Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

Mueller, Karin; Mueller, Iris; Weig, Hans-Jörg; Doernberger, Volker; Gawaz, Meinrad

doi:10.1136/bcr.09.2011.4855

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…This can find an explanation in the hypercoagulable status of diabetics [22], which enhances the formation of both bacterial and nonbacterial thrombi, so that the anticoagulation effect at preventing thrombus growth is much more evident than in the non-anticoagulated diabetic group. The prevalent thrombotic nature of this infected masses affecting the leads, which confirms the important role of anticoagulant therapy, as also sustained by the potential utility of thrombolysis to reduce very large masses (> 4 cm) [31].…”

Section: Discussionsupporting

confidence: 55%

“…In any case, our "large" infected masses were no more of 18 mm in max dimension (Figure 1), so relatively small, limiting the embolic potential during percutaneous lead extraction. Very large masses >3 cm can pose a serious risk for pulmonary embolization [10,31]. However, on the basis of our data, we also believe that prompt institution of appropriate anticoagulation is an effective approach to achieve mass shrinkage, but only after appropriate antibiotic therapy has been started.…”

Section: Discussionmentioning

confidence: 71%

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Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction

et al. 2019

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Lead pacemaker infection is a complication on the rise. An infected oscillating mass attached to the leads (ILV) is a common finding in this setting. Percutaneous extraction of the leads and of the device is the best curative option. However, extraction of leads with large masses can be complicated by pulmonary embolism. The aim of this study was to understand the factors associated with large ILV using a sophisticated ultrasound technique to visualize the masses, namely intracardiac echocardiography (ICE), and investigate whether larger masses induce more complications during and after extraction. Percutaneous lead extraction and peri-procedural ICE were done in 36 patients (pts) (75 ± 11 years old, 74% males). Vegetations (max dimension = 8.2 ± 4.1 mm) in the right cavity were found in 26 of them, mostly adhering to the leads. We subdivided the patients into 2 groups: with vegetation size < 1 cm (18 pts) and vegetation size ≥ 1 cm (8 pts). By univariate analysis, we found that patients in group 1 were more often taking anticoagulation therapy (p = 0.03, Phi (Phi coefficient) = −0.5, OR [odds ratio] 0.071) and had signs of local pocket infection (p = 0.02, Phi = −0.52, OR 0.059) while significantly more patients in group 2 had diabetes (p = 0.08, Phi = 0.566, OR 15); moreover the patients in group 2 showed a trend toward a more frequent positive blood culture (p = 0.08, Phi = 0.39, OR 5.8) and infection with coagulase negative staphylococci (p = 0.06, Phi = 0.46, OR 8.3). At multivariate analysis, only 3 factors (diabetes, younger age and anticoagulation therapy) were independently associated with ILV size: diabetes, associated with larger vegetations (group 2), showed the largest beta value (0.44, p = 0.008); age was inversely correlated with ILV size (beta value = −32, p = 0.038), and anticoagulation therapy (beta value = −029, p = 0.048) was more commonly associated with smaller vegetations (group 1). Larger ILV were not associated with more complications or death during or after the extraction. Conclusion: diabetes, anticoagulation therapy and age are independent predictors of lead vegetation size. The embolic potential of large ILV during extraction was modest, so ILVs >1cm are not a contraindication to percutaneous extraction of infected leads.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 71%

Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction

et al. 2019

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“…Thrombolytics have also been used to reduce vegetation size in patients with CIED-associated infective endocarditis. 263 Once the optimal extraction approach has been defined, the next important step is to define the procedure goal. The procedure goal for CIED-related infection (including isolated pocket, bacteremia, or CIED-endocarditis) should be complete system removal.…”

Section: Extraction Approach: Open Versus Percutaneous Extractionmentioning

confidence: 99%

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

et al. 2017

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†Deceased (see In Memoriam at the end of this document) *Representative of the Pediatric and Congenital Electrophysiology Society (PACES) ‡Representative of the European Heart Rhythm Association (EHRA) xRepresentative of the Society of Thoracic Surgeons (STS) {Representative of the American College of Cardiology (ACC) #Representative of the Latin American Heart Rhythm Society (LAHRS) **Representative of the Infectious Diseases Society of America (IDSA) ‡ ‡Representative of the American Heart Association (AHA) xxRepresentative of the American Society of Anesthesiologists (ASA) {{Representative of the Asia Pacific Heart Rhythm Society (APHRS)

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“…A closer look into the cause of death in this population reveals that nearly 50 % of these patients die due to ongoing sepsis. Since pulmonary embolization of vegetations during lead extraction may result in subsequent sepsis various interventional techniques to reduce the size of vegetations have been evaluated including the use of basket catheters for "vegectomy" 3 or systemic thrombolysis 4 . Recently, a transcatheter aspiration system based on an extracorporal circuit in a veno-venous configuration (AngioVac, Angiodynamics, Latham, NY, USA) using a specialized filter has been introduced and is successfully used in an increasing number of patients 5 .…”

Section: General Informationmentioning

confidence: 99%

“…Since pulmonary embolization of vegetations during lead extraction may be the reason for this observation, various interventional techniques to reduce the size of vegetations have been evaluated, including the use of basket catheters for “vegectomy” 3 or systemic thrombolysis. 4 A transcatheter aspiration system based on an extracorporeal circuit in a venovenous configuration (AngioVac; Angiodynamics, Latham, NY) using a specialized filter has recently been introduced and is successfully used in an increasing number of patients. 5 However, this system has limitations such as need for therapeutic anticoagulation during the procedure and high healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Leadless pacemaker tools used beyond device implantation

Berndt

Steffel

2021

HeartRhythm Case Reports

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show abstract

Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

Cited by 6 publications

References 24 publications

Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction

Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

Leadless pacemaker tools used beyond device implantation

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