Percutaneous removal of transvenous pacemaker leads using an extraction device (original) (raw)
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Surgical Management of Infected Permanent Transvenous Pacemaker Systems: Ten Year Experience
Journal of Cardiac Surgery, 1996
Abstract Background: Between January 1985 and June 1995, more than 1800 consecutive patients underwent implantation of a new permanent cardiac pacemaker at our institution. Thirty-six patients (0.02%) had 45 reinterventions for infected pacemaker systems. Methods: In group A, 24 of 27 patients received simultaneous implantation of a new pacemaker. One had reimplantation of the same pacemaker in the same pocket, and two did not require reimplantation. The leads were retained in 19 (70%) of the patients. In group B, nine patients underwent cardiopulmonary bypass or “pursestring” surgery for removal of an infected pacemaker; a new epicardial pacemaker system was simultaneously implanted in seven patients. Results: Identification of an infectious agent failed in 17 patients (47%), and Staphylococci were found in 15 patients (42%). The time from pacemaker implantation to onset of infection ranged from 1 month to 11 years (mean 31 months; median 19 months) and the time from onset of infection to surgical treatment from 1 month to 7 years (mean 7 months; median 2 months). The mean follow-up time is 74 months (range, 1 month to 10 years; median 5 years). There were 9 reoperations in 3 patients (16%) of group A for recurrent infection of their retained leads ultimately necessitating the use of open cardiac surgery. There was no early death; six patients died late due to unrelated causes. Conclusions: Complete removal of all pacemaker leads is recommended; open heart surgery with the use of cardiopulmonary bypass is indicated in selected cases and is effective and safe.
Journal of Cardiothoracic Surgery, 2009
A 59 year old man underwent mechanical tricuspid valve replacement and removal of pacemaker generator along with 4 pacemaker leads for pacemaker endocarditis and superior vena cava obstruction after an earlier percutaneous extraction had to be abandoned, 13 years ago, due to cardiac arrest, accompanied by silent, unsuspected right atrial perforation and exteriorisation of lead. Postoperative course was complicated by tricuspid valve thrombosis and secondary pulmonary embolism requiring TPA thrombolysis which was instantly successful. A review of literature of pacemaker endocarditis and tricuspid thrombosis along with the relevant management strategies is presented. We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis.
Europace, 2013
After extraction of an infected cardiac implantable electronic device (CIED) in a pacemaker-dependent patient, a temporary pacemaker wire may be required for long periods during antibiotic treatment. Loss of capture and under sensing are commonly observed over time with temporary pacemaker wires, and patient mobility is restricted. The use of an externalized permanent active-fixation pacemaker lead connected to a permanent pacemaker generator for temporary pacing may be beneficial because of improved lead stability, and greater patient mobility and comfort. The aim of this study was to investigate the efficacy and safety of a temporary permanent pacemaker (TPPM) system in patients undergoing transvenous lead extraction due to CIED infection. Methods and results Of 47 patients who underwent lead extraction due to CIED infection over a 2-year period at our centre, 23 were pacemaker dependent and underwent TPPM implantation. A permanent pacemaker lead was implanted in the right ventricle via the internal jugular vein and connected to a TPPM generator, which was secured externally at the base of the neck. The TPPM was used for a mean of 19.4 + 11.9 days (median 18 days, range 3-45 days), without loss of capture or sensing failure in any patient. Twelve of 23 patients were discharged home or to a nursing facility with the TPPM until completion of antibiotic treatment and re-implantation of a new permanent pacemaker. Conclusion External TPPMs are safe and effective in patients requiring long-term pacing after infected CIED removal.
Heart rhythm : the official journal of the Heart Rhythm Society, 2015
Pacemaker (PM) infection in pacing-dependent patients is challenging. Following extraction, temporary pacing is usually utilized before delayed re-implantation (after an appropriate course of antibiotics), resulting in prolonged hospital stays. A single combined procedure of epicardial (EPI) PM implantation and system extraction may avoid this. We evaluated the feasibility and safety of these two approaches by comparing clinical outcome for both strategies over one year. In center 1, 80 consecutive PM-dependent patients underwent extraction with an externalized PM and delayed implantation on the contralateral side (ENDO group). In center 2, 80 consecutive patients had 2 epicardial ventricular leads surgically implanted with extraction of the infected PM during the same procedure (EPI group). Patients were followed up for 12 months. 160 pacing-dependent patients were successfully implanted and extracted (ENDO group: 71±13 yrs, vs EPI group: 73±14, P=NS). In the EPI group, 2 patients ...
