Author/Authors :
Norton, Caleb Department of Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Holmes, Benjamin Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Aboud, Asad Al Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Kim, Eun-Jeong Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Gonzales, Holly Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Ellis, Christopher Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , John, Roy Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Crossley III, George H. Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA , Montgomery, Jay Division of Cardiovascular Medicine - Vanderbilt University Medical Center, Nashville, TN, USA
Abstract :
There is an increasing prevalence of cardiac implantable electronic devices (CIEDs) due to expanding adoption and availability of
these evidence-based therapies. With the increased prevalence of these life-saving devices, there has also been an increased demand
for lead removal and lead extraction. Understanding the specific subgroups of patients at high risk for complications during and
after lead extraction has become imperative to properly manage endovascular CIED leads. There have been multiple published
studies describing clinical variables that predict adverse outcomes in CIED system extractions; however, the risk of
complications in leads placed after cardiac transplantation has not specifically been addressed to date. We present four cases of
transvenous extraction and removal of pacing leads placed after cardiac transplantation. There were no major complications
related to extraction in these four cases; however, three of the four patients died within one year after the procedure. While the
etiology of death in these cases seemed to be unrelated to the extraction procedure, the indications for extraction (infection in
the setting of immunosuppression and calcineurin-associated ESRD and poor sensing/capture possibly secondary to chronic
rejection and/or frequent right heart biopsies) likely contributed at least indirectly to the subsequent death.
