Long‐Term Outcome of Patients with Multiple (≥ 3) Noninfected Transvenous Leads: A Clinical and Echocardiographic Study

Abstract

To prospectively assess the incidence and clinical significance of thromboembolic complications in patients with multiple (> or = 3) noninfected transvenous leads; 48 consecutive patients were evaluated. Half of the patients had two ventricular leads and one atrial lead, 15 patients had two atrial leads and one ventricular lead, while 9 patients had two ventricular and two atrial leads. No additional care was provided except for aspirin (80 mg bid) and annually performed echo-Doppler studies. Clinical follow-up included signs and symptoms of subclavian and/or axillary vein thrombosis, the presence of right congestive heart failure, the number of hospital admissions, and death. Echo-Doppler studies assessed the presence of an enlarged right atrium or ventricle, right atrial or ventricular spontaneous contrast, and the presence of tricuspid regurgitation. During a total follow-up of 7.4 +/- 2.2 years there were no differences in the incidence of clinical variables as compared to age-matched controls with DDD pacemakers. The most common complication was transient venous thrombosis (mostly presenting as venous prominence 1-2 weeks after implantation), which was seen in 17% of the study group versus 15% in controls (NS). Cumulative mortality was not different in both groups (13% in the study group vs 15% in controls). No differences were present with respect to hospital admissions (1.1 +/- 0.27/year in the study group vs 1.2 +/- 0.30/year in the controls). In patients with multiple ventricular leads, tricuspid regurgitation on echo-Doppler studies was more frequent (24%) as compared to controls (4%); however, clinical signs of right heart failure were equally distributed. Thus, patients with multiple (> or = 3) noninfected leads have no clinical adverse outcome during long-term follow-up.

Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis

“…Especially the impact of multiple leads is of interest when considering possible lead extraction of superfluous leads [20]. In our cohort we did not find any association of increased risk of venous obstruction with multiple leads being implanted which is in line with other studies as well [13,21]. In a prospective study by Costa et al, long-term anticoagulation with warfarin after device implantation in patients with a high risk of thrombosis led to a significantly lower frequency of venous thrombosis compared to the control group without warfarin (38.6 % vs. 60.4 %) [22].…”

Right ventricular pacemaker lead as an independent risk factor in the development of tricuspid regurgitation in the early postoperative period? Single-center prospective study

“…Распространенность TР со-ставила 29% против 13,5% в контрольной группе (р < 0,05). Функциональные показатели клапана до имплантации в данной работе не оценива-лись [34].…”

Tricuspid Valve Regurgitation After Antiarrhythmic Device Implantation

“…В ряде исследований была выявлена более ча-стая встречаемость ТР у больных с имплантируе-мыми антиаритмическими устройствами (ААУ) в сравнении с контрольной группой: 25-29% против 12-13% случаев соответственно [12,13]. Впервые развитие ТР у пациента после имплан-тации электрокардиостимулятора было описа-но T.C.…”

“…Причем подобные изменения функции клапанного аппарата ПЖ в некоторых случаях могут быть определены только через несколько лет после имплантации ААУ [13]. В то же время существуют работы, в которых ухудше-ния функции ТК у больных после имплантации ААУ выявлено не было.…”

“…Прямое повреждение структур ТК желудоч-ковым электродом, включая перфорацию створ-ки, хорд и папиллярных мышц, а также запуты-вание электрода в структурах клапана, может приводить как к возникновению выраженной ТР сразу после имплантации, так и к постепен-ному ее развитию в отдаленном периоде наблю-дения [9,[12][13][14][29][30][31]. Одним из самых не-обычных механизмов развития ТР в отдаленном послеоперационном периоде, встречающих-ся в литературе, является случай, описанный A. Loupy et al [15]: выраженная ТР у пациента диагностирована через 17 лет после первичной имплантации ААУ по поводу атриовентрику-лярной блокады, через 9 лет после имплантации второго желудочкового электрода и через 1 мес после протезирования аортального клапана.…”