a predictor of subsequent venous stenosis (P =0.009). Multiple lead implant procedures may be associated with venous stenosis (P =0.057). No other variables approached statistical significance.ConclusionsA significant association exists between venous stenosis and the number of implanted leads and also the sum of the lead diameters. When combined with multiple implant procedures, the incidence of venous stenosis is increased.

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Section: Resultsmentioning

confidence: 99%

Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients

Abu-El-Haija

Bhave

Campbell

et al. 2015

JAHA

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“…The problem is the lack of consistency in the time that would be the dividing line. In the literature, the limit for early complications is 1 month after the procedure [ 3 ] but also 1 year as in the case of infectious complications associated with artificial valves [ 5 , 6 ]. The second criterion mentioned above is that the lead is usually removed by simple traction by this time, and after more than 1 year, due to the healing and ingrowing process, it is often necessary to use more complex equipment to perform transvenous lead extraction (TLE) [ 7 ].…”

Section: The Criterion Of Timementioning

confidence: 99%

“…Sometimes, it leads to complete or partial emergence of the device. In the past, a popular form of therapy was local surgical treatment of the pocket, when all elements of the pacing system were left in the patient’s body, which led to the suppression of the inflammatory process and a delay in proper management – transvenous lead extraction [ 3 , 6 ].…”

Section: Early and Late Infectionsmentioning

confidence: 99%

“…The clinical manifestation is less pronounced than with left-sided endocarditis. Symptoms can include recurrent sweats, weight loss, fever and subfeverish states of unknown origin, which are signs of repeated or chronic bacteremia, while cough, recurrent pneumonia, and dyspnea result from pulmonary embolism of bacterial material from the right heart [ 3 , 6 , 46 , 47 , 55 ]. In this group of patients it is harder to fulfill the classic Duke criteria necessary for the diagnosis of infective endocarditis, which is the reason for their suggested modification for LRIE and joining the major criteria for local pocket infection and septic pulmonary embolism [ 55 – 57 ].…”

Section: Early and Late Infectionsmentioning

confidence: 99%

“…The first pacemaker implanted in Poland, in Gdansk in 1963, stopped functioning after a few months due to spontaneous damage to the device casing and its destruction by tissue fluids [ 2 ]. Although malfunctions of the electronic systems of the device are rare today, the number of complications associated with the presence of the leads is constantly increasing [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications of electrotherapy – the dark side of treatment with cardiac implantable electronic devices

Domagała

Domagała²,

Chyła

et al. 2018

pwki

Self Cite

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In the past years we have been observing the dynamic development of electrotherapy, as evidenced by the steadily rising number of implanted pacemakers (PM), as well as devices used in the treatment of dangerous arrhythmia and heart failure, such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT-P/D). This is a consequence of the ageing of the populations of the majority of developed countries and also the gradually widening indications for the use of such devices. Along with the observed rise in the number of new implantations, the number of complications of electrotherapy is rising as well. In view of the increase in the incidence of complications, it is necessary to systematize the knowledge on this subject, because there is still no official classification of this type of complication and guidelines for dealing with such cases do not appear to cover the scale of the problem. In addition, late complications of electrotherapy play the most important role, in which case the removal of the entire pacing system, transvenous lead extraction (TLE), is a challenge due to the older age of leads strongly attached to the venous walls and endocardium of the heart cavity. The present paper presents a modern classification of electrotherapy complications and discusses the types of complications according to the most recent literature reports. Moreover, the diagnosis and management of particular types of complications with the assessment of indications for TLE are discussed.

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Leads and Electrodes for Cardiac Implantable Electronic Devices

Lau¹

2017

Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy

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Late complications of electrotherapy — a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience

Abstract: Clinical manifestations of electrotherapy complications in the study group varied and included a relatively small number of infectious complications (24%) and a relatively large number of late myocardial perforations (14%). Efficacy and safety of the procedures were very high.

Cited by 5 publications

References 22 publications

Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients

Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients

Complications of electrotherapy – the dark side of treatment with cardiac implantable electronic devices

Leads and Electrodes for Cardiac Implantable Electronic Devices

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