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Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads
Amit Noheria1, Shiva P Ponamgi2, Christopher V Desimone1
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Cardiac implantable electronic devices (CIEDs) can cause thrombi, but clinical pulmonary embolism (PE) is rare. Most PE cases in CIED patients have other risk factors, suggesting lead thrombus is not the primary cause.
Area of Science:
- Cardiology
- Medical Devices
- Pulmonary Medicine
Background:
- Cardiac implantable electronic devices (CIEDs) are frequently associated with transvenous lead-related thrombi.
- These thrombi are a potential cause of pulmonary embolism (PE).
Purpose of the Study:
- To evaluate the incidence of pulmonary embolism (PE) in patients with transvenous cardiac implantable electronic device (CIED) leads.
- To identify risk factors and outcomes associated with PE in this patient population.
Main Methods:
- Retrospective evaluation of 5646 patients with transvenous CIED leads implanted between 2000 and 2010.
- Pulmonary embolism (PE) outcomes were identified using diagnosis codes and confirmed with imaging reports.
- Follow-up data included patient demographics, comorbidities, hospitalization status, and mortality.
Main Results:
- A total of 88 patients (1.6%) developed PE, with an incidence of 3.32 per 1000 person-years.
- The majority of PE cases (84%) had other established risk factors, such as deep vein thrombosis, recent surgery, or malignancy.
- Pulmonary embolism (PE) occurred in 22% of patients despite anticoagulation, and 45% of PE patients subsequently died.
Conclusions:
- Clinical pulmonary embolism (PE) occurs with a low incidence in patients with transvenous CIED leads.
- Lead-related thrombus may not be the primary cause of PE in most CIED patients.
- Embolism from lead thrombus might be uncommon or result in non-consequential pulmonary infarction.
Background:
Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE).
Methods And Results:
We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001).
Conclusions:
Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
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