Volume 15, Issue 11, Pages (November 2018)

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Presentation transcript:

Volume 15, Issue 11, Pages 1593-1600 (November 2018) Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal Justin Z. Lee, MBBS, Pradyumna Agasthi, MBBS, Ahmed K. Pasha, MD, Claudia Tarin, APRN, Andrew S. Tseng, MD, Nancy N. Diehl, BS, David O. Hodge, MS, Christopher V. DeSimone, MD, PhD, Ammar M. Killu, MBBS, Peter A. Brady, MD, FHRS, Krishna Kancharla, MD, Fred M. Kusumoto, MD, FHRS, Komandoor Srivathsan, MD, Michael J. Osborn, MD, FHRS, Raul E. Espinosa, MD, Robert F. Rea, MD, FHRS, Malini Madhavan, MD, Christopher J. McLeod, MBChB, PhD, FHRS, Win-Kuang Shen, MD, FHRS, Yong-Mei Cha, MD, FHRS, Paul A. Friedman, MD, FHRS, Samuel J. Asirvatham, MD, FHRS, Siva K. Mulpuru, MD, FHRS Heart Rhythm Volume 15, Issue 11, Pages 1593-1600 (November 2018) DOI: 10.1016/j.hrthm.2018.08.008 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Patient inclusion and categorization CONSORT (Consolidated Standards of Reporting Trials) flow diagram. CIED = cardiovascular implantable electronic device; VAD = ventricular assist device. Heart Rhythm 2018 15, 1593-1600DOI: (10.1016/j.hrthm.2018.08.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Timing of stroke in relation to transvenous lead removal procedure. Heart Rhythm 2018 15, 1593-1600DOI: (10.1016/j.hrthm.2018.08.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A: Transvenous lead removal may lead to dislodgment of endocardial lead vegetation. B: Paradoxical embolism of vegetation across a patent foramen ovale into the systemic circulation. C: Even after removal of the pacemaker lead, a mobile cast may still remain, leading to persistent risk of embolization. Heart Rhythm 2018 15, 1593-1600DOI: (10.1016/j.hrthm.2018.08.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 4 A: Transesophageal echocardiogram with agitated saline showing patent foramen ovale with right-to-left shunt (arrow). B: Patent foramen ovale closure with 25-mm Gore Helex device (WL Gore & Associates, Flagstaff, AZ). C: SpiderFX filter (Covidien, Mansfield, MA) in bilateral common carotid arteries (arrows). D: Balloon occlusion of the patent foramen ovale. Arrow points to waist of the balloon. E: Transesophageal echocardiogram showing the balloon crossing the patent foramen ovale into the left atrium (arrowhead). New clot was visualized in the right atrial portion of the balloon after balloon deployment (arrow). F: Transesophageal echocardiogram after balloon removal showing new clot across the mitral valve (arrow). LA = left atrium; RA = right atrium. Heart Rhythm 2018 15, 1593-1600DOI: (10.1016/j.hrthm.2018.08.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions