Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram
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 cons...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2010-03, Vol.55 (9), p.886-894 |
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| creator | Grammes, Jon A., DO Schulze, Christopher M., DO Al-Bataineh, Mohammad, MD Yesenosky, George A., MD Saari, Christine S., MSN, CRNP Vrabel, Michelle J., MSN, CRNP Horrow, Jay, MD, MS Chowdhury, Mashiul, MD Fontaine, John M., MD Kutalek, Steven P., MD |
| description | 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. |
| doi_str_mv | 10.1016/j.jacc.2009.11.034 |
| format | Article |
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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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2009.11.034</identifier><identifier>PMID: 20185039</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; cardiac device infection ; Cardiology ; Cardiovascular ; cardioverter-defibrillator ; Catheterization - methods ; Colorectal cancer ; Defibrillators, Implantable - adverse effects ; Device Removal - methods ; Echocardiography, Transesophageal ; Electrocardiography ; endocarditis ; Female ; Follow-Up Studies ; Hospitalization ; Hospitals ; Humans ; Incidence ; Internal Medicine ; intravascular infection ; Male ; Middle Aged ; Mortality ; Ostomy ; pacemaker ; Pacemaker, Artificial - adverse effects ; Patients ; Pennsylvania - epidemiology ; percutaneous lead extraction ; Population ; Postoperative period ; Prosthesis-Related Infections - diagnosis ; Prosthesis-Related Infections - epidemiology ; Prosthesis-Related Infections - surgery ; Retrospective Studies ; Sepsis ; Staphylococcus infections ; Survival Rate ; Tachycardia - therapy ; Transplants & implants ; Treatment Outcome ; Vegetation ; vegetations ; Young Adult</subject><ispartof>Journal of the American College of Cardiology, 2010-03, Vol.55 (9), p.886-894</ispartof><rights>American College of Cardiology Foundation</rights><rights>2010 American College of Cardiology Foundation</rights><rights>Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2, 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-26f5f85ee87982fcfdfde933901083de8860e2ed692468bc2bc3733d4a99bc93</citedby><cites>FETCH-LOGICAL-c482t-26f5f85ee87982fcfdfde933901083de8860e2ed692468bc2bc3733d4a99bc93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109709040650$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20185039$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grammes, Jon A., DO</creatorcontrib><creatorcontrib>Schulze, Christopher M., DO</creatorcontrib><creatorcontrib>Al-Bataineh, Mohammad, MD</creatorcontrib><creatorcontrib>Yesenosky, George A., MD</creatorcontrib><creatorcontrib>Saari, Christine S., MSN, CRNP</creatorcontrib><creatorcontrib>Vrabel, Michelle J., MSN, CRNP</creatorcontrib><creatorcontrib>Horrow, Jay, MD, MS</creatorcontrib><creatorcontrib>Chowdhury, Mashiul, MD</creatorcontrib><creatorcontrib>Fontaine, John M., MD</creatorcontrib><creatorcontrib>Kutalek, Steven P., MD</creatorcontrib><title>Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>cardiac device infection</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>cardioverter-defibrillator</subject><subject>Catheterization - methods</subject><subject>Colorectal cancer</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Device Removal - methods</subject><subject>Echocardiography, Transesophageal</subject><subject>Electrocardiography</subject><subject>endocarditis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>intravascular infection</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>pacemaker</subject><subject>Pacemaker, Artificial - adverse effects</subject><subject>Patients</subject><subject>Pennsylvania - epidemiology</subject><subject>percutaneous lead extraction</subject><subject>Population</subject><subject>Postoperative period</subject><subject>Prosthesis-Related Infections - diagnosis</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Prosthesis-Related Infections - surgery</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Staphylococcus infections</subject><subject>Survival Rate</subject><subject>Tachycardia - therapy</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Vegetation</subject><subject>vegetations</subject><subject>Young Adult</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kl-LEzEUxQdR3G71C_ggAR98mnqTdDITEEFq1ULBBYs-hkxyp013_nSTdLEfab-lme2qsA8-5SG_c7j3nJtlryjMKFDxbj_ba2NmDEDOKJ0Bnz_JJrQoqpwXsnyaTaDkRU5BlhfZZQh7ABAVlc-zCwa0KoDLSXZ3hd4co-5xOAZypQ12-ho90b0lq-7Q6j7qukWy0N664RZ9RJ9_wsbV3rWtjoMna9SWLH9Fr010Q09cTyhA8ooO-xjITxd3ZNWP_6OJNuQHbjHqEQ5k9OrRkvpENl73AcNw2Okt6pYszW64lwxbr7sX2bNGtwFfPrzTbPN5uVl8zdffvqwWH9e5mVcs5kw0RVMViFUpK9aYxjYWJecSKFTcYlUJQIZWSDYXVW1YbXjJuZ1rKWsj-TR7e7Y9-OHmiCGqzgWDadf7iFRiRSmFpIl884jcD0ffp9kULUAwUZQJnmbsTBk_hOCxUQfvOu1PioIaa1R7NdaoxhoVpSrVmESvH6yPdYf2r-RPbwl4fwYwJXHr0KtgUtoGrfNoorKD-7__h0dy07reGd1e4wnDvz1UYArU9_GQxjsCCXMQaYLfrJDF6Q</recordid><startdate>20100302</startdate><enddate>20100302</enddate><creator>Grammes, Jon