Abstract
End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.
Highlights
Implantable cardiac devices are used in advanced heart failure patients to improve the symptom, and prognosis
The purpose of this study is to investigate the frequency of retained Implantable cardioverter-defibrillators (ICD)/ cardiac resynchronization therapy (CRT)-D lead materials in the central venous system after heart transplantation (HTPL) operation and to assess its clinical sequelae
We retrospectively reviewed the data of study patients with focus on the following topics to assess the clinical implications: (1) any subsequent procedure performed to remove the retained lead not removed during HTPL, (2) any infection related to the retained lead, (3) evidence of embolization or erosion of the retained lead materials, and (4) mortality
Summary
Implantable cardiac devices are used in advanced heart failure patients to improve the symptom, and prognosis. Retained ICD/CRT-D lead materials after heart transplantation because it is the regarded as the last-resort treatment option in these patients, and is associated with excellent long-term survival [4, 5]. The implanted ICD/CRT-D is usually removed at the time of HTPL operation. The leads within the central venous system can be difficult to remove without specialized extraction tools or techniques. This is the case because ICD/CRT-D leads contain defibrillating coils. Complete removal of previously-implanted ICD/CRT-D during HTPL operation presents quite a clinical challenge, and, as a result, parts of the lead materials especially within the central venous system are often retained after the surgery [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
