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

Fingerprint

Chronic Pain
Pain
Equipment and Supplies
Replantation
Asymptomatic Infections
Lead
Thoracic Wall
Pain Management
Observational Studies
Retrospective Studies

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)

Cite this

Lewis, K., Dai, M., Patton, K. K., Cha, Y-M., Pollema, T., Feld, G. K., ... 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

Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device. / Lewis, Kathryn; Dai, Mingyan; Patton, Kristen K.; Cha, Yong-Mei; Pollema, Travis; Feld, Gregory K.; Birgersdotter-Green, Ulrika; Pretorius, Victor.

In: Europace, Vol. 21, No. 5, 01.01.2019, p. 781-786.

Research output: Contribution to journalArticle

Lewis, K, Dai, M, Patton, KK, Cha, Y-M, Pollema, T, Feld, GK, Birgersdotter-Green, U & Pretorius, V 2019, 'Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device', Europace, vol. 21, no. 5, pp. 781-786. https://doi.org/10.1093/europace/euy320
Lewis, Kathryn ; Dai, Mingyan ; Patton, Kristen K. ; Cha, Yong-Mei ; Pollema, Travis ; Feld, Gregory K. ; Birgersdotter-Green, Ulrika ; Pretorius, Victor. / Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device. In: Europace. 2019 ; Vol. 21, No. 5. pp. 781-786.
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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.",
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AU - Dai, Mingyan

AU - Patton, Kristen K.

AU - Cha, Yong-Mei

AU - Pollema, Travis

AU - Feld, Gregory K.

AU - Birgersdotter-Green, Ulrika

AU - Pretorius, Victor

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AB - 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.

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KW - Implantable cardioverter-defibrillator

KW - Pacemaker

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