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Akhtar Z, Kontogiannis C, Georgiopoulos G, Starck CT, Leung LWM, Lee SY, Lee BK, Seshasai SRK, Sohal M, Gallagher MM. Comparison of non-laser and laser transvenous lead extraction: a systematic review and meta-analysis. Europace 2023; 25:euad316. [PMID: 37882609 PMCID: PMC10638006 DOI: 10.1093/europace/euad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/07/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) is performed using non-laser and laser techniques with overall high efficacy and safety. Variation in outcomes between the two approaches does exist with limited comparative evidence in the literature. We sought to compare non-laser and laser TLE in a meta-analysis. METHODS AND RESULTS We searched Medline, Embase, Scopus, ClinicalTrials.gov, and CENTRAL databases for TLE studies published between 1991 and 2021. From the included 68 studies, safety and efficacy data were carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR), and pooled rates were synthesized from eligible studies to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed. Non-laser in comparison with laser had lower procedural mortality (pooled rate 0% vs. 0.1%, P < 0.01), major complications (pooled rate 0.7% vs. 1.7%, P < 0.01), and superior vena cava (SVC) injury (pooled rate 0% vs. 0.5%, P < 0.001), with higher complete success (pooled rate 96.5% vs. 93.8%, P < 0.01). Non-laser comparatively to laser was more likely to achieve clinical [OR 2.16 (1.77-2.63), P < 0.01] and complete [OR 1.87 (1.69-2.08), P < 0.01] success, with a lower procedural mortality risk [OR 1.6 (1.02-2.5), P < 0.05]. In the subgroup analysis, rotational tool compared with laser achieved greater complete success (pooled rate 97.4% vs. 95%, P < 0.01) with lower SVC injury (pooled rate 0% vs. 0.7%, P < 0.01). CONCLUSION Non-laser TLE is associated with a better safety and efficacy profile when compared with laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George’s University Hospital, London, UK
| | | | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Lisa W M Leung
- Department of Cardiology, St George’s University Hospital, London, UK
| | - Sun Y Lee
- Department of Medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Byron K Lee
- Division of Cardiology, University of California, San Francisco, CA, USA
| | | | - Manav Sohal
- Department of Cardiology, St George’s University Hospital, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St George’s University Hospital, London, UK
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2
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Akhtar Z, Sohal M, Sheppard MN, Gallagher MM. Transvenous Lead Extraction: Work in Progress. Eur Cardiol 2023; 18:e44. [PMID: 37456768 PMCID: PMC10345938 DOI: 10.15420/ecr.2023.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiac implantable electronic devices are the cornerstone of cardiac rhythm management, with a significant number of implantations annually. A rising prevalence of cardiac implantable electronic devices coupled with widening indications for device removal has fuelled a demand for transvenous lead extraction (TLE). With advancement of tools and techniques, the safety and efficacy profile of TLE has significantly improved since its inception. Despite these advances, TLE continues to carry risk of significant complications, including a superior vena cava injury and mortality. However, innovative approaches to lead extraction, including the use of the jugular and femoral accesses, offers potential for further gains in safety and efficacy. In this review, the indications and risks of TLE are discussed while examining the evolution of this procedure from simple traction to advanced methodologies, which have contributed to a significant improvement in safety and efficacy.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Mary N Sheppard
- Cardiac Risk in the Young, Cardiovascular Pathology Unit, St George's University of LondonLondon, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
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3
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Boarescu PM, Popa ID, Trifan CA, Roşian AN, Roşian ŞH. Practical Approaches to Transvenous Lead Extraction Procedures-Clinical Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:379. [PMID: 36612704 PMCID: PMC9819065 DOI: 10.3390/ijerph20010379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Transvenous lead extraction (TLE) is regarded as the first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIEDs), when lead removal is mandatory. The decision to perform a lead extraction should take into consideration not only the strength of the clinical indication for the procedure but also many other factors such as risks versus benefits, extractor and team experience, and even patient preference. TLE is a procedure with a possible high risk of complications. In this paper, we present three clinical cases of patients who presented different indications of TLE and explain how the procedures were successfully performed. In the first clinical case, TLE was necessary because of device extravasation and suspicion of CIED pocket infection. In the second clinical case, TLE was necessary because occlusion of the left subclavian vein was found when an upgrade to cardiac resynchronization therapy was performed. In the last clinical case, TLE was necessary in order to remove magnetic resonance (MR) non-conditional leads, so the patient could undergo an MRI examination for the management of a brain tumor.
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Affiliation(s)
- Paul-Mihai Boarescu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Gheorghe Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Iulia Diana Popa
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Cătălin Aurelian Trifan
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
| | - Adela Nicoleta Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Ştefan Horia Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiology—Heart Institute, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
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4
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Rotational mechanical dilator sheaths for effective transvenous lead extraction. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
An exponential rise in clinical demand for cardiac implantable electronic device (CIED) therapy is observed all over the world due to the rapidly expanding lifespan. Accordingly, appropriate lead management including lead extraction is becoming increasingly essential components for the comprehensive care of patients with various CIEDs.
Main body
With a high success rate and a low complication rate, transvenous lead extraction (TLE) has now been established as first-line therapy for lead extraction. However, TLE is often challenging when there are heavily calcified fibrous adhesions between leads and cardiovascular structures. Recently, rotational mechanical dilator (RMD) sheaths were introduced to resolve this issue and facilitate TLE procedure. There are two types of commercially available RMD sheaths, Evolution® systems and TightRail™. Thorough knowledge of the proper use of the RMD devices is essential to increase success rate and to reduce complications of TLE. In the present review, mechanical features, various techniques, and clinical data of RMD sheaths will be described.
Conclusion
According to recent advancement of device technology, the clinical outcomes of TLE using the RMD sheaths are continuously improving. However, as the RMD sheath is a potentially aggressive tool, special care should be taken when used in patients with longer lead ages.
