[Indications for the procedure for transvenous removing of electrodes based on the guidelines of U.S. societies].
The number of implanted the cardiovascular implantable electronic device(s) (CIED(s))--pacemakers (PM) and implantable cardioverters defibrillators (ICD)--increases each year. The number of CIED(s) exchange procedures as well as changes in models of stimulation (upgrade to dual chamber pacemakers or three chamber cardiac resynchronization therapy devices) also grows. Also increases the inactive electrode left in the cardiovascular system. The risk of infection is higher during the exchange of devices than with their implantation. Treatments for patients with multiple electrode systems are becoming a potential source of infection. The incidence of damage defibrillator is greater than pacemaker leads. Intracardiac electrodes causes the growth of connective tissue, fibrosis in the venous system and may cause obstruction subclavian vein or brachiocephalic preventing implantation needed a new electrode. Damaged and broken electrodes may migrate to the cavities of the heart. This increases the risk of thrombosis, pulmonary embolism, tricuspid valve dysfunction and serious arrhythmias. All these facts presented lead to the conclusion that the growing need to remove the electrodes (both infected and inactive) pacemaker or cardioverter defibrillator. There are two classes of indications to remove the electrodes. Procedures for removing the benefits must outweigh the risks. Should be considered for each patient individually and take into account the experience of the operator and its results. Class I indications are: lead dependent endocarditis, sepsis, arrhythmias or embolism secondary to the presence of lead, venous occlusion prevents the implantation of new electrodes, interference between the electrodes, an implantable device infection box. Class II includes: chronic pain in the area and inactive pacemaker electrodes in young people. After removal must be individually examined whether there is a need to implant the new layout. It should not be implanted in a place that has previously been infected. The preferred area is the opposite, iliac vein, reaching epicardial implantation.
Lelakowski
Jacek
J
Uniwersytet Jagielloński, Collegium Medicum, Instytut Kardiologii, Klinika Elektrokardiologii w Krakowskim Szpitalu Specjalistycznym im. Jana Pawła II, Kraków. jlelakow@szpitaljp2.krakow.pl
D017147:Defibrillators, Implantable / Q000009:adverse effects; D020878:Device Removal / Q000592:standards*; D004566:Electrodes; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control; D017408:Guidelines as Topic; D006801:Humans