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

JOURNAL OF CARDIAC FAILURE

卷:24

Article

Holzhauser, Luise¹  Imamura, Teruhiko¹  Nayak, Hemal M.¹  Sarswat, Nitasha¹  Kim, Gene¹  Raikhelkar, Jayant¹  Kalantari, Sara¹  Patel, Amit¹  Onsager, David²  Song, Tae²  Ota, Takeyoshi²  Jeevanandam, Valluvan²  Sayer, Gabriel¹  Uriel, Nir¹ 

[1] Univ Chicago, Dept Med, Div Cardiol, 5841 S Maryland Ave, Chicago, IL 60637 USA

[2] Univ Chicago, Dept Surg, Div Cardiothorac Surg, 5841 S Maryland Ave, Chicago, IL 60637 USA

关键词: Heart transplantation;    retained ICD leads;    deep venous thrombosis (DVT);    magnetic resonance imaging (MRI);   

DOI  :  10.1016/j.cardfail.2017.12.012

来源: Elsevier

【 摘 要 】

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 a 1). 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.

【 授权许可】

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