101
|
Farooqi FM, Talsania S, Hamid S, Rinaldi CA. Extraction of cardiac rhythm devices: indications, techniques and outcomes for the removal of pacemaker and defibrillator leads. Int J Clin Pract 2010; 64:1140-7. [PMID: 20642712 DOI: 10.1111/j.1742-1241.2010.02338.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide not only for symptomatic bradycardia, but also for the management of arrhythmia and heart failure. Their use in more elderly patients with significant comorbidities is rising steeply and consequently long-term complications are increasingly arising. Such an increase in device therapy is being paralleled by an increase in the requirement for system extraction. Safe lead extraction is central to the management of much of the complications related to pacemakers. The most common indication for lead extraction is system infection Adhesions in chronically implanted leads can become major obstacles to safe lead extraction and life-threatening bleeding and cardiac perforations may occur. Over the last 20 years, specific tools and techniques for transvenous lead extraction have been developed to assist in freeing the lead body from the adhesions. This article provides a comprehensive review of the indications, tools, techniques and outcomes for transvenous lead extraction. The success rate largely depends on the time from implant. Up to 12 months from implant, it is rare that traction alone will not suffice. For longer lead implant duration, no single technique is sufficient to address all extractions, but laser provides the best chance of extracting the entire lead. Operator experience is vital in determining success as familiarity of a wide array of techniques will increase the likelihood of uncomplicated extraction. Long implantation time, lack of operator experience, ICD lead type and female gender are risk factors for life-threatening complications. Lead extraction should therefore, ideally be performed in high volume centres with experienced staff and on-site support from a cardiothoracic surgical team able to deal with bleeding complications from cardiovascular perforation.
Collapse
Affiliation(s)
- F M Farooqi
- St Thomas' Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
102
|
Hussein AA, Wilkoff BL, Martin DO, Karim S, Kanj M, Callahan T, Baranowski B, Saliba WI, Wazni OM. Initial experience with the Evolution mechanical dilator sheath for lead extraction: Safety and efficacy. Heart Rhythm 2010; 7:870-3. [PMID: 20346418 DOI: 10.1016/j.hrthm.2010.03.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 03/10/2010] [Indexed: 11/19/2022]
|
103
|
Kröpil P, Lanzman RS, Miese FR, Blondin D, Winter J, Scherer A, Fürst G. Minimally invasive catheter procedures to assist complicated pacemaker lead extraction and implantation in the operating room. Cardiovasc Intervent Radiol 2010; 34:345-51. [PMID: 20502898 DOI: 10.1007/s00270-010-9887-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 04/08/2010] [Indexed: 01/04/2023]
Abstract
We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 ± 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thus required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.
Collapse
Affiliation(s)
- Patric Kröpil
- Department of Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | |
Collapse
|
104
|
Effectiveness of implantable cardioverter-defibrillator lead coil treatments in facilitating ease of extraction. Heart Rhythm 2010; 7:890-7. [PMID: 20420939 DOI: 10.1016/j.hrthm.2010.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 04/21/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Expanded polytetrafluoroethylene (ePTFE) coated and medical adhesive back-filled (MABF) implantable cardioverter-defibrillator (ICD) coils have been promoted to reduce the fibrous ingrowth into coils that can complicate lead extraction. OBJECTIVE The purpose of this study was to test the hypothesis that ePTFE or MABF coatings are associated with greater ease of extraction. METHODS Consecutive isolated ICD lead extraction cases were identified from a prospectively collected clinical database. Primary endpoints included total procedure and fluoroscopy times, radiation dose, and fibrosis sites. Data were analyzed using univariate and multivariate analyses in total and propensity-matched groups, adjusting for lead age and other factors. RESULTS Among 329 patients (80% male; age 63.7 +/- 5.4 years), 284 (86.3%) had standard coil ICD and 45 (13.7%) had treated coil ICD leads extracted, of which 17 (5.2%) were ePTFE coated and 28 (8.5%) were MABF ICD leads. The ePTFE and MABF leads were associated with lower procedure and fluoroscopy times, radiation dose, and fibrosis sites, even after adjustment for lead age, which was significantly shorter in the treated coil leads. To further adjust for the difference in lead age, a propensity-matched group was analyzed. Procedure time, fluoroscopy time, radiation dose, and brachiocephalic fibrosis remained significantly lower in the treated coil lead group. CONCLUSIONS The ePTFE- and MABF-treated coils appear to provide some incremental benefit in ease of extraction over conventional, nontreated coil ICD leads. Although many current ICD leads do not have fibrosis ingrowth-limiting strategies, our study may rationalize the consideration of adding such technologies to future leads.
Collapse
|
105
|
Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NAM, Gewitz M, Newburger JW, Schron EB, Taubert KA. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121:458-77. [PMID: 20048212 DOI: 10.1161/circulationaha.109.192665] [Citation(s) in RCA: 728] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening. This has prompted the study of all aspects of CIED infections. Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research.
