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Isawa T, Honda T, Yamaya K, Toyoda S, Taguri M. Associated factors and outcomes of crossover from a laser sheath to a bidirectional rotational mechanical sheath during transvenous lead extraction. J Arrhythm 2023; 39:947-955. [PMID: 38045454 PMCID: PMC10692839 DOI: 10.1002/joa3.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background During transvenous lead extraction (TLE), a GlideLight laser sheath (Philips) cannot always be advanced over the lead, and crossover to the Evolution system (i.e., an Evolution RL sheath or Evolution Shortie RL sheath [Cook Medical]) is required. We aimed to determine the associated factors and outcomes of such device crossover. Methods This observational study included 112 patients who underwent TLE. The patients were divided into crossover and non-crossover groups. Outcomes and associated factors of crossover were evaluated. Results Overall, 57 (50.9%) patients required crossover to the Evolution system (crossover group), whereas 55 (49.1%) patients did not require crossover (non-crossover group). Clinical success rate was similar between the two groups (98.3% vs. 100%; p = 1.00). No major intraprocedural complications related to powered sheaths occurred. Multivariate logistic regression analysis results showed that dwell time of the oldest extracted lead (per year) (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.02-1.36; p = .026), number of leads extracted per procedure (OR: 7.23, 95% CI: 1.74-29.99; p = .007), and use of a femoral approach (OR: 21.09, 95% CI: 2.33-190.67; p = .007) were associated factors of crossover. The cutoff for crossover was 7.7 years from the implant (sensitivity 90.5%, specificity 64.9%, area under the curve 0.80). Conclusions Both groups showed a high rate of clinical success. Switching to the Evolution system may facilitate a safe and effective TLE when a laser sheath does not advance despite laser activation.
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Affiliation(s)
- Tsuyoshi Isawa
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Taku Honda
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Kazuhiro Yamaya
- Department of Cardiovascular SurgerySendai Kousei HospitalSendaiJapan
| | - Shigeru Toyoda
- Department of Cardiovascular MedicineDokkyo Medical UniversityMibuJapan
| | - Masataka Taguri
- Department of Health Data ScienceTokyo Medical UniversityTokyoJapan
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2
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Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
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Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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3
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Akhtar Z, Kontogiannis C, Elbatran AI, Leung LWM, Starck CT, Zuberi Z, Sohal M, Gallagher MM. Transvenous lead extraction: Experience of the Tandem approach. Europace 2023; 25:euad331. [PMID: 37936325 PMCID: PMC10903175 DOI: 10.1093/europace/euad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with 'bail-out' support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach. METHOD The 'Tandem' procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive 'Tandem' procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics. RESULTS The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar. CONCLUSION The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christos Kontogiannis
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Ahmed I Elbatran
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Lisa W M Leung
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christoph T Starck
- Department of Cardiothoracic Surgery, German Heart Centre, Berlin, Germany
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
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4
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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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Segreti L, Bongiorni MG, Barletta V, Parollo M, Di Cori A, Fiorentini F, Giannotti Santoro M, De Lucia R, Viani S, Grifoni G, Paperini L, Sodati E, Mazzocchetti L, Canu AM, Zucchelli G. Transvenous lead extraction: Efficacy and safety of the procedure in female patients. Heart Rhythm O2 2023; 4:625-631. [PMID: 37936665 PMCID: PMC10626182 DOI: 10.1016/j.hroo.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Existing data on the impact of sex differences on transvenous lead extraction (TLE) outcomes in cardiac device patients are limited. Objective The purpose of this study was to evaluate the safety and efficacy of mechanical TLE in female patients. Methods A retrospective evaluation was performed on 3051 TLE patients (group 1: female; group 2: male) from a single tertiary referral center. All individuals received treatment using single sheath mechanical dilation and various venous approaches as required. Results Our analysis included 3051 patients (group 1: 750; group 2: 2301), with a total of 5515 leads handled with removal. Female patients were younger, had a higher left ventricular ejection fraction, and lower prevalences of coronary artery disease and diabetes mellitus. Infection was more common in male patients, whereas lead malfunction or abandonment were more frequent in female patients. Radiologic success was lower in female patients (95.8% vs 97.5%; P = .003), but there was no significant difference in clinical success between groups (97.2% vs 97.5%; P = .872). However, major complications (1.33% vs 0.60%; P <.001) and procedural mortality (0.4% vs 0.1%; P <.001) were higher in females compared to male patients. After multivariate analysis, female sex emerged as the only predictor of major complications, including deaths (odds ratio 3.96; 95% confidence interval 1.39-11.24). Conclusion TLE using unpowered simple mechanical sheaths in female patients is safe and effective, but is associated with lower radiologic success and higher complication rates and mortality than in males. This finding underscores the importance of recognizing sex differences in TLE outcomes.
