Leadless pacemaker placement in a patient with chronic kidney disease: A strategy to preserve central veins

Maradey, Joan; Jao, Geoffrey T.; Vachharajani, Tushar J.

doi:10.1111/hdi.12665

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Data from epicardial studies emphasized that the effectiveness and survival of epicardial leads are essentially the same as the endocardial leads [15][16][17][18]. Recently, a subcutaneous approach has also been reported in hemodialysis patients [16][17][18]. In our study only 4% (28/688) patients had leadless implanted cardiac devices (ICDs) implanted.…”

Section: Discussionmentioning

confidence: 54%

“…To preserve the central vascular access in CKD patient who are planning to have cardiac devices, placement of the leadless cardiac device and the use of the epicardial route is an important alternative to avoid the transvenous pathway. The validity of this approach was provided by recent studies [15][16][17][18]. Data from epicardial studies emphasized that the effectiveness and survival of epicardial leads are essentially the same as the endocardial leads [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…The validity of this approach was provided by recent studies [15][16][17][18]. Data from epicardial studies emphasized that the effectiveness and survival of epicardial leads are essentially the same as the endocardial leads [15][16][17][18]. Recently, a subcutaneous approach has also been reported in hemodialysis patients [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

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Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study

et al. 2020

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Background: Cardiovascular issues (especially arrhythmia and sudden cardiac death) are one of the most common causes of mortality in patients with chronic kidney disease (CKD). To minimize cardiac mortality, these patients frequently require various cardiac devices, such as pacemakers, loop recorders, and defibrillators which can compromise their vascular access. In this study, we aim to determine the prevalence of CKD in patients undergoing cardiac device placement and their progression of CKD.Methods: Institutional review board approval was obtained for this study. A total of 688 patients undergoing cardiac device placement were included in this study over a 3-year period at Jersey Shore University Medical Center. Demographic characteristics, comorbidities, base-line renal functions during the procedure, types of cardiac devices, sites of vascular access and follow-up renal function when available were assessed retrospectively. Patients were categorized into CKD stages 1 -5 based on the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines. The patients who were already on hemodialysis were excluded in this study. Results:The average age of the patient were 73.9 years with male predominance (60%). A total of 227 patients (33%) had estimated glomerular filtration rate (eGFR) < 60 mL/min consistent with the evidence of advanced-stage CKD (stages 3 -5) at the time of cardiac device placement. The most common types of device placements were new insertion/replacement of atrial and ventricular leads (39.5%), loop recorder implantation (21.1%) and generator changes on an already implanted device (11%). Only 4% (28/688) had a leadless cardiac device placement. The most common access sites were subclavian (47.1%), axillary (32.3%) and femoral (12.2%). Conclusions:The present study demonstrated that nearly one-third of the patient undergoing cardiac device placement had an advanced degree of renal failure. Because CKD is a progressive disease, many of these patients might require renal replacement therapy in the future. Transvenous devices is not a good choice in this group of patients as they will ultimately require an arteriovenous fistula. Subcutaneous leadless cardiac device insertion might be a better option in patients with advanced CKD.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study

et al. 2020

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“…Nonetheless, the percent agreement of the interrater reliability regarding CVS was >96% ( Supplemental eTable 2 ). The development of leadless cardiac devices, such as subcutaneous ICDs and leadless pacemakers, offers opportunities to avoid lead-associated CVS in the dialysis population [ 32 – 36 ]. Unfortunately, with regard to complications, still little is known from these techniques in this vulnerable patients.…”

Section: Discussionmentioning

confidence: 99%

Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue

Timal¹,

Karalis²,

Cabezas³

et al. 2022

Cardiol Cardiovasc Med

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Background In hemodialysis patients, implantable cardioverter-defibrillator (ICD) implantation may result in central venous stenosis (CVS) with associated symptoms, such as pain, edema of the ipsilateral arm, facial edema, and loss of dialysis access. However, literature concerning CVS in dialysis patients with a cardiac implantable electronic device is scarce. Methods We conducted a prospective cohort study in which we investigated the incidence of CVS in end-stage renal disease patients on chronic dialysis who received an ICD as part of participation in the randomized ICD2 trial. A venography was performed before ICD implantation and at 1 year follow-up. Results Between 2007 and 2017, 80 patients on dialysis received an ICD according to ICD2 trial protocol. Our population mainly consisted of males (76.3%), and had a median age of 67 years. Hemodialysis was the predominant dialysis modality (71.3%). The ICD was implanted in the right pectoral region in 58 patients (72.5%). A minority of the patients (27.5%) had a history of central venous catheters use, ipsilateral to ICD implantation site. Median follow-up was 16 months (IQR 13–35). Prospective assessment of central vein patency was possible in 56 patients (70.0%). Partial obstruction of central vein at follow-up was present in 19 out of 56 patients (33.9%) and complete occlusion in 4 patients (7.1%). With a complete clinical follow-up of all patients with a median duration of 3.5 years (IQR 2.7 – 6.3), 3 patients developed clinically significant symptoms of CVS. Conclusions Development of CVS in patients on chronic dialysis who received an ICD is a cause of concern. Prevention of such complications deserves attention and further research. Trial Registration: ISRCTN20479861

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“…This is because the risk of developing symptoms is high. A promising emerging method to treat cardiac rhythm disorders could be the use of leadless devices that have the advantage of less risk of CVO ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective?

et al. 2018

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Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs.Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed.Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty.Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.

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Leadless pacemaker placement in a patient with chronic kidney disease: A strategy to preserve central veins

Cited by 8 publications

References 8 publications

Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study

Chronic Kidney Disease in Patients Undergoing Cardiac Device Placement: Results of a Retrospective Study

Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue

Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective?

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