Frequency and clinical impact of retained implantable cardioverter defibrillator lead materials in heart transplant recipients

Abstract

End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.

Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

“…The overall incidence was 16.2%, which is on the lower end of prevalence as compared to prior reports (16.1-47.5%) 3,4,8. The overall incidence was 16.2%, which is on the lower end of prevalence as compared to prior reports (16.1-47.5%) 3,4,8.…”

“…1 Heart transplantation is an accepted treatment option for stage D heart failure, and more than 4000 heart transplants are performed each year worldwide. [3][4][5][6][7][8] The purpose of our study was to evaluate the prevalence of retained CIED fragments in patients undergoing heart transplantation at our institution, and to identify risk factors and associated complications. Nevertheless, sometimes complete extraction is not possible and ICD coils or lead fragments are left behind.…”

“…[3][4][5][6][7][8] The purpose of our study was to evaluate the prevalence of retained CIED fragments in patients undergoing heart transplantation at our institution, and to identify risk factors and associated complications. 1 Heart transplantation is an accepted treatment option for stage D heart failure, and more than 4000 heart transplants are performed each year worldwide.…”

“…required removal of the retained fragments because of bacteremia.A transvenous extraction approach was performed in both patients, with one patient requiring resection and reconstruction of innominate vein and SVC to control the infection4 | D ISCUSS I ONIn this retrospective study of patients undergoing heart transplantation at our institution, we describe the frequency and subsequent complications of retained CIED fragments. It is known that lead types as well as a longer interval between device implant and transplant are associated with retained CIED fragments 4,7. CIED fragments were associated with increased age, body surface area, diabetes mellitus, number of active leads, dual coil ICD, abandoned leads, and longer interval between device implantation and transplantation.…”

Highly complicated lead extraction procedure in patient with previous early orthotopic heart transplantation: A first case report

“…The difficulties involved both the procedural approach due to many postsurgical lead's adherences, and also the high risk of infection especially due to concomitant immunosuppressive therapy. In the decision‐making process between the abandonment of malfunctioning RV/LV leads and the extraction of both, a lead extraction strategy prevailed due to the patient's long life expectancy and the pre‐existing presence of three leads in the vascular system . Therefore, we proceeded to RV and LV leads extraction through a subclavian approach due to: (a) both RV and LV leads malfunction; (b) no subclavian vein access; (c) higher risk of infection in case of implantation of new leads on the contralateral side and tunneling of these to the ipsilateral pocket, due to the presence of abandoned leads.…”