Atrial septal closure device explant may resolve nickel allergy symptoms

SAN DIEGO — Patients with nickel allergy and severe refractory symptoms after implantation with an atrial septal closure device experienced complete resolution of symptoms after device explantation, according to a report presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Divya Ratan Verma, MD, MS, from University of Utah Hospitals and Clinics, said a small number of patients with cardiac pathology who are implanted with biomedical devices may experience allergic reactions to nickel as the device corrodes, releasing nickel particles that trigger immune response. The systemic reaction typically presents with chest pain, exertional dyspnea, asthenia and mild leukocytosis, with other symptoms including migraine and pericarditis.

The researchers evaluated 10 consecutive patients with nickel allergy (mean age, 45 years) who required removal of an atrial septal closure device due to refractory nickel allergy symptoms after unsuccessful conservative medical therapy. All patients received independent evaluation by a cardiologist, dermatologist and cardiothoracic surgeon, and the patients underwent explantation via minimal right thoracotomy. Nickel allergy was confirmed in each patient via patch (60%) and/or prick testing (50%). Eighty percent of patients had a history of nickel allergy as indicated by a reaction to artificial jewelry.

Patients developed symptoms indicating nickel allergy early after implantation, and 80% exhibiting symptoms within days of the procedure. Chest pain occurred in all patients (80% dyspnea, 40% palpitations).

Patients who had their allergies confirmed via positive prick test were more likely to experience symptoms within 14 days of implant (100% vs. 67% confirmed via patch test) and also were more likely to report recurring migraines or transient ischemic attack (100% vs. 25%).

No surgical complications were reported. All patients experienced resolution of their symptoms and reported feeling significantly better after explant.

Three patients underwent assessment of urine nickel levels an average of 40 months after implantation. The three patients had elevated levels ranging from 1.4 µg/L to 17 µg/L. These higher nickel levels normalized after explant.

“In this single-center experience, patients with nickel allergy and severe refractory symptoms were effectively treated with surgical explantation of their [atrial septal closure device],” Verma said. “In patients undergoing percutaneous [atrial septal or patent foramen ovale] closure, particularly those with a history of metal allergy, routine nickel allergy testing should be considered to identify patients at higher risk of an exaggerated inflammatory reaction in whom surgical closure may be favored.” – by Adam Taliercio

Reference:

Verma DR, et al. Abstract O1-02. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions: May 6-9, 2015; San Diego.

Disclosure: The researchers report no relevant financial disclosures.