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Tabata H, Okada A, Kobayashi H, Shoin W, Okano T, Higuchi S, Yagishita D, Ebisawa S, Motoki H, Shoda M, Kuwahara K. Usefulness of the controlled-rotation dilator sheath "Evolution RL" for extraction of old leads in two Japanese centers - An experience in use. J Cardiol 2022; 80:339-343. [PMID: 35701313 DOI: 10.1016/j.jjcc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is an established procedure for the management of cardiovascular implantable electronic devices. However, some difficulties and risks of complications still exist, especially in old and adhered leads. Evolution RL (Cook Medical, Bloomington, IN, USA) is a newly introduced device for TLE; however, no clinical results have been reported in Japan, and the results with older leads are unknown. We investigated the efficacy and safety of Evolution RL and its usefulness for old leads at two TLE centers in Japan. METHODS A total of 27 consecutive patients who underwent lead extraction using Evolution RL at Shinshu University Hospital and Tokyo Women's Medical University Hospital from September 2017 to December 2019 were retrospectively enrolled. We examined the backgrounds of the patients and leads and investigated the efficacy and safety of the procedures. We divided the leads into two groups according to the number of years of implantation (10 years) and compared the results. RESULTS Among the 27 patients, 20 (74.1%) were men, and the median age was 62 (14-91) years. The total number of leads was 58, and the median implantation duration was 136 months (8-448). We achieved clinical success in all patients and complete procedural success in 24 patients (88.9%). In three patients, the broken tip of the lead remained in the heart. No major complications were noted. Of the 58 leads, there were 34 leads with more than 10 years of implantation, with significantly more Evolution RLs used (94.1% vs. 54.2%, p = 0.001) and significantly higher percentages of Evolution 11Fr, 13Fr, and steady sheaths used (79.4% vs. 33.3%, p = 0.001, 52.9% vs. 16.7%, p = 0.006, and 64.7% vs. 20.8%, p = 0.001, respectively). CONCLUSIONS In two TLE centers in Japan, Evolution RL was shown to be safe and effective, even in leads older than 10 years.
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Affiliation(s)
- Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Misra S, Mehta R. Outcomes of Lead Extraction Using the TIghtRail(TM) Sheath: An Opportunity for Increasing Access While Preserving Outcomes? J Cardiovasc Electrophysiol 2022; 33:738-740. [PMID: 35118755 DOI: 10.1111/jce.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
Transvenous lead extraction (TLE) has evolved significantly since initial techniques were described more than 30 years ago. In the present study, Artus et al describe outcomes with a commonly used extraction tool - the TightRailTM sheath - at five low-moderate volume extraction centers in France following their establishment by recently trained operators. This retrospective observational analysis offers an important contribution to the limited literature on outcomes using the TightRailTM sheath. Following training at high volume centers, operators returned to five regional medical centers to launch TLE programs. Over 6 years, 225 patients underwent TLE targeting 438 leads (22% ICD leads) with a mean lead dwell time of 10 years. Overall, clinical success was achieved in 93% of procedures with a 3% rate of major complications. This series, one of the largest using TightRailTM and the largest using it exclusively, demonstrates favorable outcomes and safety data even in centers early in their clinical experience with relatively low annual volumes, averaging 10 TLE procedures per year. This study, in addition to supporting use of the TightRailTM sheath for TLE, also indicate that with appropriate training and support it can be safely and effectively offered outside of high-volume centers using this tool without necessarily requiring availability of a more capital-intensive excimer laser sheath. Further investigation on appropriate patient selection, definition of the "learning curve," and optimal tool selection is needed to help deliver the best outcomes for patients in need of this complex procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, Atrium Health, 1001 Blythe Blvd, Ste 300, Charlotte, NC, 28203.,Division of Cardiology, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21287
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, Atrium Health, 1001 Blythe Blvd, Ste 300, Charlotte, NC, 28203
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Efficacy and mortality of rotating sheaths versus laser sheaths for transvenous lead extraction: a meta-analysis. J Interv Card Electrophysiol 2021:10.1007/s10840-021-01076-x. [PMID: 34839431 DOI: 10.1007/s10840-021-01076-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rotating and laser sheaths are both routinely used in transvenous lead extraction (TLE) which can lead to catastrophic complications including death. The efficacy and risk of each approach are uncertain. To perform a meta-analysis to compare success and mortality rates associated with rotating and laser sheaths. METHODS We searched electronic academic databases for case series of consecutive patients and randomized controlled trials published 1998-2017 describing the use of rotating and laser sheaths for TLE. Among 48 studies identified, rotating sheaths included 1,094 patients with 1,955 leads in 14 studies, and laser sheaths included 7,775 patients with 12,339 leads in 34 studies. Patients receiving rotating sheaths were older (63 versus 60 years old) and were more often male (74% versus 72%); CRT-P/Ds were more commonly extracted using rotating sheaths (12% versus 7%), whereas ICDs were less common (37% versus 42%), p > 0.05 for all. Infection as an indication for lead extraction was higher in the rotating sheath group (59.8% versus 52.9%, p = 0.002). The mean time from initial lead implantation was 7.2 years for rotating sheaths and 6.3 years for laser sheaths (p > 0.05). RESULTS Success rates for complete removal of transvenous leads were 95.1% in rotating sheaths and 93.4% in laser sheaths (p < 0.05). There was one death among 1,094 patients (0.09%) in rotating sheaths and 66 deaths among 7,775 patients (0.85%) in laser sheaths, translating to a 9.3-fold higher risk of death with laser sheaths (95% CI 1.3 to 66.9, p = 0.01). CONCLUSIONS Laser sheaths were associated with lower complete lead removal rate and a 9.3-fold higher risk of death.
