Utility of risk scores to predict adverse events in cardiac lead extraction

Segreti, Luca; Santoro, M Giannotti; Cori, Andrea Di; Zucchelli, Giulio; Viani, Stefano; Lucia, R De; Tommasina, Veronica Della; Barletta, Valentina; Soldati, Ezio; Bongiorni, Maria Grazia

doi:10.1080/14779072.2018.1513325

Cited by 12 publications

(19 citation statements)

References 60 publications

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“…Recently, due to the rising incidence of infectious and non-infectious CIED-related complications, the number of TLE has also been increasing [3]. According to numerous reports, the frequency of major complications of TLE ranges from 0.9 to 4.0%, and most often there is damage to the heart or venous vessels [4][5][6][7]. Assessment of risk factors for major complications and procedure complexity should have an impact on the selection of a suitable organizational model of the procedure and center preferment [4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures

Nowosielecka

Jacheć

Polewczyk

et al. 2021

Preprint

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Introduction Transesophageal echocardiography (TEE) is a useful tool in preoperative observation of patients undergoing transvenous leads extraction (TLE) due to complications associated with implanted devices. Echocardiographic phenomena may determine the safety of the procedure. Methods and results Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead-to-lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%), lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivatiate analysis were: fibrous tissue binding the lead to atrial wall (OR=1.738; p<0.05), to right ventricular wall (OR=2.167; p<0.001), lead-to-lead binding sites (OR=1.628; p<0.01) and excess lead loops (OR=1.488; p<0.05). Lead-to-lead binding sites increased probability of major complications (OR=3.034; p<0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR=0.296; p<0.05), right atrial wall (OR=323; p<0.05) and right ventricular wall (OR=0.297; p<0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR=0.307; p<0.05), Conclusions: Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.

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Section: Discussionmentioning

confidence: 99%

The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures

Nowosielecka

Jacheć

Polewczyk

et al. 2021

Preprint

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“…Except one, no risk score has been validated prospectively . The application of these scores is limited due to significant heterogeneity in the number of included patients, lead types, lead‐dwell time, operator experience, extraction tools used and lack of information regarding the availability and nature of cardiac surgery support during life‐threatening complications . This current study provides an excellent example of prospective application of risk stratification and identified a low‐risk cohort where minimal resources are needed and allowed for rapid intervention in the high‐risk group that reduces the consequences of MACEs in a high‐volume center.…”

Section: Discussionmentioning

confidence: 99%

“…16 The application of these scores is limited due to significant heterogeneity in the number of included patients, lead types, lead-dwell time, operator experience, extraction tools used and lack of information regarding the availability and nature of cardiac surgery support during life-threatening complications. 17 This current study provides an excellent example of prospective application of risk…”

Section: Risk Stratification Prior To Les-a Historical Perspectivementioning

confidence: 95%

RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)

Afzal

Daoud

Matre

et al. 2019

Cardiovasc electrophysiol

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Background An internal risk stratification algorithm was developed to decrease the risk of major adverse cardiac events (MACEs) during lead extractions (LEs). Objective To report upon the impact of a risk stratification algorithm (RISE [RIsk Stratification prior to lead Extraction] protocol) on outcomes of LEs in a high‐volume center. Methods A retrospective review of a prospectively maintained LEs database was performed to identify features associated with MACEs. On the basis of the retrospective data, the RISE protocol differentiated LEs procedures into “High” and “Low” risk for occurrence of MACEs. High‐risk LEs included dual‐coil defibrillator lead (≥3 years), pacemaker and single‐coil lead (≥5 years), and any StarFix coronary sinus lead. During the prospective evaluation of the RISE protocol, “High‐risk” LEs were performed in an operating room (OR) or hybrid laboratory with the cardiac anesthesiologist, OR nursing team, perfusionist in the room, and a cardiac surgeon on the premises. “Low‐risk” LEs were performed in the electrophysiology (EP) laboratory with anesthesia provided by EP nursing team. The preintervention (pre‐RISE) and postintervention (post‐RISE) group spanned 19 and 40 months and consisted of 449 (632 leads) and 751 patients (1055 leads), respectively. The primary outcome of MACEs in the two groups was compared. Results Protocol compliance was 100%. The primary outcome of MACEs occurred in 15 patients (3.34%) before and 12 (1.6%) after implementation of the RISE protocol (P = .04). Conclusion RISE identified a low‐risk group where minimal resources are needed and allowed for rapid intervention in the high‐risk group that reduced the consequences of MACEs.

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“…"Prophylactic" lead extraction (in order to avoid late consequences of long-term abandonment of superfluous leads or to save the veins on the contralateral side of the chest for other medical procedures) may be considered but only after taking into account potential threats due to lead abandonment (class 2b indications). Although it is relatively easy to estimate the risk of transvenous lead extraction (understood as the risk of major complications during and after the procedure) the risk of lead abandonment remains unknown [11,12,13] . However, the evidence is accumulating for late complications in those with abandoned leads going in [14,125,16] .…”

Section: Introductionmentioning

confidence: 99%

An asymptomatic patient with abandoned leads. Shall we wait decades for class I indications or is it time to consider prophylactic lead extraction?

Borzęcki¹,

Kutarski²,

Stefańczyk³

et al. 2019

Heart Beat

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For the last 20 years scientific guidelines have suggested either lead abandonment or extraction in cardiac implantable electronic device (CIED) patients (class 2b indications). The former strategy, especially in people with longer life expectancy, produces a population of subjects in whom years after device implantation transvenous lead extraction (TLE) becomes a harmful procedure although it appears the only choice in patients with class 1 indications. We describe a female patient with four leads, including two that were abandoned 20 years ago, with pocket infection and lead-related infective endocarditis in whom the sum of the ages of all leads was 100 years (in our opinion the risk associated with removal of old leads is cumulative). The extraction procedure performed in the maximally safe environment was successful. All the leads were removed, and a major complication, cardiac tamponade, was managed surgically by placing sutures over two large perforations in the right atrial appendage (RAA). We discuss the course of the disease and investigate the possible outcomes of TLE if it had been performed 12 years earlier when replacing the device. We also discuss late and very late consequences of lead abandonment on the basis of this case report.

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Utility of risk scores to predict adverse events in cardiac lead extraction

Cited by 12 publications

References 60 publications

The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures

The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures

RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)

An asymptomatic patient with abandoned leads. Shall we wait decades for class I indications or is it time to consider prophylactic lead extraction?

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