title: Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram.
abstract: OBJECTIVE
  We describe the feasibility, safety, and clinical outcomes of percutaneous lead extraction in patients at a tertiary care center who had intracardiac vegetations identified by transesophageal echocardiogram.
  
  
  BACKGROUND
  Infection in the presence of intracardiac devices is a problem of considerable morbidity and mortality. Patients with intracardiac vegetations are at high risk for complications related to extraction and protracted clinical courses. Historically, lead extraction in this cohort has been managed by surgical thoracotomy.
  
  
  METHODS
  We analyzed percutaneous lead extractions performed from January 1991 to September 2007 in infected patients with echocardiographic evidence of intracardiac vegetations, followed by a descriptive and statistical analysis.
  
  
  RESULTS
  A total of 984 patients underwent extraction of 1,838 leads; local or systemic infection occurred in 480 patients. One hundred patients had intracardiac vegetations identified by transesophageal echocardiogram, and all underwent percutaneous lead extraction (215 leads). Mean age was 67 years. Median extraction time was 3 min per lead; median implant duration was 34 months. During the index hospitalization, a new device was implanted in 54 patients at a median of 7 days after extraction. Post-operative 30-day mortality was 10%; no deaths were related directly to the extraction procedure.
  
  
  CONCLUSIONS
  Patients with intracardiac vegetations identified on transesophageal echocardiogram can safely undergo complete device extraction using standard percutaneous lead extraction techniques. Permanent devices can safely be reimplanted provided blood cultures remain sterile. The presence of intracardiac vegetations identifies a subset of patients at increased risk for complications and early mortality from systemic infection despite device extraction and appropriate antimicrobial therapy.
authors.affiliation: Division of Cardiovascular Diseases, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Grammes
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Schulze
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Bataineh
authors.forename: George A
authors.initials: GA
authors.lastname: Yesenosky
authors.forename: Christine S
authors.initials: CS
authors.lastname: Saari
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Vrabel
authors.forename: Jay
authors.initials: J
authors.lastname: Horrow
authors.forename: Mashiul
authors.initials: M
authors.lastname: Chowdhury
authors.forename: John M
authors.initials: JM
authors.lastname: Fontaine
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kutalek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010414:Pennsylvania / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013610:Tachycardia / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult