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

Justin Z. Lee, Pradyumna Agasthi, Ahmed K. Pasha, Claudia Tarin, Andrew S. Tseng, Nancy N. Diehl, David O. Hodge, Christopher V. DeSimone, Ammar M. Killu, Peter A. Brady, Krishna Kancharla, Fred M. Kusumoto, Komandoor Srivathsan, Michael J. Osborn, Raul Emilio Espinosa, Robert F. Rea, Malini Madhavan, Christopher J. McLeod, Win Kuang Shen, Yong-Mei ChaPaul Andrew Friedman, Samuel J Asirvatham, Siva Mulpuru

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR). Objective: The purpose of this study was to examine stroke and its associated factors in patients undergoing TLR for CIED infection. Methods: We performed a retrospective analysis of all patients undergoing TLR for CIED infection from January 1, 2000, to July 30, 2017, from all 3 tertiary referral centers at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). The primary outcome was stroke and was further categorized into preprocedural and postprocedural stroke. Associated risk factors were analyzed. Results: A total of 774 patients (mean age 67.6 ± 14.9 years) underwent TLR for CIED infection. The stroke rate in this cohort was 1.9% (95% confidence interval [CI] 1.1%–3.2%). The preprocedural and postprocedural stroke rate was 0.9% (95% CI 0.4%–1.9%) and 1.0% (95% CI 0.4%–2.0%), respectively. PFOs were identified in 46.7% of patients with stroke and in 12.9% of patients without stroke, and were independently associated with stroke (P =.0002). This was especially in patients with right-sided vegetations with right-to-left shunting (odds ratio 6.4; 95% CI 1.3–31.0; P =.022). Conclusion: In patients with CIED infection undergoing TLR, the presence of PFO, especially with right-sided vegetation with right-to-left shunting, was associated with an increased risk of stroke. This finding suggests that PFO screening before TLR warrants meticulous attention.

Original languageEnglish (US)
Pages (from-to)1593-1600
Number of pages8
JournalHeart Rhythm
Volume15
Issue number11
DOIs
StatePublished - Nov 1 2018

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Stroke
Equipment and Supplies
Infection
Patent Foramen Ovale
Confidence Intervals
Lead
Paradoxical Embolism
Patient Rights
Tertiary Care Centers
Odds Ratio

Keywords

  • Cerebrovascular accident
  • Endocarditis
  • Outcomes
  • Patent foramen ovale
  • Transvenous lead extraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal. / Lee, Justin Z.; Agasthi, Pradyumna; Pasha, Ahmed K.; Tarin, Claudia; Tseng, Andrew S.; Diehl, Nancy N.; Hodge, David O.; DeSimone, Christopher V.; Killu, Ammar M.; Brady, Peter A.; Kancharla, Krishna; Kusumoto, Fred M.; Srivathsan, Komandoor; Osborn, Michael J.; Espinosa, Raul Emilio; Rea, Robert F.; Madhavan, Malini; McLeod, Christopher J.; Shen, Win Kuang; Cha, Yong-Mei; Friedman, Paul Andrew; Asirvatham, Samuel J; Mulpuru, Siva.

In: Heart Rhythm, Vol. 15, No. 11, 01.11.2018, p. 1593-1600.

Research output: Contribution to journalArticle

Lee, JZ, Agasthi, P, Pasha, AK, Tarin, C, Tseng, AS, Diehl, NN, Hodge, DO, DeSimone, CV, Killu, AM, Brady, PA, Kancharla, K, Kusumoto, FM, Srivathsan, K, Osborn, MJ, Espinosa, RE, Rea, RF, Madhavan, M, McLeod, CJ, Shen, WK, Cha, Y-M, Friedman, PA, Asirvatham, SJ & Mulpuru, S 2018, 'Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal', Heart Rhythm, vol. 15, no. 11, pp. 1593-1600. https://doi.org/10.1016/j.hrthm.2018.08.008
Lee, Justin Z. ; Agasthi, Pradyumna ; Pasha, Ahmed K. ; Tarin, Claudia ; Tseng, Andrew S. ; Diehl, Nancy N. ; Hodge, David O. ; DeSimone, Christopher V. ; Killu, Ammar M. ; Brady, Peter A. ; Kancharla, Krishna ; Kusumoto, Fred M. ; Srivathsan, Komandoor ; Osborn, Michael J. ; Espinosa, Raul Emilio ; Rea, Robert F. ; Madhavan, Malini ; McLeod, Christopher J. ; Shen, Win Kuang ; Cha, Yong-Mei ; Friedman, Paul Andrew ; Asirvatham, Samuel J ; Mulpuru, Siva. / Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal. In: Heart Rhythm. 2018 ; Vol. 15, No. 11. pp. 1593-1600.
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abstract = "Background: Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR). Objective: The purpose of this study was to examine stroke and its associated factors in patients undergoing TLR for CIED infection. Methods: We performed a retrospective analysis of all patients undergoing TLR for CIED infection from January 1, 2000, to July 30, 2017, from all 3 tertiary referral centers at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). The primary outcome was stroke and was further categorized into preprocedural and postprocedural stroke. Associated risk factors were analyzed. Results: A total of 774 patients (mean age 67.6 ± 14.9 years) underwent TLR for CIED infection. The stroke rate in this cohort was 1.9{\%} (95{\%} confidence interval [CI] 1.1{\%}–3.2{\%}). The preprocedural and postprocedural stroke rate was 0.9{\%} (95{\%} CI 0.4{\%}–1.9{\%}) and 1.0{\%} (95{\%} CI 0.4{\%}–2.0{\%}), respectively. PFOs were identified in 46.7{\%} of patients with stroke and in 12.9{\%} of patients without stroke, and were independently associated with stroke (P =.0002). This was especially in patients with right-sided vegetations with right-to-left shunting (odds ratio 6.4; 95{\%} CI 1.3–31.0; P =.022). Conclusion: In patients with CIED infection undergoing TLR, the presence of PFO, especially with right-sided vegetation with right-to-left shunting, was associated with an increased risk of stroke. This finding suggests that PFO screening before TLR warrants meticulous attention.",
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T1 - Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal

