Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device

Kathryn Lewis, Mingyan Dai, Kristen K. Patton, Yong-Mei Cha, Travis Pollema, Gregory K. Feld, Ulrika Birgersdotter-Green, Victor Pretorius

Research output: Contribution to journalArticle

Abstract

Aims: Chronic pain at the cardiovascular implantable electronic device (CIED) generator or lead insertion site that is not otherwise manageable carries a IIA indication for extraction. However, limited data exist evaluating causes of pain and outcomes of extraction in eliminating pain. A multi-centre retrospective observational study was conducted to evaluate outcomes of patients undergoing device extraction for treatment of chronic device pain. Methods and results: Twenty-seven out of 2188 lead extraction candidates (1.3%) met the chronic pain IIA indication for extraction [50 ± 16 years; 14 (51%) women]. Onset, severity, triggers, and pain management were measured before and after extraction. Device type, procedure done (with/without reimplantation), and positive tissue cultures were noted. Pain was reported as constant (n = 14; 50%), intermittent (n = 13; 46%), and movement-triggered (n = 14; 50%). Average severity of pain was seven out of 10 (10 being the worst). Post-extraction, 18 (66%) received freedom from pain, including all patients with poorly formed pockets (n = 2) and subclinical infections (n = 2). Of the 18, 11 underwent reimplantation (61%) without recurrent pain. Nine still had pain (44 ± 17 years; seven women) after extraction. Eight of the nine underwent reimplantation, three on the contralateral chest wall and five ipsilaterally. Pain severity decreased (n = 5), increased (n = 1), or was unchanged (n = 3). Conclusion: Chronic pain at the CIED generator site can present as chronic or movement-triggered pain, and can be due to subclinical infection or a poorly formed device pocket. Extraction relieved constant and intermittent pain in two-thirds of patients. Extraction appears less successful in eliminating pain in women who undergo subsequent reimplantation.

Original languageEnglish (US)
Pages (from-to)781-786
Number of pages6
JournalEuropace
Volume21
Issue number5
DOIs
StatePublished - Jan 1 2019

Keywords

  • Cardiovascular implantable electronic device
  • Cardiovascular implantable electronic device lead extraction
  • Chronic pain
  • Implantable cardioverter-defibrillator
  • Pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Lewis, K., Dai, M., Patton, K. K., Cha, Y-M., Pollema, T., Feld, G. K., Birgersdotter-Green, U., & Pretorius, V. (2019). Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device. Europace, 21(5), 781-786. https://doi.org/10.1093/europace/euy320