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8
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Bencardino G, Ruscio E, Scacciavillani R. Powered sheaths for lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1769-1780. [PMID: 34486141 DOI: 10.1111/pace.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 11/27/2022]
Abstract
Transvenous lead extraction (TLE) has seen a rapid expansion in the past 20 years. The procedure has changed from early techniques involving simple manual traction that frequently proved themselves ineffective for chronically implanted leads, and carried significant periprocedural risks including death, to the availability of a wide range of more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. The reduction in morbidity and mortality associated with these new extraction techniques has widened indications to TLE from prevalent use in life-threatening situations, such as infection and sepsis, to a more widespread use even in noninfectious situations such as malfunctioning leads. Powered sheaths have been a remarkable step forward in this improvement in TLE procedures and recent registries at high-volume centers report high success rates with exceedingly low complication rates. This review is aimed at describing technical features of powered sheaths as well as reported performance during TLE procedures.
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Affiliation(s)
- Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Starck CT, Gonzalez E, Al-Razzo O, Mazzone P, Delnoy PP, Breitenstein A, Steffel J, Eulert-Grehn J, Lanmüller P, Melillo F, Marzi A, Sohal M, Domenichini G, Gallagher MM. Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques. Europace 2021; 22:1103-1110. [PMID: 32447388 PMCID: PMC7336182 DOI: 10.1093/europace/euaa103] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/08/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS Several large studies have documented the outcome of transvenous lead extraction (TLE), focusing on laser and mechanical methods. To date there has been no large series addressing the results obtained with rotational lead extraction tools. This retrospective multicentre study was designed to investigate the outcomes of mechanical and rotational techniques. METHODS AND RESULTS Data were collected on a total of 2205 patients (age 66.0 ± 15.7 years) with 3849 leads targeted for extraction in six European lead extraction centres. The commonest indication was infection (46%). The targeted leads included 2879 pacemaker leads (74.8%), 949 implantable cardioverter-defibrillator leads (24.6%), and 21 leads for which details were unknown; 46.6% of leads were passive fixation leads. The median lead dwell time was 74 months [interquartile range (IQR) 41-112]. Clinical success was obtained in 97.0% of procedures, and complete extraction was achieved for 96.5% of leads. Major complications occurred in 22/2205 procedures (1%), with a peri-operative or procedure-related mortality rate of 4/2205 (0.18%). Minor complications occurred in 3.1% of procedures. A total of 1552 leads (in 992 patients) with a median dwell time of 106 months (IQR 66-145) were extracted using the Evolution rotational TLE tool. In this subgroup, complete success was obtained for 95.2% of leads with a procedural mortality rate of 0.4%. CONCLUSION Patient outcomes in the PROMET study compare favourably with other large TLE trials, underlining the capability of rotational TLE tools and techniques to match laser methods in efficacy and surpass them in safety.
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Affiliation(s)
- Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | | | | | | | | | | | - Jan Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - Jürgen Eulert-Grehn
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | | | - Manav Sohal
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Giulia Domenichini
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, UK
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Misra S, Swayampakala K, Coons P, Cerbie C, Guifarro A, Lesiczka M, Holshouser JW, Madjarov J, Love C, Mehta R. Outcomes of transvenous lead extraction using the TightRail™ mechanical rotating dilator sheath and excimer laser sheath. J Cardiovasc Electrophysiol 2021; 32:1969-1978. [PMID: 34028112 DOI: 10.1111/jce.15105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is an important part of comprehensive lead management. The selection of tools available has expanded in recent years but data on their efficacy is limited. OBJECTIVE To evaluate outcomes using the TightRail™ mechanical rotating mechanical dilator sheath in comparison to excimer laser sheaths and describe factors predictive of successful extraction. METHODS Patients undergoing TLE at a single tertiary center (2013-2019) were included in a prospective registry. Leads targeted for extraction with either an SLS II/Glidelight™ or TightRail™ sheath were included. Outcomes were analyzed on a per-lead basis. Generalized estimating equation (GEE) models were used to assess differences in lead extraction success by extraction tool used while adjusting for nonindependence of multiple leads extracted from the same patient. Covariates included patient comorbidities, lead characteristics, and sheath size. RESULTS A total of 575 leads extracted from 372 patients were included. Overall success rate was 97%. TightRail™ was the first tool used in 180 (31.3%) leads with success rate of 61.7%; laser sheaths were the first tool in 395 leads (68.7%) with success rate of 67.8%. Predictors of successful extraction included lead age, lead type, and sheath sizing. Extraction success did not differ based on whether a laser or TightRail™ sheath was used (adjusted odds ratio = 0.94; 95% confidence interval = 0.59-1.50). CONCLUSION The TightRail™ sheath is an effective tool for TLE. Lead age, lead type, and sheath sizing were predictive of successful extraction but sheath type was not. These findings are hypothesis generating and warrant further investigation in a prospective, randomized study.
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Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Patricia Coons
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Claire Cerbie
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Angello Guifarro
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Magdalena Lesiczka
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - John W Holshouser
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Jeko Madjarov
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Charles Love
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
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Shah K, Pollema T, Birgersdotter-Green U. Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, global clinical study-"An evolution in extraction". Heart Rhythm O2 2021; 2:122-123. [PMID: 34115052 PMCID: PMC8183959 DOI: 10.1016/j.hroo.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kunal Shah
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Travis Pollema
- Division of Cardiothoracic surgery, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
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12
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Qin D, Chokshi M, Sabeh MK, Maan A, Bapat A, Bode WD, Hanley A, Hucker WJ, Ng CY, Funamoto M, Barrett CD, Mela T. Comparison between TightRail rotating dilator sheath and GlideLight laser sheath for transvenous lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:895-902. [PMID: 33675073 DOI: 10.1111/pace.14206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction. OBJECTIVE To evaluate the effectiveness and safety of the TightRail sheath as a primary or secondary tool for transvenous lead extraction (TLE). METHODS Retrospective cohort analysis of 202 consecutive patients who underwent TLE using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital. The study population was divided into three groups: Group A underwent TLE with laser sheath only (N = 157), Group B with TightRail sheath only (N = 22), and Group C with both sheaths (N = 23). RESULTS During this period, 375 leads in 202 patients were extracted, including 297 leads extracted by laser sheath alone, 45 leads by TightRail sheath alone, and 33 by both TightRail sheath and laser sheaths. The most common indications included device infection (44.6%) and lead-related complications (44.1%). The median age of leads was 8.9 years. TightRail sheath (Group B) achieved similar efficacy as a primary extraction tool compared with laser sheath (Group A), with complete procedure success rate of 93.3% (vs. 96.6%, P = .263) and clinical success rate of 100.0% (vs. 98.1%, P = .513). Among 32 leads in which Tightrail was used after laser had failed (Group C), the complete procedure success rate was 75.8%. No significant difference in procedural adverse events was observed. CONCLUSION Our single-center experience confirms that the TightRail system is an effective first-line and second-line method for TLE. Further investigation is required to guide the selection of mechanical and laser sheaths in lead extraction cases.
