1
|
Kutarski A, Jacheć W, Czajkowski M, Stefańczyk P, Kosior J, Tułecki Ł, Nowosielecka D. Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures. J Clin Med 2024; 13:2349. [PMID: 38673622 PMCID: PMC11051408 DOI: 10.3390/jcm13082349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training.
Collapse
Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| |
Collapse
|
2
|
Kim BS, Gabriels JK, Saleh M, Epstein LM. A "hands-on" approach to femoral lead extraction: Indications, tools, and techniques. Heart Rhythm 2024; 21:213-223. [PMID: 37952865 DOI: 10.1016/j.hrthm.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Beom Soo Kim
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
| | - James K Gabriels
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Moussa Saleh
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Laurence M Epstein
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| |
Collapse
|
3
|
Sakamoto S, Baba K, Wakasa S, Yanagishita S, Irishio M, Yanagishita T, Yoshisako Y, Nakatani Y, Kataoka T, Fukuda D. Unique Extraction of a Fractured Pacemaker Lead Adhered to the Spermatic Vein. JACC Case Rep 2024; 29:102160. [PMID: 38264307 PMCID: PMC10801801 DOI: 10.1016/j.jaccas.2023.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 01/25/2024]
Abstract
Transvenous lead extraction has been increasingly recognized as a safe and effective method of lead extraction, but there are only few references for extracting leads migrating outside the heart. We present a successful extraction of a fractured pacemaker lead from the spermatic vein using several approaches and multiple tools.
Collapse
Affiliation(s)
- Shogo Sakamoto
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Kenji Baba
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Shiho Wakasa
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Shiori Yanagishita
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Moritoshi Irishio
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Tomoya Yanagishita
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Yuta Yoshisako
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Yoshihiro Nakatani
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Toru Kataoka
- Department of Cardiovascular Medicine, Bellland General Hospital, Naka-ku, Sakai, Osaka, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| |
Collapse
|
4
|
Dagher L, Tfaily MA, Vavuranakis M, Bhatia NK, Westerman SB, Shah AD, Lloyd MS, Leal M, De Lurgio DB, Merchant A, Panagopoulos A, Patel AM, Tompkins C, Leon AR, Merchant FM, El-Chami MF. Safety of same-day discharge after lead extraction procedures. Heart Rhythm 2023; 20:1669-1673. [PMID: 37591366 DOI: 10.1016/j.hrthm.2023.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after cardiovascular procedures is rapidly gaining ground. OBJECTIVE We sought to evaluate the safety of SDD after transvenous lead extraction (TLE). METHODS We performed a retrospective chart review of patients who underwent elective TLE between January 2020 and October 2021 at our institution. The primary outcome was SDD, and major procedural complications and readmissions within 30 days of the procedure were secondary outcomes. RESULTS In this analysis of 111 patients who underwent elective TLE, 80 patients (72%) were discharged on the same day (SDD group) while 31 patients (28%) stayed overnight (overnight group). Lead malfunction was the most common indication for TLE in both groups. Patients in the overnight group were more likely to have a lead dwell time of ≤10 years than those in the SDD group (38.7% vs 20% of all leads in each group; P = .042), have laser sheaths used for extraction and a higher number of leads extracted. No major complications were reported in both groups. In a multivariate analysis, lower body mass index and the use of laser sheath during TLE were predictors of overnight stay. Patients who underwent a procedure using advanced extraction techniques were 3.5 times more likely to stay overnight (95% confidence interval 1.27-9.78; P = .016). CONCLUSION In appropriately selected patients undergoing elective lead extraction, SDD is feasible and safe. Higher body mass index, fewer extracted leads, shorter lead dwell times (<10 years), and less frequent use of laser-powered extraction sheaths were associated with an increased likelihood of SDD.
