Lead-related complications after DDD pacemaker implantation

Background: Pacing leads remain the weakest link in pacemaker systems despite advances in manufacturing technology. Aim: The aim of the study was to assess the long-term pacing lead performance in an unselected real-life cohort following primary DDD pacing system implantation. Methods: A single-centre retrospective analysis of patients who underwent DDD pacing system implantation between October 1984 and December 2014 and were followed-up until August 2016 was conducted. The inclusion criterion was at least one follow-up visit after post-implant discharge. The performance of each atrial and ventricular lead implanted was evaluated during the follow-up period, and the incidence of, and predictive factors for, lead dislodgement and failure were analysed. Results: The data of 3771 patients and 24,431.8 patient-years of follow-up were analysed. The mean follow-up of patients was 77.7 ± 61.8 months. During the study period, 7887 transvenous atrial and right ventricular pacing leads were implanted. Lead dislodgement occurred in 94 (1.2%) leads (92 [2.4%] patients), perforation in 11 (0.1%) leads (10 [0.3%] patients), and lead failure in 329 (4.2%) leads (275 [7.3%] patients). Atrial lead position was a predictive factor for lead dislodgement, while age at implantation, polyurethane 80A insulation, subclavian vein access, unipolar lead construction, and lead manufacturer were multivariate predictors of lead failure. Conclusions: Leads with polyurethane 80A insulation, unipolar construction, and those implanted via subclavian vein puncture exhibited the worst long-term performance

Inflammatory markers in the diagnostic workup of pacemaker- and defibrillator-related infections in patients referred for transvenous lead extraction

Background: Infectious complications can be life‑threatening in patients with permanent transvenous pacemakers and their diagnosis can be challenging. Aims: The aim of the study was to assess the diagnostic utility of white blood cell (WBC) count and C‑reactive protein (CRP) concentrations in infectious complications in patients with cardiac pacemakers. Methods: The prospective study included patients who underwent transvenous lead extraction (TLE) due to various indications. The diagnosis of lead‑dependent infective endocarditis (LDIE) was based on the modified Duke criteria, and the diagnosis of local infection was based on symptoms related to device pocket. The study population consisted of 640 patients: 63 (9.9%) with LDIE, 61 (9.5%) with local infection, and 516 controls (80.6%) referred for TLE due to noninfectious indications. We evaluated WBC count and CRP concentrations in each group of patients and assessed the predictive value of these tests for the diagnosis of LDIE and local infection. Results: Patients with local infection did not differ in terms of median WBC and CRP values compared with controls (P = 0.99 and P = 0.13, respectively), whereas patients with LDIE had higher median WBC count and CRP level (P < 0.001 and P < 0.001, respectively). In the LDIE group, WBC diagnostic test showed 46.0% sensitivity, 95.3% specificity, 90.5% accuracy, 51.8% positive predictive value, and 94.2% negative predictive value. The diagnostic test based on CRP levels showed 84.1% sensitivity, 81.8% specificity, 82.0% accuracy, 33.5% positive predictive value, and 97.9% negative predictive value. Conclusions: In patients undergoing TLE due to infectious indications, inflammatory markers (WBC count, CRP level) were within normal range in the local‑infection group and markedly elevated in the LDIE group. Inflammatory markers were useful to determine the extent of the infection in patients with local infection

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in comparison to the age- and sex-matched general population, assess changes in baseline characteristics over three decades of the inclusion period and determine the association between selected variables and patient survival. Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performed between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter university hospital. Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time. Compared to the general population, the observed survival was significantly inferior until 12 years post DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics over three decades revealed the following significant changes: more elderly patients, more female patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter (AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades. In multivariate analysis male sex and higher age were the only variables significantly associated with shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device infection were not associated with survival. Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associated with survival were sex and baseline age at first implantation

Effectiveness and safety of transvenous extraction of single- versus dual-coil implantable cardioverter-defibrillator leads at single-center experience

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in manyparts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients incomparison to the age- and sex-matched general population, assess changes in baseline characteristicsover three decades of the inclusion period and determine the association between selected variables andpatient survival.Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performedbetween 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenteruniversity hospital.Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time.Compared to the general population, the observed survival was significantly inferior until 12 years postDDD pacemaker implant (HR = 1.499, p &lt; 0.001), whereas after 12 years of follow-up the observedsurvival was significantly superior (HR = 0.555, p &lt; 0.001). A comparison of patient baseline characteristicsover three decades revealed the following significant changes: more elderly patients, more femalepatients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter(AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades.In multivariate analysis male sex and higher age were the only variables significantly associated withshorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and deviceinfection were not associated with survival.Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associatedwith survival were sex and baseline age at first implantation