Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction

Tarakji, Khaldoun G.; Saliba, Walid; Markabawi, Danny; Rodríguez, E. René; Krauthammer, Yoaav; Brunner, Michael; Hussein, Ayman A.; Baranowski, Bryan; Cantillon, Daniel J.; Kanj, Mohamed; Niebauer, Mark; Rickard, Jack; Callahan, Thomas; Shao, Mingyuan; Martin, David O.; Wazni, Oussama; Wilkoff, Bruce L.; Tan, Carmela D.

doi:10.1016/j.hrthm.2017.11.008

Cited by 18 publications

(11 citation statements)

References 22 publications

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“…This should, however, be interpreted with caution as microscopic evaluation of extracted leads by Tarakji and colleagues showed that over 15% of the patients showed signs of (often transmural) focal venous injury. Interestingly, only five major clinical complications (1.1%) occurred in that study population 19 . More research is needed to evaluate the effects of TLE induced endothelial damage.…”

Section: Discussionmentioning

confidence: 80%

Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach

Lensvelt

Egorova

Schalij

et al. 2020

Pacing Clinical Electrophis

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The aim of this study was to evaluate the efficacy and safety of the stepwise mechanical transvenous lead extraction approach in a patient population with chronically implanted transvenous leads with a long dwell time. From January 2014 till December 2018, all lead extractions with lead dwell time ≥5 years performed at our tertiary centre were retrospectively analysed. A total of 173 leads, from 78 patients (median age 68 years; 81% male) with a median dwell time of 9 years (interquartile range [IQR] 5) were extracted, with three or more leads in 42% of the patients. Right atrial leads: 41%; right ventricular pacing leads: 16%; implantable cardioverter‐defibrillator (ICD) leads: 31% (72% dual coil); coronary sinus leads: 12%. The majority (75%) of the leads had an active fixation. Most frequent indication for extraction was pocket infection/erosion (76%). Overall clinical success was 97%, and complete procedural success was 93%. Venous patency, assessed with venous angiography, was well preserved in 93% of the cases. The overall procedural complication rate was 3.8% (2.6% major and 1.3% minor). Despite the complexity of the population and a very long dwell time (median 9 years), a clinical success rate of 97% was achieved with the stepwise mechanical approach. Analysis of impeding progression of pectoral extraction suggests that dense fibrosis and sharp lead curvature in the transvenous trajectory pose a challenge. Complication rate was low, and acute venous patency was generally well preserved.

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Section: Discussionmentioning

confidence: 80%

Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach

Lensvelt

Egorova

Schalij

et al. 2020

Pacing Clinical Electrophis

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“…In all patients transvenous lead placement results in encasement of the lead by fibrous tissue. In a Cleveland Clinic study, 6 861 extracted device leads of more than 1 year were examined histologically revealing dense fibrous tissue with the presence of calcification. In locations where the lead irritates the endothelium the inflammatory cascade results in proliferation of connective tissue attaching the lead to the vein (fibrous binding sites).…”

Section: Discussionmentioning

confidence: 99%

Paclitaxel coated balloon fibroplasty: A more effective treatment for chronic symptomatic lead/catheter related central venous obstruction?

Yacob

Worley

Brar

et al. 2021

Cardiovasc electrophysiol

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“…Adhesion caused by thrombo-fibrotic lead encapsulations (TFLE) is a serious secondary complication in cardiac arrhythmia treatment based on implantable electronic devices with transvenous leads (TVL) (37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

“…Despite ongoing progress in enhancing lead design reducing technical defects such as fractures and insulation defects, TLE is necessary for an infinitive period, particularly due to leadrelated infections. As a consequence, excessive TFLE persist as a serious challenge interfering with TLE, causing higher costs (51) and periprocedural risks (39), e.g., for vein injury (38). However, we actually assent to the view that moderate TFLE adhesions are desirable for leads due to a certain mechanical stability after implantation (24).…”

Section: Future Perspectivesmentioning

confidence: 99%

Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients—A Post Mortem Study

Keiler

Schulze

Dreger

et al. 2020

Front. Cardiovasc. Med.

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The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1–2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.

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Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction

Abstract: Microscopic venous injuries during lead extraction are common but often not recognized clinically.

Cited by 18 publications

References 22 publications

Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach

Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach

Paclitaxel coated balloon fibroplasty: A more effective treatment for chronic symptomatic lead/catheter related central venous obstruction?

Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients—A Post Mortem Study

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