Collapse
Affiliation(s)
- Lilas Dagher
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamad Ali Tfaily
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Vavuranakis
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Neal Kumar Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Miguel Leal
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - David B De Lurgio
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Alam Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anastasios Panagopoulos
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anshul M Patel
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Tompkins
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
5
|
Celikyurt U, Acar B, Torun A, Karakullukcu M, Cakir O, Baris O, Vural A, Agacdiken A. Radiographic predictors of failure of simple manual traction of transvenous implantable cardioverter-defibrillator leads: a single-center experience. J Interv Card Electrophysiol 2023; 66:1341-1347. [PMID: 35751717 DOI: 10.1007/s10840-022-01289-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extraction of the implantable cardioverter-defibrillator (ICD) leads could be a difficult procedure due to fibrous tissue around the lead and anatomical variations. In this report, we present our experience in the radiographic predictors of failure of simple manual traction (SMT) in patients with dual-coil ICD requiring lead extraction (LE). METHODS Between January 2017 and February 2021, 103 leads were removed in 65 consecutive patients; 65 (63.1%) were dual-coil ICD leads, 22 (21.4%) were atrial, and 16 (15.5%) were coronary sinus leads. Patient-based and procedural data were collected and analyzed retrospectively. Clinical and procedural characteristics were compared and radiographic predictors of failure of SMT of ICD leads were assessed. Projected anteroposterior (AP) lead tortuosity was measured and lead slack score was estimated on chest X-ray (CXR). RESULTS Simple manual traction failed in 27 (42%) of the ICD leads. Ottawa slack score (odds ratio [OR] 2.368, 95% CI [1.261-4.447]; P = 0.007), AP lead tortuosity > 1.10 (OR 7.477, 95% CI [1.718-35.542]; P = 0.007), and number of previous interventions (OR 6.016, 95% CI [1.184-30.557]; P < 0.030) were found to be independently related to the failure of SMT. Receiver-operator characteristic curve analysis yielded an AP lead tortuosity cutoff value of > 1.10 for predicting the failure of SMT. The area under the curve was 0.744; the 95% confidence interval (CI) was 0.617 to 0.871 (P = 0.001), with a sensitivity of 63% and a specificity of 73%. CONCLUSION Simple manual traction success in our study varied based on radiographic lead-related parameters. Before planning the procedure, increased AP lead tortuosity in vasculature and higher lead slack score can be easily determined on CXR and may be associated with more fibrous adherences, the complexity of the LE, and failure of SMT.
Collapse
Affiliation(s)
- Umut Celikyurt
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey.
| | - Burak Acar
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey
| | - Akin Torun
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey
| | - Muzeyyen Karakullukcu
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Kocaeli University Medical Faculty, İzmit, Kocaeli, Turkey
| | - Ozgur Baris
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, İzmit, Kocaeli, Turkey
| | - Ahmet Vural
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey
| | - Aysen Agacdiken
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, İzmit, 41380, Kocaeli, Turkey
| |
Collapse
|
6
|
Kasai Y, Haraguchi T, Morita J, Kitai T, Okada T, Tamura T, Munakata Y, Tsujimoto M, Kasai J, Fujita T. Wire ThRoUgh Snare Twice (Wire TRUST) technique: A novel method to grasp a lead with inaccessible ends as a supportive femoral approach for transvenous lead extraction. J Cardiovasc Electrophysiol 2023; 34:1990-1995. [PMID: 37579218 DOI: 10.1111/jce.16041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is a crucial procedure for managing cardiac implantable electronic devices. The use of a combined superior and femoral approach has been found to enhance the success rate of TLE. This report introduces a novel technique, named "Wire ThRoUgh Snare Twice" (Wire TRUST), for effectively grasping a lead without a free end during TLE. METHOD The Wire TRUST technique was applied in a case involving a 49-year-old male patient requiring TLE due to electrical artifact on the right ventricular (RV) lead, replacement of the RV lead, and pacemaker generator exchange. The Wire TRUST technique involved the insertion of a 4-Fr pigtail catheter and a 6-Fr snare catheter through the 14-Fr sheath inserted from the right common femoral vein. The 4-Fr pigtail catheter was hooked to the RV lead under multidirectional fluoroscopic guidance in the right atrium. The 0.014-in. guidewire was advanced through the pigtail catheter, crossing the RV lead until reaching the inferior vena cava. Subsequently, the distal end of the 0.014-in. guidewire was captured using a snare and pulled, facilitating externalization of the guidewire. After externalization, both ends of the 0.014-in. guidewire were passed through the snare outside the body and reinserted into the 14-Fr sheath. By simultaneously advancing and closing the snare while applying tension to the 0.014-in. guidewire, a secure grip on the lead without free ends was achieved. RESULTS The Wire TRUST technique enabled successful lead extraction and replacement without any complications. The technique facilitated the co-axial alignment of the powered sheath with the RV lead, ensuring safe and efficient extraction. CONCLUSION The Wire TRUST technique presents a novel and effective approach for grasping leads with inaccessible ends during TLE.
Collapse
Affiliation(s)
- Yuhei Kasai
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takuya Haraguchi
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Junji Morita
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takayuki Kitai
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takuya Okada
- Asia Medical Group, Department of Clinical Engineering, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takashi Tamura
- Asia Medical Group, Department of Clinical Engineering, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Yumetsugu Munakata
- Asia Medical Group, Department of Clinical Engineering, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Masanaga Tsujimoto
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Jungo Kasai
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington, USA
| | - Tsutomu Fujita
- Asia Medical Group, Department of Cardiology, Sapporo CardioVascular Clinic, Sapporo Heart Center, Sapporo, Japan
| |
Collapse
|