SpringerLink
Log in

Mobile thrombus on cardiac implantable electronic device leads of patients undergoing cardiac ablation: incidence, management, and outcomes

  • MULTIMEDIA REPORT
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The rates of cardiovascular implantable electronic device (CIED) implantations and cardiac ablation procedures are increasing worldwide. To date, the management of CIED lead thrombi in the peri-ablation period remains undefined and key clinical management questions remained unanswered. We sought to describe the clinical course and management strategies of patients with a CIED lead thrombus detected in the peri-ablative setting.

Methods

We performed a retrospective analysis of all patients who underwent a cardiac ablation procedure at Mayo Clinic Rochester from 2000 to 2014. Patients were included in our study cohort if they had documented CIED lead thrombus noted on peri-ablation imaging studies. Electronic medical records were reviewed to determine the overall management strategy, outcomes, and embolic complications in these patients.

Results

Our overall cohort included 1833 patients, with 27 (1.4 %) having both cardiac ablation procedures as well as CIED lead thrombus detected on imaging. Of these 27 patients, 21 were male (77 %), and the mean age was 59.2 years. The mean duration of follow-up was 16.5 months (range 3 days–48.3 months). Anticoagulation was an effective therapeutic strategy, with 11/14 (78.6 %) patients experiencing either resolution of the thrombus or reduction in size on re-imaging. For atrial fibrillation ablation, the most common management strategy was a deferment in ablation with initiation/intensification of anticoagulation medication. For ventricular tachycardia ablations, most procedures involved a modified approach with the use of a retrograde aortic approach to access the left ventricle. No patient had any documented embolic complications.

Conclusions

The incidence of lead thrombi in patients undergoing an ablation was small in our study cohort (1.4 %). Anticoagulation and deferral of ablation represented successful management strategies for atrial fibrillation ablation. For patients undergoing ventricular tachycardia ablation, a modified approach using retrograde aortic access to the ventricle was successful. In patients who are not on warfarin anticoagulation at the time of thrombus detection, we recommend initiation of this medication, with a goal INR of 2–3. For patients on warfarin at the time of thrombus detection, we recommend an intensification of anticoagulation with a goal INR of 3.0.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gadler, F., Valzania, C., & Linde, C. (2015). Current use of implantable electrical devices in Sweden: data from the Swedish pacemaker and implantable cardioverter-defibrillator registry. Europace, 17(1), 69–77.

    Article  PubMed  Google Scholar 

  2. Voigt, A., Shalaby, A., & Saba, S. (2010). Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing and Clinical Electrophysiology, 33(4), 414–9.

    Article  PubMed  Google Scholar 

  3. Uslan, D. Z., et al. (2008). Temporal trends in permanent pacemaker implantation: a population-based study. American Heart Journal, 155(5), 896–903.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zhan, C., et al. (2008). Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. Journal of General Internal Medicine, 23(Suppl 1), 13–9.

    Article  PubMed  Google Scholar 

  5. Boriani, G., et al. (2010). Implantable electrical devices for prevention of sudden cardiac death: data on implant rates from a ‘real world’ regional registry. Europace, 12(9), 1224–30.

    Article  PubMed  Google Scholar 

  6. van Veldhuisen, D. J., et al. (2009). Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: changes from 2004 to 2008. European Journal of Heart Failure, 11(12), 1143–51.

    Article  PubMed  Google Scholar 

  7. Raatikainen, M. J., et al. (2015). Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace, 17(Suppl 1), i1–i75.

    Article  PubMed  Google Scholar 

  8. Epstein, A. E., et al. (2013). 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 61(3), e6–75.

    Article  PubMed  Google Scholar 

  9. European Society of, C. (2013). ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace, 15(8), 1070–118.

    Article  Google Scholar 

  10. Kumar, S., et al. (2013). Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia. Europace, 15(12), 1702–9.

    Article  PubMed  Google Scholar 

  11. Kneeland, P. P., & Fang, M. C. (2009). Trends in catheter ablation for atrial fibrillation in the United States. Journal of Hospital Medicine, 4(7), E1–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Palaniswamy, C., et al. (2014). Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States. Heart Rhythm, 11(11), 2056–63.

    Article  PubMed  Google Scholar 

  13. Katz, D.F. et al. (2015). Safety of ventricular tachycardia ablation in clinical practice: findings from 9,699 hospital discharge records. Circular Arrhythmetic Electrophysiology

  14. Spittell, P. C., & Hayes, D. L. (1992). Venous complications after insertion of a transvenous pacemaker. Mayo Clinic Proceedings, 67(3), 258–65.

    Article  CAS  PubMed  Google Scholar 

  15. Mitrovic, V., et al. (1983). Thrombotic complications with pacemakers. International Journal of Cardiology, 2(3–4), 363–74.

    Article  CAS  PubMed  Google Scholar 

  16. Stoney, W. S., et al. (1976). The incidence of venous thrombosis following long-term transvenous pacing. Annals of Thoracic Surgery, 22(2), 166–70.

    Article  CAS  PubMed  Google Scholar 

  17. Prozan, G. B., et al. (1968). Pulmonary thromboembolism in the presence of an endocardiac pacing catheter. JAMA, 206(7), 1564–5.

    Article  CAS  PubMed  Google Scholar 

  18. Supple, G. E., et al. (2011). Mobile thrombus on device leads in patients undergoing ablation: identification, incidence, location, and association with increased pulmonary artery systolic pressure. Circulation, 124(7), 772–8.

    Article  PubMed  Google Scholar 

  19. DeSimone, C. V., et al. (2013). Stroke or transient ischemic attack in patients with transvenous pacemaker or defibrillator and echocardiographically detected patent foramen ovale. Circulation, 128(13), 1433–41.

    Article  PubMed  Google Scholar 

  20. Vaidya, V. R., et al. (2014). Implanted endocardial lead characteristics and risk of stroke or transient ischemic attack. Journal of Interventional Cardiac Electrophysiology, 41(1), 31–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rahbar, A. S., et al. (2013). Risk factors and prognosis for clot formation on cardiac device leads. Pacing and Clinical Electrophysiology, 36(10), 1294–300.

    PubMed  Google Scholar 

  22. Baker, W. L., et al. (2009). Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. Journal of Managed Care Pharmacy, 15(3), 244–52.

    Article  PubMed  Google Scholar 

  23. van Walraven, C., et al. (2006). Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest, 129(5), 1155–66.

    Article  PubMed  Google Scholar 

  24. Narducci, M. L., et al. (2013). Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device-related endocarditis. Journal of the American College of Cardiology, 61(13), 1398–405.

    Article  PubMed  Google Scholar 

  25. Noheria, A., et al. (2015). Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Alan Sugrue & Charles J. Lenz

  2. Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Christopher V. DeSimone, Douglas L. Packer & Samuel J. Asirvatham

  3. Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Samuel J. Asirvatham

Authors
  1. Alan Sugrue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher V. DeSimone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles J. Lenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Douglas L. Packer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samuel J. Asirvatham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel J. Asirvatham.

Ethics declarations

Financial support

Dr. DeSimone is supported by a NIH Training Grant T32 #HL0070111.

Conflict of interest

None

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(MP4 18547 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sugrue, A., DeSimone, C.V., Lenz, C.J. et al. Mobile thrombus on cardiac implantable electronic device leads of patients undergoing cardiac ablation: incidence, management, and outcomes. J Interv Card Electrophysiol 46, 115–120 (2016). https://doi.org/10.1007/s10840-015-0085-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0085-2

Keywords

Search

Navigation