TY - JOUR
T1 - Incidence, management, and outcomes of the arteriovenous fistula complicating transvenous lead extraction
AU - Cronin, Edmond M.
AU - Brunner, Michael P.
AU - Tan, Carmela D.
AU - Rene Rodriguez, E.
AU - Rickard, John
AU - Martin, David O.
AU - Wazni, Oussama M.
AU - Tarakji, Khaldoun G.
AU - Wilkoff, Bruce L.
AU - Baranowski, Bryan J.
PY - 2014/3
Y1 - 2014/3
N2 - Background An arteriovenous (AV) fistula is an infrequently reported complication of transvenous lead extraction (TLE), but may be under-recognized. Objective To determine the incidence, management, and outcomes of the AV fistula complicating TLE. Methods All TLE procedures from July 2001 to December 2012 were reviewed. Results Of 2471 patients who underwent TLE, the AV fistula occurred in 8 (0.3%; 6 pacemaker and 2 implantable cardioverter-defibrillator) procedures. Patients who developed an AV fistula had longer lead implant duration (11.8 [interquartile range 7.7] vs 5.2 [interquartile range 7.0] years) and were more likely to have required a powered sheath (8 of 8 [100%] vs 1392 of 2463 [56.5%]) compared to those who did not. Other procedural and demographic details did not discriminate. All patients had a continuous bruit along the anterior chest wall. Catheter angiography was more sensitive (100%) than computed tomography (75%) or ultrasound (25%) for confirming the diagnosis and identifying the vessels involved. One fistula closed spontaneously, while others were closed with covered stents (4) or surgical glue (1). One attempt at closure failed, and one was diagnosed postmortem. Mortality related to the AV fistula was 3 of 8 (37.5%). Patients who died all had structural heart disease. In the 5 patients with normal hearts, the AV fistula was well tolerated for up to 2 years. Conclusions An AV fistula is an infrequent, though possibly under-recognized, complication of TLE. It requires a high index of suspicion for early diagnosis, may present late, and may be associated with significant morbidity and mortality in patients with structural heart disease.
AB - Background An arteriovenous (AV) fistula is an infrequently reported complication of transvenous lead extraction (TLE), but may be under-recognized. Objective To determine the incidence, management, and outcomes of the AV fistula complicating TLE. Methods All TLE procedures from July 2001 to December 2012 were reviewed. Results Of 2471 patients who underwent TLE, the AV fistula occurred in 8 (0.3%; 6 pacemaker and 2 implantable cardioverter-defibrillator) procedures. Patients who developed an AV fistula had longer lead implant duration (11.8 [interquartile range 7.7] vs 5.2 [interquartile range 7.0] years) and were more likely to have required a powered sheath (8 of 8 [100%] vs 1392 of 2463 [56.5%]) compared to those who did not. Other procedural and demographic details did not discriminate. All patients had a continuous bruit along the anterior chest wall. Catheter angiography was more sensitive (100%) than computed tomography (75%) or ultrasound (25%) for confirming the diagnosis and identifying the vessels involved. One fistula closed spontaneously, while others were closed with covered stents (4) or surgical glue (1). One attempt at closure failed, and one was diagnosed postmortem. Mortality related to the AV fistula was 3 of 8 (37.5%). Patients who died all had structural heart disease. In the 5 patients with normal hearts, the AV fistula was well tolerated for up to 2 years. Conclusions An AV fistula is an infrequent, though possibly under-recognized, complication of TLE. It requires a high index of suspicion for early diagnosis, may present late, and may be associated with significant morbidity and mortality in patients with structural heart disease.
KW - Arteriovenous fistula
KW - Implantable cardioverter-defibrillator (ICD)
KW - Pacemaker
KW - Transvenous lead extraction
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U2 - 10.1016/j.hrthm.2013.11.024
DO - 10.1016/j.hrthm.2013.11.024
M3 - Article
C2 - 24291414
AN - SCOPUS:84894537516
SN - 1547-5271
VL - 11
SP - 404
EP - 411
JO - Heart Rhythm
JF - Heart Rhythm
IS - 3
ER -