Transvenous Pacemaker Lead Removal Is Safe and Effective Even in Large Vegetations: An Analysis of 53 Cases of Pacemaker Lead Endocarditis

Ruttmann, Elfriede; Hangler, Herbert; Kilo, Juliane; Höfer, Daniel; Müller, Ludwig; Hintringer, Florian; Müller, Silvana; Laufer, Günther; Antretter, Herwig

doi:10.1111/j.1540-8159.2006.00328.x

Cited by 89 publications

(56 citation statements)

References 26 publications

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“…Niektórzy autorzy sugerują leczenie operacyjne u pacjentów z bardzo dużymi wegetacjami [405]. Dopóki nie pojawią się dodatkowe dane, decyzję dotyczącą przezskórnego versus chirurgicznego usunięcia elektrod w przypadku wegetacji o rozmiarach > 2 cm należy podejmować indywidualnie w odniesieniu do poszczególnych chorych.…”

Section: Usunięcie Układu W Całości (Usunięcie Urządzenia I Elektrod)unclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

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Section: Usunięcie Układu W Całości (Usunięcie Urządzenia I Elektrod)unclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

View full text Add to dashboard Cite

“…Pulmonary embolism occurred in 5 patients (55%), but survival and length of hospitalization were not influenced by this complication. Ruttmann et al 27 described the safe and highly effective procedure in patients with vegetations >10 mm (mean vegetation, 1.78 ± 0.6 cm). They recommended that patients with vegetations larger than 2.5 cm should undergo open surgery lead removal.…”

Section: Discussionmentioning

confidence: 99%

Transvenous Extraction of Pacemaker Leads in Infective Endocarditis With Vegetations ≥20 mm: Our Experience

Baztarrica

Gariglio

Salvaggio

et al. 2011

Clinical Cardiology

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Background: According to published evidence, treatment of infective endocarditis (IE) associated with cardiovascular implantable electronic devices (CIEDs) should include complete removal of the system. Several publications have shown that transvenous removal is an effective and safe nonthoracotomy approach in patients with large vegetations, but experiences with vegetations larger than 20 mm have rarely been reported. Hypothesis: Our aim was to describe our experience in percutaneous removal of CIEDs in patients with IE with large vegetations. Methods: The data were collected retrospectively and analyzed prospectively. We evaluated in-hospital morbidity and mortality related to percutaneous removal of vegetations ≥20 mm. This included 8 cases with a follow-up period of 20 months. We removed 100% of leads in the study population. Results: Two patients experienced minor complications. No patient experienced subclavian vein laceration, hemothorax and lead fracture, or severe tricuspid regurgitation. After the removal procedure, 2 patients had symptoms compatible with pulmonary embolism. Both in-hospital mortality and mortality at follow-up were zero. Conclusions: Transvenous extraction of pacing leads with larger vegetations is a feasible technique. There was a tendency toward symptomatic pulmonary embolism in patients with vegetations larger than 20 mm; however, morbidity and mortality were not influenced. We agree with the consensus that this procedure is highly useful and that the selection of the removal techniques will depend not only on the size of vegetation but also on prior cardiopulmonary conditions, concomitant cardiac surgery, atrial septal defect with risk of paradoxical embolism, center experience, and the possibility of complete removal of the device. IntroductionSeveral publications and scientific lectures on percutaneous extraction of cardiovascular implantable electronic devices (CIEDs) in patients with infective endocarditis (IE) have focused on factors associated with complications related to the procedure. Investigators have discussed fibrosis around the electrode and adherence to the surrounding cardiac tissue (myocardium, tricuspid valve, and vein) with risk of damage during removal.

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“…On the contrary, systemic lead infection seems to counteract or dissolve fibrotic adherences. Current literature suggests that, the best outcome is achieved with percutaneous removal of infected devices by applying external traction on the leads (Sohail et al 2007;Ruttmann et al 2006). However, while simple traction is often successful in newly placed leads, it can be problematic with chronic leads and cause catastrophic complications, ranging from septic embolic phenomena to tricuspid valve injury, subclavian vein laceration, hemothorax, pocket hematoma, massive hemorrhage, and lead fracture requiring urgent surgical intervention (Sohail et al 2007;Ruttmann et al 2006;Panidis et al 1984).…”

Section: Technique Of Extraction: Surgical or Percutaneous?mentioning

confidence: 99%

“…Current literature suggests that, the best outcome is achieved with percutaneous removal of infected devices by applying external traction on the leads (Sohail et al 2007;Ruttmann et al 2006). However, while simple traction is often successful in newly placed leads, it can be problematic with chronic leads and cause catastrophic complications, ranging from septic embolic phenomena to tricuspid valve injury, subclavian vein laceration, hemothorax, pocket hematoma, massive hemorrhage, and lead fracture requiring urgent surgical intervention (Sohail et al 2007;Ruttmann et al 2006;Panidis et al 1984). Damage to the left sided cardiac structures is rare but may be a complication of an infected lead extraction, manifesting as iatrogenic ventricular septum disruption with consequent aortic valve leaflet prolapse and massive acute aortic regurgitation ( fig.3) (Rossi et al 2011).…”

Section: Technique Of Extraction: Surgical or Percutaneous?mentioning

confidence: 99%