Author + information
- Received January 13, 2020
- Revision received February 4, 2020
- Accepted February 5, 2020
- Published online June 15, 2020.
- Eric Black-Maier, MDa,
- Jonathan P. Piccini, MDa,
- Muath Bishawi, MDb,
- Sean D. Pokorney, MD, MBA, MHSa,
- Benjamin Bryner, MDb,
- Jacob N. Schroder, MDb,
- Vance G. Fowler Jr., MD, MHSc,
- Jason N. Katz, MD, MHSd,
- John C. Haney, MDb,
- Carmelo A. Milano, MDb,
- Alina Nicoara, MDe,
- Donald D. Hegland, MDa,
- James P. Daubert, MD, MHSa and
- Robert K. Lewis, MD, PhDa,∗ ()
- aDivision of Electrophysiology, Duke University Medical Center, Durham, North Carolina
- bDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
- cDivision of Infectious Disease, Duke University Medical Center, Durham, North Carolina
- dDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- eDivision of Anesthesiology, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Robert K. Lewis, Electrophysiology Section, Duke University Medical Center, Duke Medicine Circle, Durham, North Carolina 27710.
Objectives The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD).
Background The use of transvenous lead extraction for the management CIED infection in patients with a durable LVAD has not been well described.
Methods Clinical and outcomes data were collected retrospectively among patients who underwent lead extraction for CIED infection after LVAD implantation at Duke University Hospital.
Results Overall, 27 patients (n = 6 HVAD; n = 15 HeartMate II; n = 6 Heartmate III) underwent lead extraction for infection. Median (interquartile range) time from LVAD implantation to infection was 6.1 (2.5 to 14.9) months. Indications included endocarditis (n = 16), bacteremia (n = 9), and pocket infection (n = 2). Common pathogens were Staphylococcus aureus (n = 10), coagulase-negative staphylococci (n = 7), and Enterococcus faecalis (n = 3). Sixty-eight leads were removed, with a median lead implant time of 5.7 (3.6 to 9.2) years. Laser sheaths were used in all procedures, with a median laser time of 35.0 s (17.5 to 85.5s). Mechanical cutting tools were required in 11 (40.7%) and femoral snaring in 4 (14.8%). Complete procedural success was achieved in 25 (93.6%) patients and clinical success in 27 (100%). No procedural failures or major adverse events occurred. Twenty-one patients (77.8%) were alive without persistent endovascular infection 1 year after lead extraction. Most were treated with oral suppressive antibiotics after extraction (n = 23 [82.5%]). Persistent infection after extraction occurred in 4 patients and was associated with 50% 1-year mortality.
Conclusions Transvenous lead extraction for LVAD-associated CIED infection can be performed safely with low rates of persistent infection and 1-year mortality.
This study research was supported by U.S. National Heart, Lung, and Blood Institute grant 1R38HL143612-01 (Dr. Bishawi). Drs. Bishawi and Milano have received research support from Abbott and Medtronic. Dr. Pokorney has received research grants from Boston Scientific, Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, and Gilead; and has received consulting support from Boston Scientific, Medtronic, Bristol-Myers Squibb, Pfizer, Janssen Pharmaceuticals, and Zoll. Dr. Fowler is a consultant to Novartis, NovaDigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, The Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Basilea, Affinergy, Janssen, xBiotech, Contrafect, Regeneron, Destiny, AmphliPhi Biosciences, Integrated Biotherapeutics, and C3J Therapeutics; has received grants or pending to his institute from the National Institutes of Health, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, Genentech, Regeneron, Basilea, and Janssen; has received royalties from UpToDate; and has a patent pending on sepsis diagnostics. Dr. Daubert has received research funding from St. Jude Medical; has received honoraria from Medtronic, Boston Scientific, Abbott, Biotronik, MicroPort, Biosense, VytronUS, and Farapulse; and has received research grants from Medtronic and Abbott. Dr. Katz has received research support from Abbott. Dr. Lewis serves as a consultant to Philips, Medtronic, and Boston Scientific. Dr. Hegland serves as consultant to Abbott, Boston Scientific, Medtronic, and Philips. Dr. Piccini has received grants for clinical research from Abbott, American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, the National Heart, Lung, and Blood Institute, and Philips; and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, LivaNova, Medtronic, Milestone, MyoKardia, Sanofi, Philips, and UpToDate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Angelo Auricchio, MD, served as Guest Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 13, 2020.
- Revision received February 4, 2020.
- Accepted February 5, 2020.
- 2020 American College of Cardiology Foundation
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