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Affiliation(s)
- Dingxin Qin
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moulin Chokshi
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamad Khaled Sabeh
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abhishek Maan
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aneesh Bapat
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Weeranun D Bode
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alan Hanley
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William J Hucker
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chee Yuan Ng
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theofanie Mela
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, international clinical study. Heart Rhythm O2 2021; 2:113-121. [PMID: 34113913 PMCID: PMC8183877 DOI: 10.1016/j.hroo.2021.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Transvenous lead extraction (TLE) plays a critical role in managing patients with cardiovascular implantable electronic devices. Mechanical TLE tools, including rotational sheaths, are used to overcome fibrosis and calcification surrounding leads. Prospective clinical data are limited regarding the safety and effectiveness of use of mechanical TLE devices, especially rotational tools. Objective To prospectively investigate the safety and effectiveness of mechanical TLE in real-world usage. Methods Patients were enrolled at 10 sites in the United States and Europe to evaluate the use of mechanical TLE devices. Clinical success, complete procedural success, and complications were evaluated through follow-up (median, 29 days). Patient data were source verified and complications were adjudicated by an independent clinical events committee (CEC). Results Between October 2018 and January 2020, mechanical TLE tools, including rotational sheaths, were used to extract 460 leads with a median indwell time of 7.4 years from 230 patients (mean age 64.3 ± 14.4 years). Noninfectious indications for TLE were more common than infectious indications (61.5% vs 38.5%, respectively). The extracted leads included 305 pacemaker leads (66.3%) and 155 implantable cardioverter-defibrillator leads (33.7%), including 85 leads with passive fixation (18.5%). A bidirectional rotational sheath was needed for 368 leads (88.0%). Clinical success was obtained in 98.7% of procedures; complete procedural success was achieved for 96.3% of leads. CEC-adjudicated device-related major complications occurred in 6 of 230 (2.6%) procedures. No isolated superior vena cava injury or procedural death occurred. Conclusion This prospective clinical study demonstrates that use of mechanical TLE tools, especially bidirectional rotational sheaths, are effective and safe.
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Subcutaneous Implantable Cardioverter-Defibrillator Lead Extraction. JACC Clin Electrophysiol 2020; 6:863-870. [DOI: 10.1016/j.jacep.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
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15
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Cay S, Ozeke O, Ozcan F, Topaloglu S, Aras D. Comparison of two types of rotational mechanical dilatator sheath: Evolution
®
and TightRail
™. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1226-1235. [DOI: 10.1111/pace.13755] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 05/02/2019] [Accepted: 06/19/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Firat Ozcan
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
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16
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Bode K, Whittaker P, Lucas J, Müssigbrodt A, Hindricks G, Richter S, Doering M. Deep sedation for transvenous lead extraction: a large single-centre experience. Europace 2019; 21:1246-1253. [DOI: 10.1093/europace/euz131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Transvenous lead extraction for cardiac implantable electronic devices (CIED) is of growing importance. Nevertheless, the optimal anaesthetic approach, general anaesthesia vs. deep sedation (DS), remains unresolved. We describe our tertiary centre experience of the feasibility and safety of DS.
Methods and results
Extraction procedures were performed in the electrophysiology (EP) laboratory by two experienced electrophysiologists. We used intravenous Fentanyl, Midazolam, and Propofol for DS. A stepwise approach with locking stylets, dilator sheaths, and mechanical sheaths via subclavian, femoral, or internal jugular venous access was utilized. Patient characteristics and procedural data were collected. Logistic regression models were used to identify parameters associated with sedation-related complications. Extraction of 476 leads (dwelling time/patient 88 ± 49 months, 30% ICD leads) was performed in 220 patients (64 ± 17 years, 80% male). Deep sedation was initiated with bolus administration of Fentanyl, Midazolam, and Propofol; mean doses 0.34 ± 0.12 μg/kg, 24.3 ± 6.8 μg/kg, and 0.26 ± 0.13 mg/kg, respectively. Deep sedation was maintained with continuous Propofol infusion (initial dose 3.7 ± 1.1 mg/kg/h; subsequently increased to 4.7 ± 1.2 mg/kg/h with 3.9 ± 2.6 adjustments) and boluses of Midazolam and Fentanyl as indicated. Sedation-related episodes of hypotension, requiring vasopressors, and hypoxia, requiring additional airway management, occurred in 25 (11.4%) and 5 (2.3%) patients, respectively. These were managed without adverse consequences. Five patients (2.3%) experienced major intraprocedural complications; there were no procedure-related deaths. All of our logistic regression models indicated intraprocedural support was associated with administration higher Fentanyl doses.
Conclusion
Transvenous lead extraction under DS in the EP laboratory is a safe procedure with high success rates when performed by experienced staff.
