DOI QR코드

DOI QR Code

SUPERIOR VENA CAVA ECHOCARDIOGRAPHY AS A SCREENING TOOL TO PREDICT CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE LEAD FIBROSIS

  • YAKISH, S. JEFFREY (DEPARTMENT OF MEDICINE, DREXEL UNIVERSITY COLLEGE OF MEDICINE) ;
  • NARULA, ARVIN (DEPARTMENT OF MEDICINE, DREXEL UNIVERSITY COLLEGE OF MEDICINE) ;
  • FOLEY, ROBERT (DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, DREXEL UNIVERSITY COLLEGE OF MEDICINE) ;
  • KOHUT, ANDREW (DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, DREXEL UNIVERSITY COLLEGE OF MEDICINE) ;
  • KUTALEK, STEVEN (DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, DREXEL UNIVERSITY COLLEGE OF MEDICINE)
  • Received : 2014.12.04
  • Accepted : 2015.03.10
  • Published : 2015.03.27

Abstract

BACKGROUND: Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased. METHODS: This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed. RESULTS: 62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value < 0.05). The CIED group was subdivided into 2 groups based on device implant duration (< 2 years vs. ${\geq}2years$). Of the CIED implanted for ${\geq}2years$, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction. CONCLUSION: Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.

Keywords

References

  1. Kurtz SM, Ochoa JA, Lau E, Shkolnikov Y, Pavri BB, Frisch D, Greenspon AJ. Implantation trends and patient profiles for pacemakers and implantable cardioverter defibrillators in the United States: 1993- 2006. Pacing Clin Electrophysiol 2010;33:705-11. https://doi.org/10.1111/j.1540-8159.2009.02670.x
  2. Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, Epstein LM, Friedman RA, Kennergren CE, Mitkowski P, Schaerf RH, Wazni OM; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009;6:1085-104. https://doi.org/10.1016/j.hrthm.2009.05.020
  3. Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000;23(4 Pt 1):544-51. https://doi.org/10.1111/j.1540-8159.2000.tb00845.x
  4. Kutalek SP. Pacemaker and defibrillator lead extraction. Curr Opin Cardiol 2004;19:19-22. https://doi.org/10.1097/00001573-200401000-00005
  5. Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK, Kallinen LM. Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction. Europace 2010;12:395-401. https://doi.org/10.1093/europace/eup375
  6. Smith HJ, Fearnot NE, Byrd CL. Where does scar tissue form to inhibit extraction of chronic pacemaker leads (Abstract). J Am Coll Cardiol 1992;19:148A.
  7. Lo R, D’Anca M, Cohen T, Kerwin T. Incidence and prognosis of pacemaker lead-associated masses: a study of 1,569 transesophageal echocardiograms. J Invasive Cardiol 2006;18:599-601.
  8. Bongiorni MG, Di Cori A, Soldati E, Zucchelli G, Arena G, Segreti L, De Lucia R, Marzilli M. Intracardiac echocardiography in patients with pacing and defibrillating leads: a feasibility study. Echocardiography 2008;25:632-8. https://doi.org/10.1111/j.1540-8175.2008.00656.x
  9. Bulur S, Vural A, Yazici M, Ertas G, Ozhan H, Ural D. Incidence and predictors of subclavian vein obstruction following biventricular device implantation. J Interv Card Electrophysiol 2010;29:199-202. https://doi.org/10.1007/s10840-010-9516-2
  10. Korkeila P, Mustonen P, Koistinen J, Nyman K, Ylitalo A, Karjalainen P, Lund J, Airaksinen J. Clinical and laboratory risk factors of thrombotic complications after pacemaker implantation: a prospective study. Europace 2010;12:817-24. https://doi.org/10.1093/europace/euq075
  11. Korkeila P, Ylitalo A, Koistinen J, Airaksinen KE. Progression of venous pathology after pacemaker and cardioverter-defibrillator implantation:a prospective serial venographic study. Ann Med 2009;41:216-23. https://doi.org/10.1080/07853890802498961
  12. Khouzam RN, Minderman D, D'Cruz IA. Echocardiography of the superior vena cava. Clin Cardiol 2005;28:362-6. https://doi.org/10.1002/clc.4960280804
  13. Cohen ML, Cohen BS, Kronzon I, Lighty GW, Winer HE. Superior vena caval blood flow velocities in adults: a Doppler echocardiographic study. J Appl Physiol (1985) 1986;61:215-9. https://doi.org/10.1152/jappl.1986.61.1.215
  14. Nishino M, Tanouchi J, Ito T, Tanaka K, Aoyama T, Kitamura M, Nakagawa T, Kato J, Yamada Y. Echographic detection of latent severe thrombotic stenosis of the superior vena cava and innominate vein in patients with a pacemaker: integrated diagnosis using sonography, pulse Doppler, and color flow. Pacing Clin Electrophysiol 1997;20(4 Pt 1):946-52. https://doi.org/10.1111/j.1540-8159.1997.tb05498.x
  15. Hammerli M, Meyer RA. Doppler evaluation of central venous lines in the superior vena cava. J Pediatr 1993;122:S104-8. https://doi.org/10.1016/S0022-3476(09)90053-1
  16. Kohut AR, Grammes J, Schulze CM, Al-Bataineh M, Yesenosky GA, Horrow JC, Kutalek SP. Percutaneous extraction of ePTFE-coated ICD leads: a single center comparative experience. Pacing Clin Electrophysiol 2013;36:444-50. https://doi.org/10.1111/pace.12074
  17. Maytin M, Epstein LM, John RM. Lead implant duration does not always predict ease of extraction: extraction sheath may be required at < 1 year. Pacing Clin Electrophysiol 2011;34:1615-20. https://doi.org/10.1111/j.1540-8159.2011.03225.x
  18. Jones SO 4th, Eckart RE, Albert CM, Epstein LM. Large, single-center, single-operator experience with transvenous lead extraction: outcomes and changing indications. Heart Rhythm 2008;5:520-5. https://doi.org/10.1016/j.hrthm.2008.01.009
  19. Farooqi FM, Talsania S, Hamid S, Rinaldi CA. Extraction of cardiac rhythm devices: indications, techniques and outcomes for the removal of pacemaker and defibrillator leads. Int J Clin Pract 2010;64:1140-7. https://doi.org/10.1111/j.1742-1241.2010.02338.x
  20. Smith MC, Love CJ. Extraction of transvenous pacing and ICD leads. Pacing Clin Electrophysiol 2008;31:736-52. https://doi.org/10.1111/j.1540-8159.2008.01079.x
  21. Bracke F, Meijer A, Van Gelder B. Extraction of pacemaker and implantable cardioverter defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools. Pacing Clin Electrophysiol 2002;25:1037-40. https://doi.org/10.1046/j.1460-9592.2002.01037.x

Cited by

  1. Cardiovascular implantable electronic device lead extraction: evidence, techniques, results, and future directions vol.31, pp.1, 2015, https://doi.org/10.1097/hco.0000000000000247
  2. Transvenous Lead Extractions: Current Approaches and Future Trends vol.7, pp.3, 2015, https://doi.org/10.15420/aer.2018.33.2
  3. Echocardiographic findings in patients with cardiac implantable electronic devices—analysis of factors predisposing to lead‐associated changes vol.41, pp.1, 2021, https://doi.org/10.1111/cpf.12662
  4. Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction vol.10, pp.7, 2021, https://doi.org/10.3390/cells10071794