Exploring Lead Management and Extraction: Entrapped, Abandoned or Fragmented Leads, Vegetation Debulking, and Tricuspid Valve Interventions-Exploring Lead Management and Extraction: Entrapped, Abandoned or Fragmented Leads, Vegetation Debulking, and Tricuspid Valve Interventions

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Video Summary

In this series of medical presentations at UC San Diego, topics revolved around advances and challenges in cardiac device management and procedures, primarily focusing on issues related to lead management, tricuspid valve interventions, and infections associated with cardiac implantable electronic devices.<br /><br />Dr. Graham Pei presented research from Northwestern on the outcomes of right ventricular pacing or defibrillator leads post tricuspid valve replacement. He highlighted that while the EVOKE transcatheter tricuspid valve system improves quality of life, lead entrapment poses potential complications. The study showed that a minority of patients experienced lead-related complications, underscoring the importance of tailored cardiac management.<br /><br />Dr. Christian Bichard from Temple University Hospital discussed the prevalence of retained lead fragments post-heart transplant. His findings revealed a significant percentage of patients had retained lead fragments, which may lead to bacteremia and other complications, suggesting a protocol that emphasizes careful lead management during transplants.<br /><br />Further studies, like those in the French Honest cohort, addressed the safety of having abandoned leads after switching to a subcutaneous ICD due to transvenous ICD complications. Another important aspect was researched through a comparative study on the outcomes of concurrent or subsequent pacemaker implementations following tricuspid valve procedures. This research indicated a higher mortality rate in procedures where pacemaker implantation was concurrent with tricuspid valve repairs.<br /><br />Lastly, the presentation on mechanical aspiration and debulking of large vegetations during device extraction indicated potential benefits of new techniques to reduce risks associated with embolization and infection, showing promise in improving patient outcomes during complex device extractions. These talks collectively advance understanding and demonstrate the evolving strategies in cardiac electrophysiology and implantable device management.

Keywords

cardiac device management

tricuspid valve interventions

lead management

cardiac implantable electronic devices

right ventricular pacing

lead entrapment

retained lead fragments

subcutaneous ICD

pacemaker implantation

device extraction techniques