Incidence and risk factors for acute kidney injury in patients with cardiac implantable electronic devices undergoing transvenous lead removal.

BACKGROUND: This study aimed to investigate the incidence and potentially modifiable risk factors of acute kidney injury (AKI) in patients with cardiac implantable electronic devices (CIED) admitted for removal of infected and non-infected transvenous leads. MATERIALS AND METHODS: In this observational cohort study, data from 147 consecutive patients with CIED undergoing transvenous lead removal were analyzed. Study endpoint was AKI according to the KDIGO criteria. Multivariable logistic regression analysis was performed to identify independent risk factors for AKI. RESULTS: Lead removal was performed due to systemic infection (50.3%), isolated pocket infection (34.0%), pocket or lead perforation without infection (13.6%), and endocarditis (2.0%). Out of 147 patients, 34 (23.1%) developed AKI (82.4% stage 1, 8.8% stage 2, and 8.8% stage 3). There was no difference regarding incidence of AKI when separated by infectious vs. non-infectious lead status (25.5 vs. 25.0%) p = 0.605. Defibrillator lead type (HR 24.55, CI 2.41 - 249.97, p = 0.007), necessity to perform laser-assisted lead removal (HR 5.41, CI 1.12 - 26.13, p = 0.035), and time from initial implantation to lead removal (HR 1.01, CI 1.00 - 1.02, p = 0.013) were independent risk factors for AKI. Also, AKI was associated with in-hospital mortality (HR 8.44, CI 2.08 - 34.33, p = 0.003). CONCLUSION: Almost a quarter of patients undergoing transvenous lead removal developed AKI. Independent modifiable risk factors for AKI were identified. The role of procedure-related risk factors for AKI, such as lead type and use of laser, needs further evaluation in these patients.

Laparoscopic repositioning of a dislocated pacemaker into the rectovesical pouch.

Dislocation of the epicardial pacemaker into the peritoneal cavity is an uncommon but potentially life-threatening complication. We report a case of a 74 year old with an abdominally implanted epicardial pacemaker that migrated through the peritoneum to the excavatio rectovesicalis. The laparoscopic approach was chosen because of the increased risks of perioperative morbidity and decreased survival. The generator was implanted into a pocket beneath the anterior rectus sheath and the lead was peritonalized with a running suture. In conclusion, a laparoscopic retrieval is feasible and safe in the treatment of a displaced pacemaker in the rectovesical pouch.

[Exceptional pacemaker complication in Still's disease]. / Ungewöhnliche Schrittmacherkomplikation bei Morbus Still.

CASE REPORT: A 49-year-old man with Still's disease presented with a rash above his pacemaker scar. In 2012, there was a replacement of the generator in which the position was changed from subpectoral to subcutaneous. A revision operation was performed after the local finding became worse, turning from a granuloma to a macula. THERAPY: During surgery, a superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into a subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing. CONCLUSION: After repositioning of the generator to a subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Still's disease. A superficial position of a pacemaker should be avoided in patients affected by Still's disease.