Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper

Deharo, Jean‐Claude; Bongiorni, Maria Grazia; Rozkovec, A.; Bracke, Frank; Defaye, Pascal; Fernández‐Lozano, Ignacio; Golzio, Pier Giorgio; Hansky, Bert; Kennergren, Charles; Manolis, Antonis S.; Mitkowski, Przemysław; Platou, Eivind S.; Love, Charles J.; Wilkoff, Bruce L.

doi:10.1093/europace/eur338

Cited by 172 publications

(119 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…41,42 Complete device and lead removal is also reasonable in patients with persistent occult Gram-negative bacteria, but is not indicated for superficial or incisional infection without involvement of the device and/or leads, nor to treat chronic bacteraemia due to a source other than the CIED, when the source could not be eliminated and long-term antibiotic treatment is required. 41 Satisfactory control of the infection is required before implantation of a replacement device may be considered.…”

Section: Management Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

“…50 Factors associated with increased procedural complications (not mortality) risk include body mass index (BMI) <25 kg/m 2 , damaged leads and ICD leads. 42 Predictors of major complications associated with TLE include cerebrovascular disease, ejection fraction ≤15 %, lower platelet count, international normalised ratio ≥1.2, mechanical sheaths and powered sheaths. 51 Thirty-day all-cause mortality following TLE has been associated with BMI, haemoglobin, end-stage renal disease left ventricular ejection fraction, New York Heart Association (NYHA) functional class, extraction for infection, number of prior lead extractions performed by the operator and extraction of a dual-coil defibrillator lead.…”

Section: Management Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Implantable Electronic Device Infection in Patients at Risk

Tarakji

Ellis

Defaye

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Device TherapyOver the last few decades an increasing body of evidence has supported the role of cardiovascular implantable electronic devices However, the cost and complications of device implantation, including infection or hardware malfunction in patients receiving CIEDs, have led to the concern that negative outcomes may partially counteract the expected benefits. The rate of CIED infection has been estimated at 0.5 % with primary implants and 1-7 % with secondary interventions.3,5-8 It is difficult to give accurate estimates of infection rates, given the fact that figures are partly based on retrospective series of varying duration, and that different definitions of infection exist. However, the incidence of CIED infection is increasing out of proportion to CIED implantation. 3,5,9 A US study reported a 12 % increase in the number of CIED implantations from 2004 to 2006, with a 57 % increment in CIED infections during the same period. 9Reasons for this rise in CIED infections include the fact that younger patients are receiving CIEDs, and therefore surviving long enough to require more pulse generator changes and lead revisions, which are associated with a higher infection rate. 7,10 In addition, there has been an increase in comorbidities, such as diabetes and kidney disease, resulting in poor wound healing and diminished immune responses. 3,9,11,12 Expanding indications for CIED use, coupled with an ageing population with more comorbidities, mean this trend is likely to increase.2 Better awareness and improved reporting of CIED infections may, however, help to decrease the higher complication rates noted in recent years.CIED infections also impose a substantial financial burden resulting from prolonged hospital stays, long duration of antibiotic therapy, management of sepsis and complications, device extraction and reimplantation.3 These infections typically cost at least $52,000 13 and may exceed $100,000. 14 This article will review strategies for management and prevention of CIED infections, including lead extraction and the use of an absorbable antibacterial envelope. Risk Factors for Cardiac Implantable Electronic Device Infections

show abstract

Section: Management Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Section: Management Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Cardiac Implantable Electronic Device Infection in Patients at Risk

Tarakji

Ellis

Defaye

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

show abstract

“…Before undertaking reimplantation, a careful individual assessment should be carried out to confirm if there is a continued need for a new CIED. 4,32,42 A retrospective review indicated that reimplantation was unnecessary in one-third of cases.…”

Section: Reimplantation Of a Device After Infectionmentioning

confidence: 99%

Management of Cardiac Implantable Electronic Device Infection

Podoleanu

Deharo

2014

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

The increasing use of cardiac implantable electronic devices (CIEDs) for management of cardiac conditions has over the last few years been associated with higher infection rates.1 Expanded CIED use alone cannot account for this rise, 2-4 which involves both patient-and device-related factors. Indeed patients are tending to be older and presenting with co-morbidities, while devices are becoming more sophisticated and requiring more leads and revision. 6 In terms of patient demographics, the occurrence of CIED infection was greatest in white males over 65 years of age, and the most significant associated co-morbidities were renal failure, respiratory failure, heart failure and diabetes. The greatest risk factors for mortality were respiratory failure (odds ratio [OR] 13.58; 95 % confidence interval [CI] 12.88-14.3), renal failure (OR 4.28; 95 % CI 4.04-4.53) and heart failure (OR 2.71; 95 % CI 2.54-2.88). Post-operative haematoma was more frequent in patients who developed infection. Sites reporting higher infection rates had sicker patients and lower overall procedure volumes. AbstractDespite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.

show abstract

“…In a recent review of 189 patient admitted in a single tertiary center with device infection, pocket infection was present in 52% of them while 17% had evidence of pocket infection with blood stream infection and 23% had developed device-related endocarditis [24] Finally, even in patients presenting with an erosion of the pocket, as a consequence of infection or mechanical pressure or both, the system should be considered contaminated and has to be completely removed. Of note, adherence of the generator or leads to the skin often proceeds erosion and is an indication for extraction too (Figure 4) [6,15]. Nevertheless, a few authors may still advocate a conservative approach with debridement and chronic antibiotic administration in elderly, infirmary patients with a limited life expectancy [25].…”

Section: Indications For Lead Extractionmentioning

confidence: 99%

“…Both European and American Societies of Electrophysiology have set standards for training and accreditation in order to overcome these limitations. Generally, a minimum of 40 lead extractions as the primary operator is required to be considered fully trained, and 20 leads per year is needed to maintain competency [6,15]. …”

Section: Introductionmentioning

confidence: 99%