Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads

Amit Noheria, Shiva P. Ponamgi, Christopher V. DeSimone, Vaibhav R. Vaidya, Christopher A. Aakre, Elisa Ebrille, Tiffany Hu, David O. Hodge, Joshua P. Slusser, Naser M. Ammash, Charles J Bruce, Alejandro Rabinstein, Paul Andrew Friedman, Samuel J Asirvatham

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)246-252
Number of pages7
JournalEuropace
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2016

Keywords

  • Andexanet alfa
  • CIED
  • Ciraparantag
  • Defibrillator
  • Epidemiology
  • ICD
  • Idarucizumab
  • Pacemaker
  • Pulmonary embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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