Neointimal fibrotic lead encapsulation – Clinical challenges and demands for implantable cardiac electronic devices

Keiler, Jonas; Schulze, M.; Sombetzki, Martina; Heller, Thomas; Tischer, T.; Grabow, Niels; Wree, Andreas; Bänsch, Dietmar

doi:10.1016/j.jjcc.2017.01.011

Cited by 38 publications

(37 citation statements)

References 170 publications

(243 reference statements)

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“…The difference in size may be based on their distinct growth durations. The EN type made by endocardial tissue, like encapsulated fibrosis, grows slowly, showing monthly changes 12,23 . However, the NC type made mainly by fibrin can develop day‐by‐day in bacteremia 20,24 …”

Section: Discussionmentioning

confidence: 99%

Histological properties of oscillating intracardiac masses associated with cardiac implantable electric devices

Miyagi

Kawase

Κunugi

et al. 2020

Journal of Arrhythmia

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Background: There have been a few cases of echogenic cardiac implantable electric device (CIED) lead-associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients. Methods: Preoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open-heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed. Results: A total of 106 patients underwent lead removal in our institute (April 2009-March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead-related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). Conclusions: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead-associated intracardiac masses. K E Y W O R D S CIED, histology, IE, intracardiac mass, vegetation | 479 MIYAGI et Al.

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Section: Discussionmentioning

confidence: 99%

Histological properties of oscillating intracardiac masses associated with cardiac implantable electric devices

Miyagi

Kawase

Κunugi

et al. 2020

Journal of Arrhythmia

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“…On the downside, bigger lead diameters affect venous hemodynamics and hinder blood drainage, thereby increasing the risk of thromboembolic events (25). Moreover, intense contact between the lead and the endothelium promotes thrombo-fibrotic lead encapsulations (26,27) which can cause complications in the case of the indicated lead explantation (21,(28)(29)(30).…”

Section: Significance Of the Coronary Vein Morphology In Crtmentioning

confidence: 99%

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Keiler

Meinel

Ortak

et al. 2020

Front. Cardiovasc. Med.

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Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20–70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.

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“…Likewise, the next generation of pacemakers, i.e., leadless pacemakers directly implanted into the heart are designed to be removed. Nonetheless, there is no doubt that without any smart coating those devices will be encapsulated by fibrotic tissues after long‐term implantation . Indeed, one of the first phenomena implicated in the body response to an implant is the interfacial interactions.…”

Section: Existing Types Of “Classical” Implanted Medical Devices Estamentioning

confidence: 99%

“…The extraction procedure is more risky for pacemaker leads in long‐term implantation, especially for children because of the adherence appearing at the interface between the lead and the surrounding tissues . Likewise, the next generation of pacemakers, i.e., leadless pacemakers directly implanted into the heart are designed to be removed.…”

Section: Existing Types Of “Classical” Implanted Medical Devices Estamentioning

confidence: 99%

Tackling the Concept of Symbiotic Implantable Medical Devices with Nanobiotechnologies

Alcaraz

Cinquin

Martin

2018

Biotechnology Journal

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This review takes an approach to implanted medical devices that considers whether the intention of the implanted device is to have any communication of energy or materials with the body. The first part describes some specific examples of three different classes of implants, analyzed with regards to the type of signal sent to cells. Through several examples, the authors describe that a one way signaling to the body leads to encapsulation or degradation. In most cases, those phenomena do not lead to major problems. However, encapsulation or degradation are critical for new kinds of medical devices capable of duplex communication, which are defined in this review as symbiotic devices. The concept the authors propose is that implanted medical devices that need to be symbiotic with the body also need to be designed with an intended duplex communication of energy and materials with the body. This extends the definition of a biocompatible system to one that requires stable exchange of materials between the implanted device and the body. Having this novel concept in mind will guide research in a new field between medical implant and regenerative medicine to create actual symbiotic devices.

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Neointimal fibrotic lead encapsulation – Clinical challenges and demands for implantable cardiac electronic devices

Cited by 38 publications

References 170 publications

Histological properties of oscillating intracardiac masses associated with cardiac implantable electric devices

Histological properties of oscillating intracardiac masses associated with cardiac implantable electric devices

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Tackling the Concept of Symbiotic Implantable Medical Devices with Nanobiotechnologies

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