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.
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.
Authors: Aina Hognestad; Annika Michelsen; Frank Brosstad; Jan K Damås; Torbjørn Holm; Svein Simonsen; John K Kjekshus; Pål Aukrust; Arne K Andreassen Journal: Clin Transplant Date: 2004-04 Impact factor: 2.863
Authors: Christian G Wollmann; Dirk Böcker; Andreas Löher; Julia Köbe; Hans H Scheld; Günter E Breithardt; Rainer Gradaus Journal: Pacing Clin Electrophysiol Date: 2005-08 Impact factor: 1.976
Authors: Krzysztof Kuśmierski; Andrzej Przybylski; Artur Oręziak; Małgorzata Sobieszczańska-Małek; Piotr Kołsut; Jacek Różański Journal: Kardiol Pol Date: 2013 Impact factor: 3.108
Authors: Michael Glikson; Mahmoud Suleiman; David M Luria; Marjorie L Martin; David O Hodge; Win-Kuang Shen; David J Bradley; Thomas M Munger; Robert F Rea; David L Hayes; Stephen C Hammill; Paul A Friedman Journal: Heart Rhythm Date: 2008-10-11 Impact factor: 6.343
Authors: Raymond L Benza; Matthew A Cavender; Joseph Barchue; Jose A Tallaj; Robert C Bourge; James K Kirklin; Christopher S Coffey Journal: J Heart Lung Transplant Date: 2007-05 Impact factor: 10.247
Authors: Bach T Nguyen; Bhumi Bhusal; Amir Ali Rahsepar; Kate Fawcett; Stella Lin; Daniel S Marks; Rod Passman; Donny Nieto; Richard Niemzcura; Laleh Golestanirad Journal: Magn Reson Med Date: 2021-12-27 Impact factor: 3.737