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Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal

Justin Z Lee1, Pradyumna Agasthi1, Ahmed K Pasha2

  • 1Mayo Clinic Arizona, Phoenix, Arizona.

Heart Rhythm
|January 19, 2019
PubMed

Insights

Stroke risk increases in patients with cardiovascular implantable electronic device (CIED) infections undergoing transvenous lead removal (TLR). Patent foramen ovale (PFO), especially with right-to-left shunting, significantly elevates stroke risk.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • Cardiovascular implantable electronic device (CIED) infections pose a stroke risk.
  • Paradoxical septic embolism can occur during transvenous lead removal (TLR) in patients with CIED leads and patent foramen ovale (PFO).

Purpose of the Study:

  • To investigate stroke occurrence and associated risk factors in patients undergoing TLR for CIED infection.

Main Methods:

  • Retrospective analysis of 774 patients undergoing TLR for CIED infection from 2000-2017.
  • Primary outcome: stroke (preprocedural and postprocedural).
  • Analysis of associated risk factors, including PFO presence.

Main Results:

  • Overall stroke rate was 1.9%.
  • PFO identified in 46.7% of stroke patients vs. 12.9% of non-stroke patients.
  • PFO independently associated with stroke (P = .0002), particularly with right-sided vegetation and right-to-left shunting (OR 6.4, P = .022).

Conclusions:

  • Patent foramen ovale (PFO) is a significant stroke risk factor in CIED infection patients undergoing TLR.
  • The risk is amplified with right-sided vegetation and right-to-left shunting.
  • Pre-TLR screening for PFO is crucial in these patients.
Abstract

Keywords:
Cerebrovascular accidentEndocarditisOutcomesPatent foramen ovaleTransvenous lead extraction

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