Surgical Removal of a Pacemaker Lead Causing Infective Endocarditis: A Case Report
0.4-1.1% of patients having permanent pacemaker implantation suffer serious infections leading to endocarditis. Generally accepted mode of therapy in these group of patients is removal of the infected pacemaker and lead that has caused endocarditis and accomplishing long term antibiotic therapy and accompanied by implantation of a new pacemaker to another anatomic site. A 71 year old female had implantation of permenant pacemaker 8 years ago owing to total AV block which was tended to be removed 1 year ago. However the lead was left in place because of the dense adherences and another pacemaker was introduced through left subclavian vein. Patient then addmited with signs and complaints of infection. Although the newly implanted pacemaker and lead was removed with suspected infection and ampiric antibiotherapy was initiated, clinical signs continued and ecocardiography revealed vegetation on the previously implanted lead. Surgical extraction of the lead was planned and preoperative angiography showed aterosclerotic leison in the circumflex artery. Infected lead was extracted by the use of cardiopulmonary bypass through right atriotomy incision with concommitant bypass and implantation of epicardial DDD-R pacemaker. Postoperative period was uneventful and patient was discharged on 15 th postoperative day without signs of infection.The pacemaker system must be removed in cases of endocarditis owing to the infected pacemaker lead. Simple transvenous extraction has to be avioded especially when the tip of the lead is infected. This method prevents the risk of pulmonary embolisation associated with vegetation and mechanic injury to the tricuspid valve and right ventricule
Pacing and clinical electrophysiology : PACE, 2018
Treatment infections is challenging in pacemaker (PM) dependent patients. We proposed a novel implantation strategy for this group of patients. Patients who were PM dependent and were admitted with a PM infection received a combined procedure of left ventricular (LV) epicardial implantation of a PM lead and subsequent extraction of the infected system. No temporary pacing wire was used and the PM generator was placed in the left flank. Between 2012 and 2015 we treated 16 patients who were PM dependent and with a PM infection. The majority of patients were male (81% [13/16]) and the median age was 71 years (50-91). The cause of infection was valvular endocarditis in 38% (6/16), lead infection in 25% (4/16), and isolated pocket infection in 38% (6/16). All patients underwent epicardial implantation of a LV lead (1084T bipolar lead; St. Jude Medical Myodex, St. Paul, MN, USA) and extraction of the infected device. There was no occurrence of periprocedural mortality and no postprocedura...
Pacing and Clinical Electrophysiology, 1985
MAISCH, B., ET AL.: Extraction of a chronically infected endocardial screw-in pacemaker lead by pigtail catheter and wire loop via the femoral vein. A 7i-year'0ld woman was admitted after partial removal of an infected pacemaker system. Septicemia and subcJavian vein fhromhosis were presenl. With combined use 0/ a pigtail catheter and a wire loop originally developed for endoscopic polypedomy, the infected catheter was pulled into the inferior vena cava. Counterclockwise rotation of the pigtail catheter following its fixation to the electrode by the wire loop aiJowed removal of the tip of the endocardial screvv-in electrode from the myocardium and its extraction. Open heart surgery was avoided and the source of chronic infection was removed. (PACE, Vol. 8, March-Aprii, 1985) infected pacemaker, vein thrombosis, sepdcemia, screw-in electrode Case Report
Europace, 2013
Systemic cardiac implantable electronic device (CIED) infection is a serious complication, especially in patients with pacemaker (PM) dependency. In those patients after infectious device removal temporary pacing is necessary, to obtain adequate haemodynamics. In this study, a new therapy option with temporary pacing by ipsilateral implantation of a new active-fixation right ventricular (RV)-lead was evaluated. Methods and results Between September 2009 and November 2011, infectious lead removal was performed in 17 patients with systemic CIED infection. Temporary pacing was achieved by simultaneous implantation of a new active-fixation RV-lead, which then was connected extracorporally to the old CIED device. Antibiotic therapy was initiated. When laboratory infection parameters were in normal range and blood culture samples showed negative results, new CIED was implanted on contralateral side and temporary RV-lead was removed. Mean patients' age was 71.3 + 9.1 years. Mean C-reactive protein values were 79.3 mg/dL, and mean leucocytes counts were 12.6 × 10 3. After lead extraction, temporary pacing was necessary in all patients due to severe bradycardia. Mean duration of temporary pacing was 12.7 (6-24) days. No major procedure-related peri-or post-operative adverse events occurred. Mean time of hospitalization was 20.8 (10-48) days. Mean follow-up time was 21.1 months (12-36), showing survival rate of 100% and freedom from reinfection in all patients. Conclusion Ipsilateral implantation of a temporary active-fixation RV-lead connected to an externalized PM and pursued antibiotic therapy seems to be a good option for patients with CIED infection and PM dependency, showing no temporary pacing-related complications and no reinfection after mean follow-up time of 21.1 months.