Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device

Lewis, Kathryn Monica; Dai, Mingyan; Patton, Kristen K.; Mei, Yong; Pollema, Travis; Feld, Gregory K.; Birgersdotter‐Green, Ulrika; Pretorius, Victor

doi:10.1093/europace/euy320

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…Subclinical infection and improper surgical technique with poorly formed pockets have been found to be the major etiologies for chronic pain [5], consistent with previous reports [6]. A recent multi-center study evaluating outcomes of lead extraction for chronic pain showed significant improvement in overall symptoms with removal of the device.…”

Section: Discussionsupporting

confidence: 86%

Pacemaker Pocket Stabilization Utilizing a Novel Envelope and a Three-Point Anchoring Technique

Pothineni¹,

Kumareswaran²,

Schaller³

2021

Cureus

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A 65-year-old man presented with chronic pain due to frequent movement of a dual chamber pacemaker (PPM) within the device pocket despite being secured to the underlying muscle. Due to chronic pain and possible indolent infection, the PPM was removed and a new device was implanted on the contralateral side via a persistent left superior vena cava. To prevent device movement, it was placed within a CanGaroo® envelope (Aziyo Biologics Inc., Silver Spring, MD, USA), which was secured to the underlying muscle with a silk suture along three of its corners. The envelope, which becomes incorporated into the surrounding tissue forming a vascularized tissue pocket, should further reinforce device stability over time. The patient’s left-sided symptoms abated immediately and he remains free of symptoms on the right side over a six-week follow-up period.

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Section: Discussionsupporting

confidence: 86%

Pacemaker Pocket Stabilization Utilizing a Novel Envelope and a Three-Point Anchoring Technique

Pothineni¹,

Kumareswaran²,

Schaller³

2021

Cureus

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“…In clinical practice, it may appear that sometimes, after many years, in various clinical situations, some patients with CIEDs no longer meet the treatment criteria. Device therapy is no longer needed after lead extraction for various reasons [5][6][7][8][9][10][11][12][13][14][15]. Moreover, the guidelines for lead extraction strongly recommend detailed reassessment of indications for a new CIED implantation [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…It is a widely known fact that about 15%-35% of CIED patients do not meet the criteria for continuation of cardiac pacing following device removal [5][6][7][8][9][10]. This applies to patients with infectious [5][6][7], non-infectious [13][14][15], and mixed indications [8][9][10][11][12] for lead extraction The guidelines for CIED implantation [4] and lead extraction [1][2][3] address the issue of CIED therapy discontinuation; however, most patients no longer needing device therapy receive a new CIED, which puts off device removal to a future time. The present study aimed to identify the reasons for resigning from reimplantation and the need for new CIED implantation during long-term follow-up as well as to assess long-term survival in such patients.…”

Section: W H a T ' S N E W ?mentioning

confidence: 99%

Discontinuation of cardiac implantable electronic device therapy after transvenous lead extraction

Kutarski,

Jacheć,

Kosior

et al. 2023

Kardiol Pol

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Background: Patients with cardiac implantable electronic devices (CIEDs) may no longer be eligible for continued therapy. Aims:The study aimed to assess the circumstances under which CIED reimplantation may not be necessary after transvenous lead extraction (TLE). Methods:A retrospective analysis of 3646 TLE procedures was performed with assessment of indications for device reimplantation. Results:Reimplantation was not performed immediately after TLE in 169 (4.6%) and, in long-term follow-up, in 146 (4.0%) of patients. No further need for CIED reimplantation was mostly associated with establishment of stable sinus rhythm (2.4%), conversion of sinus node dysfunction to chronic atrial fibrillation (AF; 1.4%), or improvement in left ventricular ejection fraction (LVEF) (0.9%). Independent prognostic factors were in the pacing groups: LVEF (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P <0.001), AF (OR, 3.8; 95% CI, 2.4-15.7; P <0.001), patients' age during first CIED implantation (OR, 0.97; 95% C, 0.96-0.98; P <0.001), and New York Heart Association (NYHA) class (OR, 0.616; 95% CI, 0.43-0.86; P <0.01); in the cardioverter-defibrillator group: LVEF (OR, 1.06; 95% CI, 1.04-1.09; P <001). Non-reimplanted patients had more complex procedures and more frequent complications, but survival after TLE was better in this group of patients.Conclusions: Reassessment of the need for continuation of CIED therapy should be considered in all patients following lead extraction and also before planned device replacement as TLE delay increases implant duration, complexity, and procedural risk. The predictors of non-reimplantation are a younger age during the first CIED implantation, lower NYHA class, presence of AF, and higher LVEF in pacemaker carriers, and, in the defibrillator group, only higher LVEF. A decision not to reimplant does not negatively affect the long-term prognosis.

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“…It seems to be well understood that subclinical infection is a common cause of the early presentation of pain following device placement, but it has also been linked to cases of chronic pain after device placement. 4 , 5 In addition, the clinical presentation of a device infection is often variable, ranging from subclinical device infections to a straightforward presentation with localized pocket swelling associated with fever and leukocytosis. A case series by Korantzopoulos and colleagues 6 reported 5 instances of skin lesions over cardiac device pockets that mimicked infection.…”

Section: Discussionmentioning

confidence: 99%

Malignancies masquerading as device pocket infections

Moseley

Birgersdotter‐Green

Feld

et al. 2021

HeartRhythm Case Reports

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Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device

Cited by 6 publications

References 13 publications

Pacemaker Pocket Stabilization Utilizing a Novel Envelope and a Three-Point Anchoring Technique

Pacemaker Pocket Stabilization Utilizing a Novel Envelope and a Three-Point Anchoring Technique

Discontinuation of cardiac implantable electronic device therapy after transvenous lead extraction

Malignancies masquerading as device pocket infections

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