In the Journals

Patients with PFO at risk for stroke during lead removal for device-related infection

Among patients with an implantable cardiac device undergoing transvenous lead removal due to infection, those with a patent foramen ovale were at increased risk for stroke, according to findings published in HeartRhythm.

The researchers retrospectively analyzed 774 patients (mean age, 68 years) who underwent transvenous lead removal due to CV implantable electronic device, or CIED, infection at three Mayo Clinic centers between 2000 and July 2017 to determine risk factors for stroke in this population.

Among the cohort, the total stroke rate was 1.9% (95% CI, 1.1-3.2; periprocedural, 0.9%; 95% CI, 0.4-1.9; postprocedural, 1%; 95% CI, 0.4-2), Justin Z. Lee, MBBS, from Mayo Clinic Arizona, and colleagues wrote.

The researchers identified PFOs in 46.7% of patients who had a stroke and 12.9% of those who did not have one, and determined that PFO was independently associated with stroke in the cohort (OR = 7.75; 95% CI, 2.6-23.15).

The association was pronounced in patients who had right-sided vegetations with left-to-right shunting (OR = 6.4; 95% CI, 1.3-31), according to the researchers.

In addition, left-sided vegetation was independently associated with stroke in the cohort (OR = 7.68; 95% CI, 2.5-23.6).

Those who had a stroke had a longer length of stay than those who did not (19 days vs. 13 days; P = .022), but stroke was not associated with 30-day mortality (P = .23), Lee and colleagues wrote.

“This finding highlights the importance of preprocedural PFO screening in patients with CIED infections undergoing [transvenous lead removal],” the researchers wrote. “Further studies will be needed to assess management strategies in patients with PFO undergoing [transvenous lead removal] for CIED infection, such as PFO closure or use of cerebral embolic protection devices.” – by Erik Swain

Disclosures: The authors report no relevant financial disclosures.

Among patients with an implantable cardiac device undergoing transvenous lead removal due to infection, those with a patent foramen ovale were at increased risk for stroke, according to findings published in HeartRhythm.

The researchers retrospectively analyzed 774 patients (mean age, 68 years) who underwent transvenous lead removal due to CV implantable electronic device, or CIED, infection at three Mayo Clinic centers between 2000 and July 2017 to determine risk factors for stroke in this population.

Among the cohort, the total stroke rate was 1.9% (95% CI, 1.1-3.2; periprocedural, 0.9%; 95% CI, 0.4-1.9; postprocedural, 1%; 95% CI, 0.4-2), Justin Z. Lee, MBBS, from Mayo Clinic Arizona, and colleagues wrote.

The researchers identified PFOs in 46.7% of patients who had a stroke and 12.9% of those who did not have one, and determined that PFO was independently associated with stroke in the cohort (OR = 7.75; 95% CI, 2.6-23.15).

The association was pronounced in patients who had right-sided vegetations with left-to-right shunting (OR = 6.4; 95% CI, 1.3-31), according to the researchers.

In addition, left-sided vegetation was independently associated with stroke in the cohort (OR = 7.68; 95% CI, 2.5-23.6).

Those who had a stroke had a longer length of stay than those who did not (19 days vs. 13 days; P = .022), but stroke was not associated with 30-day mortality (P = .23), Lee and colleagues wrote.

“This finding highlights the importance of preprocedural PFO screening in patients with CIED infections undergoing [transvenous lead removal],” the researchers wrote. “Further studies will be needed to assess management strategies in patients with PFO undergoing [transvenous lead removal] for CIED infection, such as PFO closure or use of cerebral embolic protection devices.” – by Erik Swain

Disclosures: The authors report no relevant financial disclosures.