Thomas Callahan

Physician

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Display name	Thomas Callahan
First name	Thomas
Last name	Callahan
Website
Bio
Member since	November 21, 2021
Society Affiliation(s)	HRS
Clinical title	Co-Director, Pacemaker and Defibrillator Lead Extraction Center
Institution (or Retired)	Cleveland Clinic
Degree 1	MD
Degree 2	MA

Topics Started
- Hemostatic Agents
  February 15, 2023
- Use of technology to manage pocket sites
  January 12, 2023
- Lead Prep
  December 13, 2022
1 2 Next »
Replies
- Nice case and excellent discussion of the approach to management of CIEDs and leads for patients needing radiation therapy. Most often, we don't see significant performance issues for CIEDs after XRT.
  February 15, 2023
- Interesting case! Of course, one has to consider all of the clinical factors, but assuming the patient is not very frail, I would favor open surgical extraction. The surgeons will be able to debride this very large vegetation. They may find the cardiac involvement greater than what is seen on the TOE. Our experience is that even TOE underestimates actual infectious involvement of the cardiac structures. I'd be concerned about Option 1, TLE, as embolization of this very large vegetation into the PA may result in hemodynamic collapse acutely. Additionally, the patient would be left with this large burden of infected tissue which may make him or her more prone to SIRS or persistent bacteremia. Just my thoughts. Thanks for sharing the case!
  December 5, 2022
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Thomas Callahan, Author at LEADconnection

Thomas Callahan

Physician

Profile

Go to profile
Display name	Thomas Callahan
First name	Thomas
Last name	Callahan
Website
Bio
Member since	November 21, 2021
Society Affiliation(s)	HRS
Clinical title	Co-Director, Pacemaker and Defibrillator Lead Extraction Center
Institution (or Retired)	Cleveland Clinic
Degree 1	MD
Degree 2	MA

Topics Started
- Hemostatic Agents
  February 15, 2023
- Use of technology to manage pocket sites
  January 12, 2023
- Lead Prep
  December 13, 2022
1 2 Next »
Replies
- Nice case and excellent discussion of the approach to management of CIEDs and leads for patients needing radiation therapy. Most often, we don't see significant performance issues for CIEDs after XRT.
  February 15, 2023
- Interesting case! Of course, one has to consider all of the clinical factors, but assuming the patient is not very frail, I would favor open surgical extraction. The surgeons will be able to debride this very large vegetation. They may find the cardiac involvement greater than what is seen on the TOE. Our experience is that even TOE underestimates actual infectious involvement of the cardiac structures. I'd be concerned about Option 1, TLE, as embolization of this very large vegetation into the PA may result in hemodynamic collapse acutely. Additionally, the patient would be left with this large burden of infected tissue which may make him or her more prone to SIRS or persistent bacteremia. Just my thoughts. Thanks for sharing the case!
  December 5, 2022
Topics Following
No topics followed by this user.

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