open access

Vol 76, No 4 (2017)
ORIGINAL ARTICLES
Published online: 2017-05-25
Submitted: 2017-02-25
Accepted: 2017-04-27
Get Citation

Morphometric parameters of cardiac implantable electronic device (CIED) pocket walls observed on device replacement

R. Steckiewicz, E. B. Świętoń, A. Kołodzińska, M. Bogdańska, Ł. Fus, P. Solarz
DOI: 10.5603/FM.a2017.0048
·
Pubmed: 28553851
·
Folia Morphol 2017;76(4):675-681.

open access

Vol 76, No 4 (2017)
ORIGINAL ARTICLES
Published online: 2017-05-25
Submitted: 2017-02-25
Accepted: 2017-04-27

Abstract

Background: The final stage of a conventional de-novo cardiac implantable electronic device (CIED) implantation procedure with transvenous lead insertion involves the formation of a pocket by tissue separation superficial to the pectoralis major muscle in the right or left infraclavicular region, where the device is subsequently placed. Over time, a scar “capsule” is formed around the CIED as a result of normal biological remodelling. Materials and methods: The purpose of this study was to analyse the structure and present the variations of CIED capsules observed during device replacement. The nature and extent of this local tissue remodelling, which had occurred from the time of device implantation to its replacement in 2016 (10 ± 3.1 years), was analysed in 100 patients (mean age 77.1 ± 14.5 years), including 45 women and 55 men. Results: The most prevalent types of “capsules” (70% of cases) were those with similar thickness of both walls or a slightly thicker posterior (< 1.0 mm) than anterior wall (< 0.5 mm). The second most common capsule type (23% of cases) was characterised by a significantly thicker posterior wall of scar tissue (> 1.0 mm). The third group of capsules was characterised by various degrees of wall calcification (7% of cases). Conclusions: The extent and nature of scar tissue structure in the CIED pocket walls seem to correlate with the relative position of cardiac lead loops with respect to the device itself; where the more extensive scarring is likely to result from pocket wall irritation in the capsule formation phase due to lead movements underneath the device. The group of cases with calcified capsules was characterised by “old” device pockets (> 13 years) and the oldest population (patients in their 80s and 90s).

Abstract

Background: The final stage of a conventional de-novo cardiac implantable electronic device (CIED) implantation procedure with transvenous lead insertion involves the formation of a pocket by tissue separation superficial to the pectoralis major muscle in the right or left infraclavicular region, where the device is subsequently placed. Over time, a scar “capsule” is formed around the CIED as a result of normal biological remodelling. Materials and methods: The purpose of this study was to analyse the structure and present the variations of CIED capsules observed during device replacement. The nature and extent of this local tissue remodelling, which had occurred from the time of device implantation to its replacement in 2016 (10 ± 3.1 years), was analysed in 100 patients (mean age 77.1 ± 14.5 years), including 45 women and 55 men. Results: The most prevalent types of “capsules” (70% of cases) were those with similar thickness of both walls or a slightly thicker posterior (< 1.0 mm) than anterior wall (< 0.5 mm). The second most common capsule type (23% of cases) was characterised by a significantly thicker posterior wall of scar tissue (> 1.0 mm). The third group of capsules was characterised by various degrees of wall calcification (7% of cases). Conclusions: The extent and nature of scar tissue structure in the CIED pocket walls seem to correlate with the relative position of cardiac lead loops with respect to the device itself; where the more extensive scarring is likely to result from pocket wall irritation in the capsule formation phase due to lead movements underneath the device. The group of cases with calcified capsules was characterised by “old” device pockets (> 13 years) and the oldest population (patients in their 80s and 90s).

Get Citation

Keywords

pacemaker, implantable cardioverter-defibrillator, capsule, structure

About this article
Title

Morphometric parameters of cardiac implantable electronic device (CIED) pocket walls observed on device replacement

Journal

Folia Morphologica

Issue

Vol 76, No 4 (2017)

Pages

675-681

Published online

2017-05-25

DOI

10.5603/FM.a2017.0048

Pubmed

28553851

Bibliographic record

Folia Morphol 2017;76(4):675-681.

Keywords

pacemaker
implantable cardioverter-defibrillator
capsule
structure

Authors

R. Steckiewicz
E. B. Świętoń
A. Kołodzińska
M. Bogdańska
Ł. Fus
P. Solarz

References (13)
  1. Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. Semin Immunol. 2008; 20(2): 86–100.
  2. Biefer HR, Hürlimann D, Grünenfelder J, et al. Generator pocket adhesions of cardiac leads: classification and correlation with transvenous lead extraction results. Pacing Clin Electrophysiol. 2013; 36(9): 1111–1116.
  3. Bongiorni MG, Proclemer A, Dobreanu D, et al. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace. 2013; 15(11): 1664–1668.
  4. DE Sensi F, Miracapillo G, Cresti A, et al. Pocket Hematoma: A Call for Definition. Pacing Clin Electrophysiol. 2015; 38(8): 909–913.
  5. Krupa W, Kozłowski D, Derejko P, et al. Permanent cardiac pacing and its influence on tricuspid valve function. Folia Morphol. 2001; 60(4): 249–257.
  6. Mandal S, Pande A, Kahali D. A Rare Case of Very Early Pacemaker Twiddler's Syndrome. Heart Views. 2012; 13(3): 114–115.
  7. Martin P, Nunan R. Cellular and molecular mechanisms of repair in acute and chronic wound healing. Br J Dermatol. 2015; 173(2): 370–378.
  8. Maytin M. Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty. J Innovat Cardiac Rhythm Management. 2015; 6(11).
  9. Perry L, Karp F, Hauch K, et al. Explanted pacemakers: observations of the long-term foreign body response. J Und Res Bioeng. 2007; 7: 13–21.
  10. Rajappan K. Permanent pacemaker implantation technique: part I: arrhythmias. Heart. 2009; 95(3): 259–264.
  11. Rohacek M, Baddour LM. Cardiovascular implantable electronic device infections: associated risk factors and prevention. Swiss Med Wkly. 2015; 145: w14157.
  12. Wynn TA. Cellular and molecular mechanisms of fibrosis. J Pathol. 2008; 214(2): 199–210.
  13. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res. 2009; 37(5): 1528–1542.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl