Pacemaker lead complications: when is extraction appropriate and what can we learn from published data?

Bracke, Frank; Meijer, Albert; Gelder, L.M.

doi:10.1136/heart.85.3.254

Cited by 81 publications

(66 citation statements)

References 48 publications

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“…With regard to pacemakers, 13% to 52% of patients may no longer require pacing support. 40,54,55 Although antibiotics are frequently used as primary prophylaxis of pacemaker implantation, there are no large randomized, controlled trials to support this practice. A recent meta-analysis 58 reviewed 7 published prospective studies.…”

Section: Secondary Prophylaxismentioning

confidence: 99%

“…Several different techniques for electrode extraction have been described. 55 One option involves the use of a "locking stylet" that is introduced onto the lead and affixed close to the distal end of the electrode to apply traction directly to the tip. If this is not successful, then a telescoping sheath can be advanced over the lead to disrupt fibrous attachments of the lead to vein or cardiac tissue, and the lead can be freed by countertraction.…”

Section: Secondary Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

Nonvalvular Cardiovascular Device–Related Infections

Baddour¹,

Bettmann²,

Bolger³

et al. 2003

Circulation

447

326

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Section: Secondary Prophylaxismentioning

confidence: 99%

Section: Secondary Prophylaxismentioning

confidence: 99%

Nonvalvular Cardiovascular Device–Related Infections

Baddour¹,

Bettmann²,

Bolger³

et al. 2003

Circulation

447

326

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“…For the latter indication, there is no solid proof that properly abandoned superfluous leads pose any danger to the patient. 1,2 Likewise, the notion that multiple leads have a higher chance of obliterating the veins has never been substantiated. Of note, occlusion of the access vein is not uncommon: it is present in about 10% of uncomplicated first implants but is mostly asymptomatic.…”

Section: Indications For Extractionmentioning

confidence: 99%

“…In contrast, there are indications that lead extraction can result in venous obstruction. 2 So, until proof of the contrary, properly abandoning nonfunctional leads is the safest approach.…”

Section: Indications For Extractionmentioning

confidence: 99%

Complications and lead extraction in cardiac pacing and defibrillation

Bracke¹

2008

NHJL

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The only indications for which lead extraction may be really necessary are infected pacing or defibrillation systems. Superfluous non-functional leads can on the whole be more safely abandoned than extracted. Improvements in lead extraction will be more helped by designing and implanting leads that can be more easily removed than current models, than with better extraction tools. Still, as infection and hence lead extraction usually follows surgical interventions of a pacing or defibrillation system, avoiding the latter -or postponing it if possibleis of great importance (Neth Heart J 2008;16 (suppl 1):S28-S31.)

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“…This is a complex surgical procedure, with unavoidable risks, including possible tearing of the surrounding blood vessel or perforating the heart. [14][15][16] The concept of a self-contained leadless pacemaker (LP) was first reported in 1970. 17 However, the battery did not last more than a few weeks.…”

mentioning

confidence: 99%

The Promise of Leadless Pacing: Based on Presentations at Nanostim Sponsored Symposium Held at the European Society of Cardiology Congress 2013, Amsterdam, The Netherlands, 2 September 2013

Knops¹,

Sperzel²,

Neužil³

2011

Arrhythmia &Amp; Electrophysiology Review

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In 1958, the world's first patient was implanted with a pacemaker.It brought numerous benefits, the most important of which was increased survival. Since then, pacemaker technology has evolved with the development of improved device longevity, by including a high-energy density battery and utilising high impedance, low threshold leads. Implantable pulse generators (IPGs) for cardiac arrhythmias are now a proven and widely used treatment method. A worldwide cardiac pacing and implantable cardioverter-defibrillator (ICD) survey found that in 2009 there were over 700,000 new implants, with the majority of these implants being performed in the US and Europe, but the greatest growth occurring in Asia. 1Despite new developments in pacemaker technology, there is still a high incidence of pacemaker-related complications.2 A large prospective multicentre study found that after two months 12 % of patients present with acute complications (see Figure 1).3 Chronic complications subsequently occur in 10 % of patients. Most of these complications are related to the lead or the surgical pocket created to hold the pacemaker.Local pocket-related complications include haematoma, wound pain, decreased mobility, pocket erosion and infection. Pocket infection can be a serious complication, which occurs in 0.5-1.5 % of implants, but has a mortality of 10 %. Staphylococcus aureus is the main source of infection and is becoming increasingly antibiotic resistant. Pocket haematoma is also a relatively common complication. It is usually benign and treated conservatively but sometimes requires repeated surgery, which can be a major issue in patients who use anticoagulant drugs. 4,5 However, the greatest potential for a complication in a pacemaker procedure is related to the lead. The overall incidence of clinical problems related to the lead is around 8 %.6 Mechanical failure and lead dislodgement are relatively common complications. AbstractPacemaker technologies have advanced dramatically over the decades since they were first introduced, and every year many thousands of new implants are performed worldwide. However, there continues to be a high incidence of acute and chronic complications, most of which are linked to the lead or the surgical pocket created to hold the device. A leadless pacemaker offers the possibility of bypassing these complications, but requires a catheter-based delivery system and a means of retrieval at the end of the device's life, as well as a way of repositioning to achieve satisfactory pacing thresholds and R waves, a communication system and low peak energy requirements.A completely self-contained leadless pacemaker has recently been developed, and its key characteristics are discussed, along with the results of an efficacy and safety trial in an animal model. The results of the LEADLESS study, the first human trial to look at safety and feasibility of the leadless device, are discussed and the possible implications for future clinical practice examined. KeywordsLeadless pacemaker, cardiac arrhythmias, pacemak...

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Pacemaker lead complications: when is extraction appropriate and what can we learn from published data?

Cited by 81 publications

References 48 publications

Nonvalvular Cardiovascular Device–Related Infections

Nonvalvular Cardiovascular Device–Related Infections

Complications and lead extraction in cardiac pacing and defibrillation

The Promise of Leadless Pacing: Based on Presentations at Nanostim Sponsored Symposium Held at the European Society of Cardiology Congress 2013, Amsterdam, The Netherlands, 2 September 2013

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