Cardiac implantable electronic device removal in patients with left ventricular assist device associated infections.

INTRODUCTION: Heart failure patients with left ventricular assist devices (LVADs) are at risk for infection. Cardiac implantable electronic devices (CIEDs) are commonly present in these patients. The course of infections in patients with an LVAD and a CIED is not well described. METHODS AND RESULTS: We identified 6 patients with a durable LVAD that underwent CIED removal because of an LVAD associated infection (LVADI). Patient and infection characteristics, management strategy, and clinical outcomes are described. All 6 patients were male, and the mean age was 59.6 years (range 43-72). Four of 6 patients had an ischemic cardiomyopathy, and 3 patients were diabetic. The median creatinine clearance for patients was 40.5 mg/dL (range 19-65). Five of 6 patients had a continuous flow LVAD placed as destination therapy. Four of 6 patients had a previous LVADI managed medically before the current infection leading to CIED removal. The indication for CIED removal was a bloodstream infection in 5 of 6 patients. Three of these patients had potential vegetations identified by echocardiography on device leads. The mean implanted age of the removed leads was 62 months (range 1-179), and 1 of the 6 patients experienced a procedural complication (hematoma) from CIED removal. Four of 6 patients that underwent CIED removal for an LVADI had recurrence of infection. Five of 6 patients died during the initial presentation or from repeat presentation for infection. CONCLUSION: Despite CIED removal for an LVADI, recurrent infections are common and mortality remains high.

Laser lead extraction in congenital heart disease: a case-controlled study.

INTRODUCTION: Patients with congenital heart disease (CHD) and implanted cardiac rhythm management devices have a high rate of endocardial lead issues requiring lead extraction. Laser lead extraction (LLE) is a promising modality for lead management though few studies have evaluated this technique in CHD. METHODS: This is a retrospective, case-controlled (gender- and age-matched, without CHD) analysis of all CHD patients from 2002-2010 at a single institution who underwent LLE as a primary extraction modality. The aim is to evaluate the utility of LLE in patients with CHD compared with controls without CHD. The primary outcome is LLE clinical success. Secondary outcomes include procedural success, complications, and factors related to LLE failure. RESULTS: Twenty-two patients with CHD underwent 24 LLE procedures to extract 35 leads. These were compared with 22 patients without CHD who underwent 24 LLE procedures to extract 37 leads. LLE clinical success was achieved for 26 of 35 leads (74%) in patients with CHD versus 35 of 37 leads (92%) in patients without CHD [P = 0.02]. No factors within the CHD group predicted LLE failure. Six of the nine leads for which LLE was unsuccessful were extracted using other methods. No complications were observed in the CHD group. CONCLUSIONS: Patients with CHD are less likely to have successful LLE than gender- and age-matched controls without CHD. LLE failures in CHD may be related to calcified adhesions. Mechanical-rotational devices and the femoral snare technique are useful for LLE failures. LLE provides an effective first-line approach for patients with CHD.