A., DO</creator><creator>Schulze, Christopher M., DO</creator><creator>Al-Bataineh, Mohammad, MD</creator><creator>Yesenosky, George A., MD</creator><creator>Saari, Christine S., MSN, CRNP</creator><creator>Vrabel, Michelle J., MSN, CRNP</creator><creator>Horrow, Jay, MD, MS</creator><creator>Chowdhury, Mashiul, MD</creator><creator>Fontaine, John M., MD</creator><creator>Kutalek, Steven P., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20100302</creationdate><title>Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram</title><author>Grammes, Jon A., DO ; Schulze, Christopher M., DO ; Al-Bataineh, Mohammad, MD ; Yesenosky, George A., MD ; Saari, Christine S., MSN, CRNP ; Vrabel, Michelle J., MSN, CRNP ; Horrow, Jay, MD, MS ; Chowdhury, Mashiul, MD ; Fontaine, John M., MD ; Kutalek, Steven P., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-26f5f85ee87982fcfdfde933901083de8860e2ed692468bc2bc3733d4a99bc93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>cardiac device infection</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>cardioverter-defibrillator</topic><topic>Catheterization - methods</topic><topic>Colorectal cancer</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Device Removal - methods</topic><topic>Echocardiography, Transesophageal</topic><topic>Electrocardiography</topic><topic>endocarditis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>intravascular infection</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>pacemaker</topic><topic>Pacemaker, Artificial - adverse effects</topic><topic>Patients</topic><topic>Pennsylvania - epidemiology</topic><topic>percutaneous lead extraction</topic><topic>Population</topic><topic>Postoperative period</topic><topic>Prosthesis-Related Infections - diagnosis</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Prosthesis-Related Infections - surgery</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Staphylococcus infections</topic><topic>Survival Rate</topic><topic>Tachycardia - therapy</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Vegetation</topic><topic>vegetations</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grammes, Jon A., DO</creatorcontrib><creatorcontrib>Schulze, Christopher M., DO</creatorcontrib><creatorcontrib>Al-Bataineh, Mohammad, MD</creatorcontrib><creatorcontrib>Yesenosky, George A., MD</creatorcontrib><creatorcontrib>Saari, Christine S., MSN, CRNP</creatorcontrib><creatorcontrib>Vrabel, Michelle J., MSN, CRNP</creatorcontrib><creatorcontrib>Horrow, Jay, MD, MS</creatorcontrib><creatorcontrib>Chowdhury, Mashiul, MD</creatorcontrib><creatorcontrib>Fontaine, John M., MD</creatorcontrib><creatorcontrib>Kutalek, Steven P., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grammes, Jon A., DO</au><au>Schulze, Christopher M., DO</au><au>Al-Bataineh, Mohammad, MD</au><au>Yesenosky, George A., MD</au><au>Saari, Christine S., MSN, CRNP</au><au>Vrabel, Michelle J., MSN, CRNP</au><au>Horrow, Jay, MD, MS</au><au>Chowdhury, Mashiul, MD</au><au>Fontaine, John M., MD</au><au>Kutalek, Steven P., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2010-03-02</date><risdate>2010</risdate><volume>55</volume><issue>9</issue><spage>886</spage><epage>894</epage><pages>886-894</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20185039</pmid><doi>10.1016/j.jacc.2009.11.034</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over cardiac device infection Cardiology Cardiovascular cardioverter-defibrillator Catheterization - methods Colorectal cancer Defibrillators, Implantable - adverse effects Device Removal - methods Echocardiography, Transesophageal Electrocardiography endocarditis Female Follow-Up Studies Hospitalization Hospitals Humans Incidence Internal Medicine intravascular infection Male Middle Aged Mortality Ostomy pacemaker Pacemaker, Artificial - adverse effects Patients Pennsylvania - epidemiology percutaneous lead extraction Population Postoperative period Prosthesis-Related Infections - diagnosis Prosthesis-Related Infections - epidemiology Prosthesis-Related Infections - surgery Retrospective Studies Sepsis Staphylococcus infections Survival Rate Tachycardia - therapy Transplants & implants Treatment Outcome Vegetation vegetations Young Adult |
| title | Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram |
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