AU - Lee, Justin Z.

AU - Agasthi, Pradyumna

AU - Pasha, Ahmed K.

AU - Tarin, Claudia

AU - Tseng, Andrew S.

AU - Diehl, Nancy N.

AU - Hodge, David O.

AU - DeSimone, Christopher V.

AU - Killu, Ammar M.

AU - Brady, Peter A.

AU - Kancharla, Krishna

AU - Kusumoto, Fred M.

AU - Srivathsan, Komandoor

AU - Osborn, Michael J.

AU - Espinosa, Raul Emilio

AU - Rea, Robert F.

AU - Madhavan, Malini

AU - McLeod, Christopher J.

AU - Shen, Win Kuang

AU - Cha, Yong-Mei

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

AU - Mulpuru, Siva

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR). Objective: The purpose of this study was to examine stroke and its associated factors in patients undergoing TLR for CIED infection. Methods: We performed a retrospective analysis of all patients undergoing TLR for CIED infection from January 1, 2000, to July 30, 2017, from all 3 tertiary referral centers at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). The primary outcome was stroke and was further categorized into preprocedural and postprocedural stroke. Associated risk factors were analyzed. Results: A total of 774 patients (mean age 67.6 ± 14.9 years) underwent TLR for CIED infection. The stroke rate in this cohort was 1.9% (95% confidence interval [CI] 1.1%–3.2%). The preprocedural and postprocedural stroke rate was 0.9% (95% CI 0.4%–1.9%) and 1.0% (95% CI 0.4%–2.0%), respectively. PFOs were identified in 46.7% of patients with stroke and in 12.9% of patients without stroke, and were independently associated with stroke (P =.0002). This was especially in patients with right-sided vegetations with right-to-left shunting (odds ratio 6.4; 95% CI 1.3–31.0; P =.022). Conclusion: In patients with CIED infection undergoing TLR, the presence of PFO, especially with right-sided vegetation with right-to-left shunting, was associated with an increased risk of stroke. This finding suggests that PFO screening before TLR warrants meticulous attention.

AB - Background: Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR). Objective: The purpose of this study was to examine stroke and its associated factors in patients undergoing TLR for CIED infection. Methods: We performed a retrospective analysis of all patients undergoing TLR for CIED infection from January 1, 2000, to July 30, 2017, from all 3 tertiary referral centers at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). The primary outcome was stroke and was further categorized into preprocedural and postprocedural stroke. Associated risk factors were analyzed. Results: A total of 774 patients (mean age 67.6 ± 14.9 years) underwent TLR for CIED infection. The stroke rate in this cohort was 1.9% (95% confidence interval [CI] 1.1%–3.2%). The preprocedural and postprocedural stroke rate was 0.9% (95% CI 0.4%–1.9%) and 1.0% (95% CI 0.4%–2.0%), respectively. PFOs were identified in 46.7% of patients with stroke and in 12.9% of patients without stroke, and were independently associated with stroke (P =.0002). This was especially in patients with right-sided vegetations with right-to-left shunting (odds ratio 6.4; 95% CI 1.3–31.0; P =.022). Conclusion: In patients with CIED infection undergoing TLR, the presence of PFO, especially with right-sided vegetation with right-to-left shunting, was associated with an increased risk of stroke. This finding suggests that PFO screening before TLR warrants meticulous attention.

KW - Cerebrovascular accident

KW - Endocarditis

KW - Outcomes

KW - Patent foramen ovale

KW - Transvenous lead extraction

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