Risk factors for lead complications in cardiac pacing: A population-based cohort study of 28,860 Danish patients

Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nøhr, Ellen Aagaard; Møller, Mogens; Arnsbo, Per; Nielsen, Jens Cosedis

doi:10.1016/j.hrthm.2011.04.014

Cited by 104 publications

(66 citation statements)

References 18 publications

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“…21 Use of active fixation leads should be advocated -with due consideration for a suspected minor increased risk of cardiac perforation -to reduce risk of lead dislodgement and need for re-operation. 52 Appropriate education and reasonable implant volume for each operator should be assured to decrease risk of lead dislodgements, and complications in general, requiring early re-operations.…”

Section: Re-operationmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Section: Re-operationmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…Lead complications are the most common reason for re-operation, with the presence of a CRT device being an important factor (OR 3.3) in re-intervention, with 4.3 % of LV leads needing to be re-operated on. 71 A meta-analysis of 25 CRT trials (9,082 patients) suggested peri-procedural complications of mechanical complications (such as coronary sinus dissection, pneumothorax, haemothorax) in 3.2 %, lead problems in 6.2 % and infections in 1.4 %. The same study reported success in LV lead placement of 94.4 % and peri-implant deaths at 0.3 %.…”

Section: Cardiac Resynchronisation Therapy Complicationsmentioning

confidence: 99%

Current Evidence and Recommendations for Cardiac Resynchronisation Therapy

Dewhurst¹,

Linker

2014

Arrhythm Electrophysiol Rev

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Approximately 2 % of the adult population in high-income countries has clinical heart failure (HF), 1 and almost the same percentage again has impaired left ventricular (LV) function without symptoms. 2The incidence and prevalence of HF rises steeply with age; the mean age at first diagnosis being 76 years, 3 with about half of these patients having a left ventricular ejection fraction (LVEF) of <50 %.1 The prevalence of HF is expected to rise because of an ageing population, improved survival of patients with ischaemic heart disease and more effective pharmacological treatments for HF. 4 Prognosis from HF is poor, with a one-year mortality rate in those admitted to hospital with clinical HF of up to 40 % in those aged >75 years.5 However, there is already evidence of increased survival of HF patients, with one study showing a reduction in six month mortality over the 10 years between 1995 and 2005 from 26 % to 14 %. 6 This has coincided with improved medical therapies and co-ordinated multidisciplinary care, but is likely to improve further since the advent of widespread use of cardiac resynchronisation therapy (CRT). Based on current guideline criteria from the European Society of Cardiology (ESC), 7 CRT is only indicated in 5-10 % of HF patients, but this is still a large number of patients. It has been estimated that up to 400 patients per million population per year in Europe may be suitable for CRT; 8 but even in Italy and Germany where the highest number of implants takes place, the implant rate is currently just over 200 per million. Cazeau and Bakker published the first case reports on LV pacing in 1994. 10,11 They described the beneficial effects of biventricular pacing for New York Heart Association (NYHA) III/IV HF patients with a prolonged QRS, describing case series of thoracoscopically placed epicardial LV leads. The feasibility of biventricular pacing was furthered in 1998 when Daubert published the results of a fully transvenous permanent biventricular pacing system using a unipolar Medtronic lead.12 Since then, there have been several large international multicentre studies extolling the virtues of CRT, which this article will review. We will suggest populations where we know the evidence to be strong for being a CRT 'responder', other populations where the data are not so strong, and unresolved issues with regard to who may benefit from CRT and what decision tools are available to clinicians in order to decide who will be most likely to benefit. Patients in Sinus Rhythm and New York Heart Association III-IVThe evidence is fairly convincing for the benefits of CRT in patients who are in sinus rhythm with severely impaired LV function, who have NYHA class III HF symptoms. Earlier studies suggested a benefit in terms of symptoms, exercise capacity and LV function. [13][14][15][16][17] More recently, two large randomised controlled trials have shown benefit in terms of all-cause mortality and HF hospitalisations. AbstractThe number of people in Europe living with symptomatic heart failure is incr...

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“…The latter intervention is considered controversial. Of 28,860 Danish patients [13], 3.6% had a lead related complication by 3 months. Risk factors for lead related complications included operator inexperience (<25 implants).…”

Section: Infectionmentioning

confidence: 99%