TY - JOUR
T1 - Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem
AU - Holzhauser, Luise
AU - Imamura, Teruhiko
AU - Nayak, Hemal M.
AU - Sarswat, Nitasha
AU - Kim, Gene
AU - Raikhelkar, Jayant
AU - Kalantari, Sara
AU - Patel, Amit
AU - Onsager, David
AU - Song, Tae
AU - Ota, Takeyoshi
AU - Jeevanandam, Valluvan
AU - Sayer, Gabriel
AU - Uriel, Nir
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Background: Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Methods: We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). Results: A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P <.05 for all). Lead implantation time was identified as an independent predictor for RLFs (P <.05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P <.04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. Conclusion: RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
AB - Background: Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Methods: We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). Results: A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P <.05 for all). Lead implantation time was identified as an independent predictor for RLFs (P <.05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P <.04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. Conclusion: RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.
KW - Heart transplantation
KW - deep venous thrombosis (DVT)
KW - magnetic resonance imaging (MRI)
KW - retained ICD leads
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U2 - 10.1016/j.cardfail.2017.12.012
DO - 10.1016/j.cardfail.2017.12.012
M3 - Article
C2 - 29325797
AN - SCOPUS:85041505920
SN - 1071-9164
VL - 24
SP - 101
EP - 108
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 2
ER -