Managing infected cardiovascular implantable electronic devices

Manolis, Antonis S; Melita, Helen

doi:10.1002/cce2.38

Cited by 4 publications

(2 citation statements)

References 66 publications

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“…Although reports of longevity have indicated a progressive increase of the life span of ICD devices over the years, from a mean of 19 months in 1980 to 48 months in 2009 to 65 months in 2015, there is still room for improvement, as this is quite an expensive therapy and patient and physician expectations run high for a more satisfactory performance of these devices, a crucial determinant of cost‐efficacy of ICD therapy . Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs . Real‐life longevity is definitely sharply shorter compared with the industry‐projected longevity, which has always overestimated ICD device performance …”

Section: Discussionmentioning

confidence: 99%

“Real life” longevity of implantable cardioverter‐defibrillator devices

Manolis¹,

Maounis

Koulouris

et al. 2017

Clinical Cardiology

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Background Manufacturers of implantable cardioverter‐defibrillators (ICDs) promise a 5‐ to 9‐year projected longevity; however, real‐life data indicate otherwise. The aim of the present study was to assess ICD longevity among 685 consecutive patients over the last 20 years. Hypothesis Real‐life longevity of ICDs may differ from that stated by the manufacturers. Methods The study included 601 men and 84 women (mean age, 63.1 ± 13.3 years). The underlying disease was coronary (n = 396) or valvular (n = 15) disease, cardiomyopathy (n = 220), or electrical disease (n = 54). The mean ejection fraction was 35%. Devices were implanted for secondary (n = 562) or primary (n = 123) prevention. Single‐ (n = 292) or dual‐chamber (n = 269) or cardiac resynchronization therapy (CRT) devices (n = 124) were implanted in the abdomen (n = 17) or chest (n = 668). Results Over 20 years, ICD pulse generator replacements were performed in 238 patients (209 men; age 63.7 ± 13.9 years; ejection fraction, 37.7% ± 14.0%) who had an ICD for secondary (n = 210) or primary (n = 28) prevention. The mean ICD longevity was 58.3 ± 18.7 months. In 20 (8.4%) patients, devices exhibited premature battery depletion within 36 months. Most (94%) patients had none, minor, or modest use of ICD therapy. Longevity was longest for single‐chamber devices and shortest for CRT devices. Latest‐generation devices replaced over the second decade lasted longer compared with devices replaced during the first decade. When analyzed by manufacturer, Medtronic devices appeared to have longer longevity by 13 to 18 months. Conclusions ICDs continue to have limited longevity of 4.9 ± 1.6 years, and 8% demonstrate premature battery depletion by 3 years. CRT devices have the shortest longevity (mean, 3.8 years) by 13 to 17 months, compared with other ICD devices. These findings have important implications, particularly in view of the high expense involved with this type of electrical therapy.

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Section: Discussionmentioning

confidence: 99%

“Real life” longevity of implantable cardioverter‐defibrillator devices

Manolis¹,

Maounis

Koulouris

et al. 2017

Clinical Cardiology

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“…Unfortunately, complications associated with CIEDs have also been increasing ( 3 , 4 , 16 ). Particularly, device infections appear to be rising out of proportion to increasing implant rates ( 17 ). Furthermore, device recipients who develop device infection have increased device-dependent, long-term mortality even after successful treatment of infection ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia

Manolis

Georgiopoulos²,

Metaxa³

et al. 2017

Anatol J Cardiol

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Objective:We have previously reported our successful approach for percutaneous cardiac implantable electronic device (CIED) lead extraction using inexpensive tools, which we have continued over the years. Herein we report the results of the systematic use of a unique stylet, the lead-locking device (LLD), which securely locks the entire lead lumen, aided with non-powered telescoping sheaths in 54 patients to extract 98 CIED leads.Methods:This prospective observational clinical study included 38 men and 16 women aged 68.9±13.1 years undergoing lead extraction for device infection (n=46), lead malfunction (n=5), or prior to defibrillator implant (n=3). Leads were in place for 6.7±4.3 years. Infections were more commonly due to Staphylococcus species (n=40). There were 78 pacing (31 ventricular, 37 atrial, 4 VDD, and 6 coronary sinus leads) and 20 defibrillating leads.Results:Using simple traction (6 leads) and the LLD stylets (92 leads) aided with telescoping sheaths (15 patients), 96 (98%) leads in 52 (96.3%) patients were successfully removed, with all but one leads removed using a subclavian approach; in 1 patient, the right femoral approach was also required. In 2 patients, distal fragments from one ventricular pacing and one defibrillating lead could not be removed. Finally, lead removal was completely (52/54) (96.3%) or partially (2/54) (3.7%) successful in 54 patients for 96 of 98 leads (98%) without major complications.Conclusion:Percutaneous lead extraction can be successful with mechanical tools using the LLD locking stylet aided with non-powered telescoping sheaths through a simplified, safe, and inexpensive procedure using local anesthesia alone.

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Infective Endocarditis: Update on Epidemiology, Outcomes, and Management

2018

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Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. Although transthoracic and transesophageal echocardiography are essential for diagnosis, additional testing (nuclear, computed tomographic, and magnetic resonance imaging) is helpful in selected patients. Early surgical management, even in high-risk patients, has a mortality benefit because eradication of infection with antibiotics alone is difficult and because valve destruction often results in hemodynamic compromise. As part of a broad differential diagnosis, clinicians should consider the diagnosis of endocarditis in patients with risk factors, even when the clinical presentation is nonspecific. Blood cultures and echocardiography are the first steps for diagnosis. Other imaging modalities can enhance diagnosis, particularly in patients with intracardiac devices or prosthetic material. Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition.

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Managing infected cardiovascular implantable electronic devices

Cited by 4 publications

References 66 publications

“Real life” longevity of implantable cardioverter‐defibrillator devices

“Real life” longevity of implantable cardioverter‐defibrillator devices

Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia

Infective Endocarditis: Update on Epidemiology, Outcomes, and Management

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