Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem

Luise Holzhauser, Teruhiko Imamura, Hemal M. Nayak, Nitasha Sarswat, Gene Kim, Jayant Raikhelkar, Sara Kalantari, Amit Patel, David Onsager, Tae Song, Takeyoshi Ota, Valluvan Jeevanandam, Gabriel Sayer, Nir Uriel

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)101-108
Number of pages8
JournalJournal of Cardiac Failure
Volume24
Issue number2
DOIs
StatePublished - Feb 2018
Externally publishedYes

Keywords

  • Heart transplantation
  • deep venous thrombosis (DVT)
  • magnetic resonance imaging (MRI)
  • retained ICD leads

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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