Lead-dependent infective endocarditis: An old problem, a new name

This paper presents a literature review on right heart endocarditis in patients with a permanent pacemaker (PM) or implantable cardioverter-defibrillator (ICD). We postulate putting a great deal more emphasis on separation of lead-dependent infective endocarditis from other types of infective endocarditis. We stress the need for screening patients with PM/ICD and pulmonary signs using transesophageal echocardiography. Antibiotic therapy and PM/ICD removal is the treatment of choice in such patients. (Cardiol J 2010; 17, 2: 205-210

Lead-dependent infective endocarditis : an old problem, a new name

This paper presents a literature review on right heart endocarditis in patients with a permanent pacemaker (PM) or implantable cardioverter-defibrillator (ICD). We postulate putting a great deal more emphasis on separation of lead-dependent infective endocarditis from other types of infective endocarditis. We stress the need for screening patients with PM/ICD and pulmonary signs using transesophageal echocardiography. Antibiotic therapy and PM/ICD removal is the treatment of choice in such patients

Broken leads with proximal endings in the cardiovascular system: Serious consequences and extraction diffi culties

Background: Retrospective analysis of effectiveness, technical problems, and complications oftransvenous extraction of leads with the free endings migrated to the cardiovascular system (CVS).Methods: A 5-year-old database of transvenous lead extraction (TLE) procedures comprising906 patients with 1563 leads being removed was analyzed. TLE procedures of leads migratedin the CVS were compared with TLE procedures of leads with their proximal ends accessiblein the pacemaker/implantable cardioverter-defi brillator (PM/ICD) pocket.Results: In our material, the phenomenon of leads migration occurred in 5% of patients referredfor TLE and affected most frequently unipolar and atrial leads. The presence of migratingleads was associated with local venous occlusion in 64% of patients. Removal of migratingleads required other techniques than extraction of leads with their proximal ends accessible inthe PM/ICD pocket. More than 95% of migrating leads were extracted transvenously, but procedureswere signifi cantly longer. The presence of other leads made extraction of migrated leadseven more complicated. Effectiveness and complication rates for removal of migrated leads andleads accessible in the PM/ICD pocket were similar.Conclusions: We postulate that every lead migrating in the CVS should be considered forTLE. However, this extraction is technically more diffi cult and challenging than extraction ofleads accessible in the PM/ICD pocket

Association of NT-proBNP and GDF-15 with markers of a prothrombotic state in patients with atrial fibrillation off anticoagulation

We investigated whether growth diferentiation factor-15 (GDF-15), also known as macrophage inhibitory cytokine-1 (MIC1), levels are associated with a prothrombotic state in atrial fbrillation (AF) as compared to N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (cTnI-hs). In 103 patients with AF assessed of anticoagulation (age: 71.0 [65.0–76.0] years; CHA2DS2-VASc score: 4.6±1.7), we measured endogenous thrombin potential (ETP), plasma fbrin clot permeability (Ks, a measure of clot density) and clot lysis time (CLT) and other hemostatic parameters, along with GDF-15, NT-proBNP, and cTnI-hs. GDF-15 positively correlated with ETP and CLT (r=0.25, P=0.01 and R=0.56, P<0.0001, respectively) but not with Ks, von Willebrand factor, thrombin-activatable fbrinolysis inhibitor, plasminogen, antiplasmin or tissue-type plasminogen activator antigen. NT-proBNP showed a stronger association with ETP (r=0.60, P<0.0001) and a similar correlation with CLT (R=0.53, P<0.0001), while cTnI-hs correlated solely with CLT (R=0.25, P=0.01). After adjustment for clinical and laboratory parameters, GDF-15 was a better independent predictor of CLT (unstandardized coefcient B 0.009; 95% confdence interval [CI] 0.006–0.012) than NT-proBNP (B 0.007; 95% CI 0.004–0.010, R (2)=0.51; P<0.0001); while among the three biomarkers, only NT-proBNP was an independent predictor of ETP. Elevated GDF-15 and NT-proBNP independently predict impaired fbrin clot lysability, while NT-proBNP is a key predictor of heightened thrombin formation in AF. Our fndings suggest that a predictive value of NT-proBNP and GDF-15 in AF could be in part attributed to their association with prothrombotic blood alterations