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Updated: Feb 12, 2026
Heterotopic Cervical Heart Transplantation in Mice
Published on: August 25, 2015
Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart
Paulino A Alvarez1, Brett W Sperry1, Antonio L Perez1
1Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Insights
Retained cardiovascular implantable electronic device fragments are common after heart transplantation. These fragments are linked to increased radiation exposure during biopsies and a higher risk of upper extremity deep venous thrombosis.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Device Research
Background:
- Cardiovascular implantable electronic devices (CIEDs) are frequently implanted in patients with advanced heart failure.
- Fragment retention after CIED removal during heart transplantation is a potential complication.
- The clinical implications of retained CIED fragments remain incompletely understood.
Purpose of the Study:
- To investigate the incidence and clinical outcomes associated with retained CIED fragments after heart transplantation.
- To identify patient and device characteristics associated with CIED fragment retention.
- To assess the association between retained CIED fragments and adverse events, including deep venous thrombosis and mortality.
Main Methods:
- Retrospective review of 402 heart transplant recipients (January 2009 - March 2017).
- Analysis of baseline CIED presence, fragment identification post-transplant, lead characteristics, and clinical outcomes.
- Competing risk analysis to evaluate associations with deep venous thrombosis and bloodstream infection.
Main Results:
- Retained CIED fragments were identified in 16.2% of patients with baseline CIEDs.
- Retained fragments were associated with longer lead dwell times, previously abandoned leads, and dual-coil defibrillator leads.
- Retained fragments correlated with increased fluoroscopic time during endomyocardial biopsies and a higher risk of upper extremity deep venous thrombosis (HR 2.19, P=0.014).
- No significant difference in overall mortality was observed between groups.
Conclusions:
- Retained CIED fragments are a frequent finding after heart transplantation.
- Fragment retention is associated with specific lead types and longer dwell times.
- Retained CIED fragments increase procedural radiation exposure and the risk of upper extremity deep venous thrombosis, necessitating careful consideration.
- Retained fragments did not impact overall mortality in this cohort.
Abstract:
We performed a retrospective review of 402 consecutive patients who underwent heart transplantation at our institution between January 2009 and March 2017. A retained cardiovascular implantable electronic device (CIED) fragment was identified after transplantation in 49 of the 301 patients (16.2%) with CIED at baseline. Patients with retained fragments had leads with longer dwell times (median 2596 [1982, 3389] vs 1384 [610, 2202] days, P < .001), higher prevalence of previously abandoned leads (14.3% vs 2.8%, P = .003), and dual-coil defibrillator leads (98% vs 81%, P = .001) compared with patients without retained fragments. Five patients (10%) with retained CIED fragments underwent magnetic resonance imaging without adverse events. There was no difference in overall mortality between patients with and without CIED fragments (12% vs 11%, P = .81) Patients with retained fragments located in the superior vena cava had significantly higher fluoroscopic times (3.3 vs 2.9 minutes, P = .024) during subsequent endomyocardial biopsies. In a competing risk analysis, presence of a retained CIED fragment was associated with upper extremity deep venous thrombosis (sub hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.17-4.10, P = .014) but not bloodstream infection after adjusting for potential confounders. In summary, retained CIED fragments are common after heart transplantation, and are associated with longer radiation exposure during biopsy procedures and upper extremity deep venous thrombosis.
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