Collapse
|
106
|
Scott PA, Chungh A, Zeb M, Yue AM, Roberts PR, Morgan JM. Is the use of an additional pace/sense lead the optimal strategy for the avoidance of lead extraction in defibrillation lead failure? A single-centre experience. Europace 2009; 12:522-6. [DOI: 10.1093/europace/eup406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
107
|
LAU ERNESTW. Achieving Permanent Left Ventricular Pacing-Options and Choice. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1466-77. [DOI: 10.1111/j.1540-8159.2009.02514.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
108
|
Scott PA, Chow W, Ellis E, Morgan JM, Roberts PR. Extraction of pacemaker and implantable cardioverter defibrillator leads: a single-centre study of electrosurgical and laser extraction. Europace 2009; 11:1501-4. [DOI: 10.1093/europace/eup263] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
109
|
Calvagna GM, Evola R, Scardace G, Valsecchi S. Single-operator experience with a mechanical approach for removal of pacing and implantable defibrillator leads. Europace 2009; 11:1505-9. [DOI: 10.1093/europace/eup222] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
110
|
|
111
|
Raatikainen MJP, Perälä J, Lahtinen J. Successful defibrillator lead remnant extraction from right ventricle using a steerable transseptal sheath and a basket retriever. Europace 2009; 11:1238-40. [PMID: 19482853 DOI: 10.1093/europace/eup133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present a case of a 73-year-old man with implantable cardioverter-defibrillator pocket erosion and Staphylococcus aureus infection who was admitted to our hospital for lead extraction. During the mechanical extraction procedure, the 12-year-old lead broke and the distal coil was trapped in the right ventricle. After several attempts to grasp the coil using a femoral workstation and various snaring tools failed, a steerable transseptal sheath was placed into the right ventricle via the right femoral vein. The sheath allowed better positioning of the basket retriever and the lead remnant was successfully grasped and extracted with direct traction.
Collapse
Affiliation(s)
- M J Pekka Raatikainen
- Department of Internal Medicine, Division of Cardiology, University of Oulu, PO Box 5000, Oulu 90014, Finland.
| | | | | |
Collapse
|
112
|
Franceschi F, Thuny F, Giorgi R, Sanaa I, Peyrouse E, Assouan X, Prévôt S, Bastard E, Habib G, Deharo JC. Incidence, Risk Factors, and Outcome of Traumatic Tricuspid Regurgitation After Percutaneous Ventricular Lead Removal. J Am Coll Cardiol 2009; 53:2168-74. [DOI: 10.1016/j.jacc.2009.02.045] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 11/16/2022]
|
113
|
Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH, Epstein LM, Friedman RA, Kennergren CEH, Mitkowski P, Schaerf RHM, Wazni OM. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009; 6:1085-104. [PMID: 19560098 DOI: 10.1016/j.hrthm.2009.05.020] [Citation(s) in RCA: 768] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Indexed: 12/20/2022]
|
114
|
Gaca JG, Lima B, Milano CA, Lin SS, Davis RD, Lowe JE, Smith PK. Laser-Assisted Extraction of Pacemaker and Defibrillator Leads: The Role of the Cardiac Surgeon. Ann Thorac Surg 2009; 87:1446-50; discussion 1450-1. [DOI: 10.1016/j.athoracsur.2009.02.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/04/2009] [Accepted: 02/09/2009] [Indexed: 11/28/2022]
|
115
|
Schliamser JE, Saleem MA, Goldberger JJ. Use of a custom-designed adapter to manage ICD lead fracture. J Cardiovasc Electrophysiol 2009; 20:1284-6. [PMID: 19302477 DOI: 10.1111/j.1540-8167.2009.01463.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report the case of a 72-year-old patient with ischemic cardiomyopathy who was found to have a lead fracture in the RV coil DF-1 connector of an integrated bipolar implantable cardioverter-defibrillator (ICD) lead system at the time of upgrade to a biventricular ICD. Due to the redundant connection of the RV coil to the DF-1 connector and the ring on the IS-1 connector, a custom-designed adapter was used to exclude the site of fracture. This novel solution spared the patient the potential risks of lead extraction or abandoning the fractured ICD lead. In this way, pacing and defibrillating capabilities were fully restored, providing the patient 6 years of optimal device functioning.
Collapse
|
116
|
Fischer A, Love B, Hansalia R, Mehta D. Transfemoral Snaring and Stabilization of Pacemaker and Defibrillator Leads to Maintain Vascular Access During Lead Extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:336-9. [PMID: 19272063 DOI: 10.1111/j.1540-8159.2008.02241.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Avi Fischer
- Section of Electrophysiology, Mount Sinai Medical Center, One Gustave L. Levy Pl., New York, NY 10029, USA.
| | | | | | | |
Collapse
|
117
|
Martínez Ferrer J, Fidalgo Andrés ML, Barba Pichardo R, Sancho-Tello de Carranza MJ. Novedades en estimulación cardiaca. Rev Esp Cardiol (Engl Ed) 2009; 62 Suppl 1:117-28. [DOI: 10.1016/s0300-8932(09)70046-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|