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Peter Whittaker
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Müssigbrodt
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
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Migliore F, Testolina M, Sagone A, Carretta D, Agricola T, Rovaris G, Piazzi E, Facchin D, Lazzari M, Zorzi A, Melillo F, Cataldi C, Marzi A, Bottio T, Tarzia V, Gerosa G, Iliceto S, Bertaglia E, Mazzone P. Multicenter experience with the Evolution RL mechanical sheath for lead extraction using a stepwise approach: Safety, effectiveness, and outcome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:989-997. [DOI: 10.1111/pace.13700] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Martina Testolina
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Antonio Sagone
- Policlinico IRCCS Multimedica Sesto San Giovanni Milano Italy
| | - Domenico Carretta
- Unit of Cardiovascular Diseases, Azienda Ospedaliera UniversitariaOspedale Policlinico Consorziale Bari Italy
| | - Tullio Agricola
- Electrophysiology Unit“Spirito Santo” Hospital Pescara Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology UnitSan Gerardo Hospital Monza Italy
| | - Elena Piazzi
- Interventional Electrophysiology UnitSan Gerardo Hospital Monza Italy
| | | | - Manuel Lazzari
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Francesco Melillo
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
| | - Claudia Cataldi
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Alessandra Marzi
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padova Padova Italy
| | - Patrizio Mazzone
- Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San Raffaele Milan Italy
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18
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Perez AA, Woo FW, Tsang DC, Carrillo RG. Transvenous Lead Extractions: Current Approaches and Future Trends. Arrhythm Electrophysiol Rev 2018; 7:210-217. [PMID: 30416735 PMCID: PMC6141917 DOI: 10.15420/aer.2018.33.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
The use of cardiac implantable electronic devices (CIEDs) has continued to rise along with indications for their removal. When confronted with challenging clinical scenarios such as device infection, malfunction or vessel occlusion, patients often require the prompt removal of CIED hardware, including associated leads. Recent advancements in percutaneous methods have enabled physicians to face a myriad of complex lead extractions with efficiency and safety. Looking ahead, emerging technologies hold great promise in making extractions safer and more accessible for patients worldwide. This review will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this novel field.
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Affiliation(s)
- Adryan A Perez
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Frank W Woo
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Darren C Tsang
- University of Miami Miller School of Medicine Miami, FL, USA
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19
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Witte OA, Adiyaman A, Smit JJJ, Ramdat Misier AR, Elvan A, Ghani A, Delnoy PPHM. Success and complication rates of lead extraction with the first- vs. the second-generation Evolution mechanical sheath. Europace 2018; 19:1717-1722. [PMID: 28339585 DOI: 10.1093/europace/euw255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/15/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The Evolution sheath (Cook Medical, USA) is a power sheath frequently used for chronic lead extraction. In 2013, a novel type (bidirectional) of Evolution sheath (the RL type) was introduced. We evaluated differences in success and complication rates of the two types. Methods and results From 2009 to 2015, all lead extractions requiring the use of an Evolution sheath were prospectively examined. According to the current guidelines, complete procedural success was defined as the removal of all targeted lead materials. Clinical success was the retention of a small portion of the lead, and failure was the inability to achieve either complete procedural or clinical success or the development of any permanently disabling complication. The Evolution sheath was used to extract 149 leads in 103 patients. The first 56 leads were extracted with the original unidirectional sheath, and 93 leads were extracted with the novel bidirectional R/L type. The median age of the lead at the time of extraction was 6.8 vs. 9.1 years (P = 0.007). Complete procedural success was higher for the Evolution R/L (80.0 vs. 98%, P = 0.0004). Clinical success rate was 98 vs. 99%. There were no major complications and 6 (12.0%) vs. 2 (3.8%) minor complications (P = 0.153). We did not observe changes in success rates or complications over time, meaning that the difference cannot be explained by learning curve. Conclusion Use of the novel Evolution R/L sheath vs. the original Evolution sheath was associated with significant higher complete success rates, without major complications and with a trend towards the reduction of minor complications.
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Affiliation(s)
- Olivier A Witte
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Anand R Ramdat Misier
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Abdul Ghani
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Peter Paul H M Delnoy
- Department of Cardiology, Isala Heart Centre, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
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20
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Sharma S, Ekeruo IA, Nand NP, Sundara Raman A, Zhang X, Reddy SK, Hariharan R. Safety and Efficacy of Transvenous Lead Extraction Utilizing the Evolution Mechanical Lead Extraction System. JACC Clin Electrophysiol 2018; 4:212-220. [DOI: 10.1016/j.jacep.2017.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022]
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21
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Domenichini G, Gonna H, Sharma R, Conti S, Fiorista L, Jones S, Arthur M, Adhya S, Jahangiri M, Rowland E, Gallagher MM. Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress. Europace 2017; 19:1521-1526. [DOI: 10.1093/europace/euw162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
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22
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Epstein LM, Maytin M. Strategies for Transvenous Lead Extraction Procedures. J Innov Card Rhythm Manag 2017; 8:2702-2716. [PMID: 32494448 PMCID: PMC7252922 DOI: 10.19102/icrm.2017.080502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis. The past four decades, however, have witnessed significant advances in lead extraction technology, resulting in more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a marked decline in the incidence of procedure-related morbidity and mortality, with recent registries at high-volume centers reporting high success rates with exceedingly low complication rates. Future developments in lead extraction are likely to focus on new tools that will allow for us to provide comprehensive device management, develop alternative systems for extraction training, and focus on the design of new leads conceived to facilitate future extraction.
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Affiliation(s)
- Laurence M Epstein
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Melanie Maytin
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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23
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Abstract
The population of patients with cardiac implantable electronic devices (CIEDs) continues to grow due to increasing indications in an aging population and breakthroughs in both the medical and the surgical care of patients with heart disease. As a result, there has been a growing need for device and lead extractions due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections, and lead advisory alerts.
