المؤلفون: Barakat AF; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Wazni OM; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Tarakji KG; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Callahan T; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Nimri N; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Saliba WI; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Shah S; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Abdur Rehman K; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Rickard J; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Brunner MP; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Martin DO; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Kanj M; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Baranowski B; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Cantillon D; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Niebauer M; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Dresing T; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Lindsay BD; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Wilkoff BL; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH., Hussein AA; From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH. husseia@ccf.org.

المصدر: Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2018 Jan; Vol. 11 (1), pp. e005706.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101474365 Publication Model: Print Cited Medium: Internet ISSN: 1941-3084 (Electronic) Linking ISSN: 19413084 NLM ISO Abbreviation: Circ Arrhythm Electrophysiol Subsets: MEDLINE

مواضيع طبية MeSH: Renal Dialysis*, Catheterization, Peripheral/*methods , Defibrillators, Implantable/*adverse effects , Device Removal/*methods , Heart Diseases/*therapy , Pacemaker, Artificial/*adverse effects , Renal Insufficiency, Chronic/*complications, Aged ; Equipment Failure ; Female ; Follow-Up Studies ; Heart Diseases/complications ; Heart Diseases/mortality ; Humans ; Male ; Renal Insufficiency, Chronic/mortality ; Renal Insufficiency, Chronic/therapy ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Treatment Outcome ; United States/epidemiology

مستخلص: Background: Cardiac implantable electronic device infections have been on the rise. A high-risk population is that with renal disease, especially dialysis. We aimed to assess procedural profiles and clinical outcomes of transvenous lead extraction for cardiac implantable electronic device infection based on renal disease status.
Methods and Results: In 1420 consecutive patients undergoing transvenous lead extraction of infected cardiac implantable electronic devices (1996-2012), we assessed procedural profiles and clinical outcomes in 3 groups: normal renal function (group 1, n=1159), renal dysfunction not requiring dialysis (group 2, n=163), and dialysis (group 3, n=98). A total of 3182 infected leads were extracted. Dialysis patients had shorter lead dwell times and were less likely to require transvenous lead extraction tools but as likely to require femoral workstations. There were higher overall rates of procedure-related complications in dialysis patients (12% versus ≈6% in nondialysis) with no difference in the major complication rates ( P =not significant). Complete procedural success rates were 94%, 96%, and 94% in groups 1, 2, and 3, respectively ( P =not significant). There were 4 intraprocedural deaths in group 1 versus none in groups 2 and 3. Mortality rates were significantly higher in dialysis patients both at 1 and 6 months ( P <0.0001 for both). In multivariable analyses, dialysis status was independently associated with increased mortality risk at 1 and 6 months. Other factors associated with mortality were lead material retention, functional (New York Heart Association) class, and occurrence of procedural complications.
Conclusions: In patients with cardiac implantable electronic device infection, dialysis status did not seem to add complexity to transvenous lead extraction but was independently associated with increased mortality at 1 and 6 months.
(© 2018 American Heart Association, Inc.)

المؤلفون: Barakat AF; Department of Medicine, Cleveland Clinic, Cleveland, Ohio., Wazni OM; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Tarakji K; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Saliba WI; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Nimri N; Department of Medicine, Cleveland Clinic, Cleveland, Ohio., Rickard J; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Brunner M; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Bhargava M; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Kanj M; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Baranowski B; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Martin DO; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Cantillon D; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Callahan T; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Dresing T; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Niebauer M; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Chung M; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Lindsay BD; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Wilkoff B; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Hussein AA; Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: husseia@ccf.org.

المصدر: Heart rhythm [Heart Rhythm] 2017 Dec; Vol. 14 (12), pp. 1807-1811. Date of Electronic Publication: 2017 Aug 23.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE

مواضيع طبية MeSH: Catheterization, Peripheral/*methods , Device Removal/*methods , Electrodes, Implanted/*adverse effects, Aged ; Arrhythmias, Cardiac/therapy ; Equipment Design ; Equipment Failure ; Female ; Follow-Up Studies ; Humans ; Male ; Patient Safety ; Prospective Studies ; Treatment Outcome

مستخلص: Background: The practice of lead abandonment at the time of cardiac implantable electronic device upgrade remains a controversial topic but is affecting an increasing number of patients. Inherent risks include high-risk extractions of redundant leads when extraction is required at a later date.
Objectives: We aimed to report our experience with transvenous lead extraction (TLE) at the time of device upgrade.
Methods: All consecutive TLE procedures at the time of device upgrade at the Cleveland Clinic between January 1, 1996 and December 31, 2012 were included (n = 503). Success and complications were defined according to the Heart Rhythm Society consensus document on TLE.
Results: There were a total of 984 leads in place, and 719 were targeted with extraction (589 pacer and 130 defibrillator leads, 63 of them being dual-coil leads). In all patients, TLEs aimed to avoid abandoning leads. Concomitant lead management issues included lead malfunction (15%), previously abandoned leads (9%), vascular access occlusion (6%), or leads on advisory (3%). In most procedures (75.4%), special extraction tools were needed. The complete procedural and clinical success rates were 96.6% and 97.2%, respectively. During planned extractions, damage of coexisting leads occurred in 19 patients (3.8%), eventually requiring extraction. The major and minor complication rates were 1% and 1.4%, respectively.
Conclusion: In a high-volume center, TLEs at the time of device upgrade were successful in the vast majority of patients with a low complication rate.
(Copyright © 2017. Published by Elsevier Inc.)