ABSTRACT
Background: Older pacemaker systems, which are magnetic resonance imaging (MRI) incompatible, require replacement with compatible systems when patients are in need of MRI. Replacement involves extraction of the pacing lead, which is usually done with a laser sheath under general anesthesia.Case presentation: We report two cases of complete pacing system replacements allowing patient access to MRI. Both replacements were made under local anesthesia and without the use of special devices over 6 years after the initial surgery. Both replacements used retractable screw-in leads with a cut-down of cephalic or external jugular veins performed during the initial surgeries. Case 1 involved a 79-year-old man with cerebral ischemia, and case 2 involved a 70-year-old man with spinal canal stenosis.Conclusion: With careful management, it is possible to replace an entire pacing system under local anesthesia without additional devices.
ABSTRACT
Objective: To explore the safety and efficacy of a novel lead locking device (LLD) in the procedure of cardiac lead extraction for heart rhythm implants. Methods: A total of 6 patients using LLD for cardiac lead extraction in our hospital were retrospectively reviewed. Clinical parameters, the reason of cardiac lead extraction, lead locking stylet condition, outcome of lead extraction and operative complications were summarized. Results: There were 6 patients including 1 female with the median age at 62.5 years. LLD was used and 13 cardiac leads were extracted including 1 scrap electrode wire and 12 functional electrode wire. Among those, LLD was successfully inserted and locked on the top of 11/13 (85%) leads for whole procedure and 2 (15%) leads were not locked for whole procedure; 12 (92 %) leads were completely removed and 1 (8%) lead was partially removed. No severe complications occurred. Conclusion: The novel LLD may safely and effectively extract electrode lead which is beneficial for complete cardiac lead extraction.
ABSTRACT
BACKGROUND: Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased. METHODS: This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed. RESULTS: 62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value or = 2 years). Of the CIED implanted for > or = 2 years, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction. CONCLUSION: Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.
Subject(s)
Humans , Aging , Echocardiography , Echocardiography, Doppler , Fibrosis , Mass Screening , Outpatients , Retrospective Studies , Vena Cava, SuperiorABSTRACT
Transvenous pacemaker lead extraction (TLE) techniques for pacemaker lead infection have developed in recent years. Several minimally invasive methods for TLE have been devised, but fatal complications are not rare in these procedures. We present the case of a 26-year-old woman with Brugada syndrome referred to our hospital with wound infection, 3 years after implantation. She had the 2 infected leads completely removed with laser sheaths and underwent antibiotic therapy. On post operative day 8, pulsatile mass with thrilling was noted at the suprasternal notch. Enhanced CT examination revealed the fistula between the brachiocephalic artery and vein (AVF). Operation was scheduled to close the fistula. Early in the morning of the scheduled operation day, extensive bleeding from the ruptured mass on the suprasternal notch occurred and emergency operation was done to suture the bleeding point and ligate both side of the fistula of the brachiocephalic vein, using an occlusion balloon inserted into the brachiocephalic artery. The postoperative course was uneventful. AVF after TLE is a rare complication. Although the cardiac implantable electronic device can provide life-saving benefits, device-associated complications should be managed carefully.
ABSTRACT
Non-typhoidal salmonella is rarely the cause of pacemaker infection. A 68-year-old man was referred to our hospital with tenderness and swelling at his cardiac resynchronization therapy defibrillator (CRT-D) implantation site. He had undergone CRT-D implantation because of sustained ventricular tachycardia and heart failure 7 years earlier, and the generator had been changed 2 months earlier. Twenty-four years earlier, he had undergone aortic valve replacement and mitral valve repair. We removed the generator and all of the CRT-D leads. After lead extraction, non-typhoidal salmonella serogroup B was cultured at the pocket and lead tip. The patient was managed successfully with lead extraction and antibiotic therapy.