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24
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Tarakji KG, Ellis CR, Defaye P, Kennergren C. Cardiac Implantable Electronic Device Infection in Patients at Risk. Arrhythm Electrophysiol Rev 2016; 5:65-71. [PMID: 27403296 DOI: 10.15420/aer.2015.27.2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The incidence of infection following implantation of cardiac implantable electronic devices (CIEDs) is increasing at a faster rate than that of device implantation. Patients with a CIED infection usually require hospitalisation and complete device and lead removal. A significant proportion die from their infection. Transvenous lead extraction (TLE) is associated with rare but serious complications including major vascular injury or cardiac perforation. Operator experience and advances in lead extraction methods, including laser technology and rotational sheaths, have resulted in procedures having a low risk of complication and mortality. Strategies for preventing CIED infections include intravenous antibiotics and aseptic surgical techniques. An additional method to reduce CIED infection may be the use of antibacterial TYRX™ envelope. Data from non-randomised cohort studies have indicated that antibacterial envelope use can reduce the incidence of CIED infection by more than 80 % in high-risk patients and a randomised clinical trial is ongoing.
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Affiliation(s)
| | - Christopher R Ellis
- Vanderbilt Heart and Vascular Institute at Vanderbilt University, Nashville, Tennessee, US
| | - Pascal Defaye
- Centre Hospitalier Universitaire de Grenoble, La Tronche, France
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Kocabaş U, Duygu H, Eren NK, Akyıldız Zİ, Özyıldırım S, Tülüce SY, Kırış T, Nazlı C. Transvenous extraction of pacemaker and implantable cardioverter defibrillator leads using Evolution® mechanical dilator sheath: a single center confirmatory experience. SPRINGERPLUS 2016; 5:356. [PMID: 27066369 PMCID: PMC4803708 DOI: 10.1186/s40064-016-1987-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/09/2016] [Indexed: 11/15/2022]
Abstract
Objective In recent years there has been an increase in clinical situations requiring lead extraction procedures of implanted cardiac devices. In our clinic, extraction procedures are performed with Evolution® mechanical lead extraction system. In this manuscript we aimed to evaluate our lead extraction procedures. Methods We retrospectively evaluated lead extraction procedures carried out on 41 patients [30 male, 11 female patient; mean age 61.5 ± 18.5 median 67 (23–85)] between 2008 and 2015 using Evolution® system. Procedural success, major and minor complications are determined according to previously published guidelines. Results Mean duration of the lead implantation was 88.4 ± 62.5 months (6–240). Implanted device was a pacemaker in 27 (65.8 %) and ICD in 14 (34.2 %) of patients. Total 67 leads were extracted from the patients, 22 (32.8 %) were atrial, 30 (44.2 %) were ventricular, 14 (21.5 %) were dual coil defibrillator and 1 (1.5 %) was coronary sinus lead. Indications for lead removal were pacemaker decubitis and infection in 29 (70.8 %), lead dysfunction in 11 (26.8 %) and subclavian vein thrombosis in 1 (2.4 %) patient. Success rate with Evolution® system without using snare was 85.3 %. Clinical success rate was 97.5 % procedural success rate was 95.1 % and failure occured in one patient. Major complications occured in 2 (4.8 %) patients, 1 (2.4 %) was procedure related mortality. Minor complications were seen in 5 (12.2 %) of patients. Conclusions In our single center study it is shown that extraction of pacemaker and defibrillator leads of relatively long implantation duration and in an older age patient group may be successfully carried out using the Evolution® system. However due to potentially serious complications it is adviced to be done by experienced operators in centers with cardiovascular surgery backup.
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Affiliation(s)
- Uğur Kocabaş
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Hamza Duygu
- Cardiology Department, Medical Faculty, Near East University, Nicosia, Cyprus
| | - Nihan Kahya Eren
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Zehra İlke Akyıldız
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | | | - Selcen Yakar Tülüce
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Tuncay Kırış
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
| | - Cem Nazlı
- Cardiology Department, İzmir Atatürk Training and Research Hospital, 35360 Basın Sitesi, Izmir, Turkey
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Hussein AA, Wilkoff BL. Extracción de electrodos transvenosos de dispositivos electrónicos implantables cardiacos: ¿quién, cuándo, cómo y dónde? Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Herzog A, Bogdan S, Glikson M, Ishaaya AA, Love C. Selective tissue ablation using laser radiation at 355 nm in lead extraction by a hybrid catheter; a preliminary report. Lasers Surg Med 2015; 48:281-7. [DOI: 10.1002/lsm.22451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Amir Herzog
- Department of Electrical and Computer EngineeringBen‐Gurion UniversityBeer‐Sheva 84105Israel
| | - Stefan Bogdan
- Leviev Heart CenterSheba Medical CenterTel‐Hashomer 52621Israel
| | - Michael Glikson
- Leviev Heart CenterSheba Medical CenterTel‐Hashomer 52621Israel
| | - Amiel Abraham Ishaaya
- Department of Electrical and Computer EngineeringBen‐Gurion UniversityBeer‐Sheva 84105Israel
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Hussein AA, Wilkoff BL. Transvenous Lead Extraction of Cardiac Implantable Electronic Devices: Who, When, How and Where? ACTA ACUST UNITED AC 2015; 69:3-6. [PMID: 26597165 DOI: 10.1016/j.rec.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Ayman A Hussein
- Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Department of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Bruce L Wilkoff
- Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Department of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, United States.
