Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram.
Publication/Presentation Date
3-2-2010
Abstract
OBJECTIVES: We describe the feasibility, safety, and clinical outcomes of percutaneous lead extraction in patients at a tertiary care center who had intracardiac vegetations identified by transesophageal echocardiogram.
BACKGROUND: Infection in the presence of intracardiac devices is a problem of considerable morbidity and mortality. Patients with intracardiac vegetations are at high risk for complications related to extraction and protracted clinical courses. Historically, lead extraction in this cohort has been managed by surgical thoracotomy.
METHODS: We analyzed percutaneous lead extractions performed from January 1991 to September 2007 in infected patients with echocardiographic evidence of intracardiac vegetations, followed by a descriptive and statistical analysis.
RESULTS: A total of 984 patients underwent extraction of 1,838 leads; local or systemic infection occurred in 480 patients. One hundred patients had intracardiac vegetations identified by transesophageal echocardiogram, and all underwent percutaneous lead extraction (215 leads). Mean age was 67 years. Median extraction time was 3 min per lead; median implant duration was 34 months. During the index hospitalization, a new device was implanted in 54 patients at a median of 7 days after extraction. Post-operative 30-day mortality was 10%; no deaths were related directly to the extraction procedure.
CONCLUSIONS: Patients with intracardiac vegetations identified on transesophageal echocardiogram can safely undergo complete device extraction using standard percutaneous lead extraction techniques. Permanent devices can safely be reimplanted provided blood cultures remain sterile. The presence of intracardiac vegetations identifies a subset of patients at increased risk for complications and early mortality from systemic infection despite device extraction and appropriate antimicrobial therapy.
Volume
55
Issue
9
First Page
886
Last Page
894
ISSN
1558-3597
Published In/Presented At
Grammes, J. A., Schulze, C. M., Al-Bataineh, M., Yesenosky, G. A., Saari, C. S., Vrabel, M. J., Horrow, J., Chowdhury, M., Fontaine, J. M., & Kutalek, S. P. (2010). Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram. Journal of the American College of Cardiology, 55(9), 886–894. https://doi.org/10.1016/j.jacc.2009.11.034
Disciplines
Medicine and Health Sciences
PubMedID
20185039
Department(s)
Department of Medicine
Document Type
Article