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Delnoy PPH, Witte OA, Adiyaman A, Ghani A, Smit JJJ, Ramdat Misier AR, Elvan A. Lead extractions: the Zwolle experience with the Evolution mechanical sheath. Europace 2015; 18:762-6. [DOI: 10.1093/europace/euv243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
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Duque M, Díaz JC, Marín JE, Aristizábal JM, Velásquez JE, Duque L, Uribe W. Experiencia inicial con el retiro de electrodos de estimulación cardiaca mediante una técnica de extracción percutánea mecánica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Forneris G, Savio D, Quaretti P, Fiorina I, Cecere P, Pozzato M, Trogolo M, Roccatello D. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27:619-25. [DOI: 10.1007/s40620-014-0150-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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Di Monaco A, Pelargonio G, Narducci ML, Manzoli L, Boccia S, Flacco ME, Capasso L, Barone L, Perna F, Bencardino G, Rio T, Leo M, Di Biase L, Santangeli P, Natale A, Rebuzzi AG, Crea F. Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis. Europace 2014; 16:1496-507. [PMID: 24965015 DOI: 10.1093/europace/euu137] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. AIM Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. METHODS Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. RESULTS When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. CONCLUSIONS In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Stefania Boccia
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lucy Barone
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Teresa Rio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Milena Leo
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | - Pasquale Santangeli
- Department of Cardiology, University of Foggia, Foggia, Italy Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Antonio Giuseppe Rebuzzi
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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Brinker J. Extraction of chronically implanted cardiovascular electronic device leads. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:325. [PMID: 24916463 DOI: 10.1007/s11936-014-0325-2] [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: 11/24/2022]
Abstract
OPINION STATEMENT Cardiovascular implantable electronic devices (CIED) are a remarkable success story. These systems are widely used to prevent symptomatic bradycardia, treat malignant tachyarrhythmia, and to restore a more physiologic contraction to a failing left ventricle. Implantation of a CIED usually involves a lifelong commitment to this therapy, which, unfortunately, is not free from complication requiring removal and/or replacement of all or part of the system. The major obstacle to removal of a CIED is the fibrous attachments that develop between a lead and co-existent leads, veins, and the heart. This process increases over time such that, by one year, removal by traction alone may be problematic and, if aggressive, result in complication. Physicians, surgeons, and engineers have refined techniques of percutaneous lead extraction and developed tools, which have facilitated the process, increased success, and lowered the incidence of complication. Extraction may be performed for a variety of indications some of which are unanimously agreed upon while others remain controversial. Proponents of a broadened application of extraction have proffered the concept of 'lead management,' which includes the removal of all leads that are not clinically relevant to the patient. The benefit of this approach would be to limit the risk of future complication, such as venous occlusion or thromboembolism, and to obviate the increase in difficulty of extraction (due to longer implant duration) that might accompany removal should that be required in the future. Intuitively appealing as this approach might be, there is little evidence supporting it, and the extraordinarily large number of patients currently implanted with recalled ICD leads is indicative of the potential impact this practice may have. This review will discuss extraction, its indications, and outcomes.
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Affiliation(s)
- Jeffrey Brinker
- Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, 7125Q, Baltimore, MD, 21287, USA,
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Diemberger I, Mazzotti A, Giulia MB, Biffi M, Cristian M, Massaro G, Matteo M, Martignani C, Letizia ZM, Ziacchi M, Reggiani B, Reggiani ML, Battistini P, Boriani G. From lead management to implanted patient management: systematic review and meta-analysis of the last 15 years of experience in lead extraction. Expert Rev Med Devices 2014; 10:551-73. [PMID: 23895081 DOI: 10.1586/17434440.2013.811837] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous lead extraction is considered a safe and effective procedure, although published results derive primarily from cohort studies. The authors performed a systematic review and meta-analysis of the last 15 years' experience in this field, to give an objective evaluation of the efficacy and safety of this procedure. Moreover, the subsequent metaregression analysis enabled the identification of the main factors influencing these results: patient age, presence of leads in situ for more than 1 year, presence of device infection and use of laser sheath. These findings are significant in order to improve our extraction approach, data reporting and future research.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
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Madhavan M, Swale MJ, Gard JJ, Hayes DL, Asirvatham SJ. Contemporary pacemaker and ICD lead management: techniques for lead extraction. Expert Rev Cardiovasc Ther 2014; 10:875-87. [DOI: 10.1586/erc.12.75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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McCANTA ANTHONYC, TANEL RONNE, GRALLA JANE, RUNCIMAN DAVIDMARTIN, COLLINS KATHRYNK. The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:104-8. [DOI: 10.1111/pace.12282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/31/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ANTHONY C. McCANTA
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
| | - RONN E. TANEL
- Department of Pediatrics; University of California San Francisco/UCSF Benioff Children's Hospital; San Francisco California
| | - JANE GRALLA
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
- Department of Biostatistics and Informatics; University of Colorado Denver School of Public Health; Aurora Colorado
| | - DAVID MARTIN RUNCIMAN
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
| | - KATHRYN K. COLLINS
- Department of Pediatrics; University of Colorado Denver School of Medicine/Children's Hospital Colorado; Aurora Colorado
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COFFEY JAMESO, SAGER SOLOMONJ, GANGIREDDY SANDEEP, LEVINE AVI, VILES-GONZALEZ JUANF, FISCHER AVI. The Impact of Transvenous Lead Extraction on Tricuspid Valve Function. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:19-24. [DOI: 10.1111/pace.12236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/11/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- JAMES O. COFFEY
- Cardiac Electrophysiology; University of Miami School of Medicine; Miami Florida
| | - SOLOMON J. SAGER
- Cardiac Electrophysiology; University of Miami School of Medicine; Miami Florida
| | | | - AVI LEVINE
- Internal Medicine; Mount Sinai School of Medicine; New York
| | | | - AVI FISCHER
- Cardiac Electrophysiology; Mount Sinai School of Medicine; New York
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Mazzone P, Tsiachris D, Marzi A, Ciconte G, Paglino G, Sora N, Gulletta S, Vergara P, Della Bella P. Advanced techniques for chronic lead extraction: heading from the laser towards the evolution system. Europace 2013; 15:1771-6. [PMID: 23645529 DOI: 10.1093/europace/eut126] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrizio Mazzone
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy
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Chu XM, Li XB, Zhang P, An Y, Duan JB, Wang L, Li D, Li B, Guo JH. Implantable defibrillator lead extraction with optimized standard extraction techniques. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:3-9. [PMID: 23610567 PMCID: PMC3627705 DOI: 10.3969/j.issn.1671-5411.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/13/2012] [Accepted: 01/30/2013] [Indexed: 11/18/2022]
Abstract
Background Implantable cardioverter-defibrillator (ICD) leads might not be extracted especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate transvenous extraction of ICD leads using optimized standard techniques. Methods We prospectively analyzed clinical characteristics, optimized extraction techniques and the feasibility of extraction for 40 patients (33 males; mean age 47.9 ± 16.1 years) with 42 ICD leads. Results Complete procedural success rate was 95.2% (40/42), and the clinical success rate was 97.6% (41/42). One ICD lead required cardiothoracic surgery. Minor complications occurred in three cases (7.5%), and no major complications or death occurred. Locking stylets were used to extract most leads (34, 81.0%) and almost half of the leads (20, 47.6%) required mechanical dilatation to free fibrotic adhesions; these leads had been implanted for a longer period of time than the others (43.7 ± 18.2 vs. 18.4 ± 13.4 months, P < 0.05). Three-quarters of the leads (30, 71.4%) were extracted with locking stylets plus manual traction (12, 28.6%), or mechanical dilatation with counter-traction (18, 42.8%) by the superior vena cava approach and one-quarter of the leads (11, 26.2%) were removed by optimized snare techniques using the femoral vein approach. Median extraction time was 20 min (range 2–68 min) per lead. Linear regression analysis showed that the extraction time was significantly correlated with implant duration (r = 0.70, P < 0.001). Median follow-up was 14.5 months (range 1–58 months), no infection, or procedure-related death occurred in our series. Conclusions Our optimized procedure for transvenous extraction of ICD leads provides a practical and low-cost method for standard procedures.
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Affiliation(s)
- Xian-Ming Chu
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China ; Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
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Starck CT, Rodriguez H, Hurlimann D, Grunenfelder J, Steffel J, Salzberg SP, Falk V. Transvenous lead extractions: comparison of laser vs. mechanical approach. Europace 2013; 15:1636-41. [DOI: 10.1093/europace/eut086] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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MAZZONE PATRIZIO, TSIACHRIS DIMITRIS, MARZI ALESSANDRA, CICONTE GIUSEPPE, PAGLINO GABRIELE, SORA NICOLETA, SALA SIMONE, VERGARA PASQUALE, GULLETTA SIMONE, BELLA PAOLODELLA. Predictors of Advanced Lead Extraction Based on a Systematic Stepwise Approach: Results from a High Volume Center. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:837-44. [DOI: 10.1111/pace.12119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/30/2012] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- PATRIZIO MAZZONE
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - DIMITRIS TSIACHRIS
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - ALESSANDRA MARZI
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - GIUSEPPE CICONTE
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - GABRIELE PAGLINO
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - NICOLETA SORA
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - SIMONE SALA
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - PASQUALE VERGARA
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - SIMONE GULLETTA
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
| | - PAOLO DELLA BELLA
- Department of Cardiology and Cardiothoracic Surgery; Arrhythmia Unit and Electrophysiology Laboratories; Ospedale San Raffaele; Milan; Italy
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McCANTA ANTHONYC, KONG MELISSAH, CARBONI MICHAELP, GREENFIELD RUTHA, HRANITZKY PATRICKM, KANTER RONALDJ. Laser Lead Extraction in Congenital Heart Disease: A Case-Controlled Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:372-80. [DOI: 10.1111/pace.12071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 10/10/2012] [Accepted: 11/04/2012] [Indexed: 12/01/2022]
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Yuasa T, Tanaka T, Suzuki N, Hirai T, Ui Y, Baba Y. A new tool for transvenous pacing lead extraction. J Arrhythm 2012. [DOI: 10.1016/j.joa.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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OTO ALI, AYTEMIR KUDRET, CANPOLAT UĞUR, YORGUN HIKMET, ŞAHINER LEVENT, KAYA ERGÜNBARIŞ, KABAKÇI GIRAY, TOKGÖZOĞLU LALE. Evolution in Transvenous Extraction of Pacemaker and Implantable Cardioverter Defibrillator Leads Using a Mechanical Dilator Sheath. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:834-40. [PMID: 22486778 DOI: 10.1111/j.1540-8159.2012.03385.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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AKSU TOLGA, GURAY UMIT, SEN TANER, DURUKAN MINE, GURAY YESIM, DEMIRKAN BURCU, KISACIK HALIL. Use of the Mechanical Dilator Sheath for Removal of Endocardial Leads: A Single Center Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:514-8. [DOI: 10.1111/j.1540-8159.2012.03329.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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47
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Deharo JC, Bongiorni MG, Rozkovec A, Bracke F, Defaye P, Fernandez-Lozano I, Golzio PG, Hansky B, Kennergren C, Manolis AS, Mitkowski P, Platou ES, Love C, Wilkoff B. Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper. Europace 2011; 14:124-34. [PMID: 22167387 DOI: 10.1093/europace/eur338] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Oto A, Aytemir K, Yorgun H, Canpolat U, Kaya EB, Kabakci G, Tokgozoglu L, Ozkutlu H. Percutaneous extraction of cardiac pacemaker and implantable cardioverter defibrillator leads with evolution mechanical dilator sheath: a single-centre experience. Europace 2011; 13:543-547. [PMID: 21084359 DOI: 10.1093/europace/euq400] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Klug D, Modine T, Marquié C, Kacet S. Weapons development programme before the lead war. Europace 2010; 13:460-1. [PMID: 21177276 DOI: 10.1093/europace/euq432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Brinker J. Tools of the trade: implements of disruption. Heart Rhythm 2010; 7:874-5. [PMID: 20434590 DOI: 10.1016/j.hrthm.2010.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Indexed: 11/25/2022]
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