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Affiliation(s)
- Luca Segreti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Federico Fiorentini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Gino Grifoni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Ezio Sodati
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Lorenzo Mazzocchetti
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Antonio Maria Canu
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
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6
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Barca L, Mascia G, Di Donna P, Sartori P, Bianco D, Della Bona R, Benenati S, Merlo AC, Buongiorno AL, Kaufman N, Vena A, Bassetti M, Porto I. Long-Term Outcomes of Transvenous Lead Extraction: A Comparison in Patients with or without Infection from the Italian Region with the Oldest Population. J Clin Med 2023; 12:4543. [PMID: 37445578 DOI: 10.3390/jcm12134543] [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: 05/28/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The gold standard for the treatment of cardiac implantable electronic devices (CIEDs)-related infection and lead malfunction is transvenous lead extraction (TLE). To date, the risk of mortality directly related to TLE procedures is relatively low, but data on post-procedural and long-term mortality are limited, even more in the aging population. METHODS Consecutive patients with CIEDs who underwent TLE were retrospectively studied. The primary outcome was the endpoint of death, considering independent predictors of long-term clinical outcomes in the TLE aging population comparing patients with and without infection. RESULTS One hundred nineteen patients (male 77%; median age 76 years) were included in the analysis. Eighty-two patients (69%) documented infection, and thirty-seven (31%) were extracted for a different reason. Infected patients were older (80 vs. 68 years, p-value > 0.001) with more implanted catheters (p-value < 0.001). At the last follow-up (FU) available (median FU 4.1 years), mortality reached 37% of the patient population, showing a statistically significant difference between infected versus non-infected groups. At univariable analysis, age at TLE, atrial fibrillation, and anemia remained significant correlates of mortality; at multivariable analysis, only patients with anemia and atrial fibrillation have a 2.3-fold (HR 2.34; CI 1.16-4.75) and a 2.5-fold (HR 2.46; CI 1.33-4.54) increased rate of death, respectively. CONCLUSION Our long-term data showed that aging patients who underwent TLE for CIED-related infection exhibit a high mortality risk during a long-term follow-up, potentially leading to a rapid and effective procedural approach in this patient population.
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Affiliation(s)
- Luca Barca
- Department of Internal Medicine, University of Genoa,16132 Genoa, Italy
| | - Giuseppe Mascia
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Paolo Di Donna
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Paolo Sartori
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Daniele Bianco
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Roberta Della Bona
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Stefano Benenati
- Department of Internal Medicine, University of Genoa,16132 Genoa, Italy
| | | | | | - Niki Kaufman
- Department of Internal Medicine, University of Genoa,16132 Genoa, Italy
| | - Antonio Vena
- Infectious Disease Clinic, Department of Health Sciences, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Matteo Bassetti
- Infectious Disease Clinic, Department of Health Sciences, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa,16132 Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
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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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8
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Okada A, Higuchi S, Shoda M, Tabata H, Kataoka S, Shoin W, Kobayashi H, Okano T, Yoshie K, Kato K, Saigusa T, Ebisawa S, Motoki H, Kuwahara K. Utility of a multipurpose catheter for transvenous extraction of old broken leads: A novel technique for fragile leads. Heart Rhythm 2023:S1547-5271(23)00514-3. [PMID: 37001747 DOI: 10.1016/j.hrthm.2023.03.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system and injury to the veins or heart, have been reported. OBJECTIVE The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported. METHODS In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction. RESULTS Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted. CONCLUSION All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.
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Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tama Metropolitan Medical Center, Tokyo, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, 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
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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9
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Hofer D, Kuster N, Bebié MC, Sasse T, Steffel J, Breitenstein A. Success and Complication Rates of Transvenous Lead Extraction in a Developing High-Volume Extraction Center: The Zurich Experience. J Clin Med 2023; 12:jcm12062260. [PMID: 36983262 PMCID: PMC10051593 DOI: 10.3390/jcm12062260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Transvenous lead extractions are increasingly performed for malfunction or infection of cardiac implantable electronic devices, but they harvest a potential for complications and suboptimal success. Apart from multicenter registries and reports from highly experienced single centers, the outcome in individual newly developing high-volume centers starting a lead extraction program is less well established. We aimed to evaluate the clinical and radiological success and complication rate at our center, having started a lead extraction program less than a decade ago. Methods: We retrospectively analyzed patients who underwent transvenous lead extraction at the University Hospital Zurich from 2013 to 2021 regarding success as well as complications and compared our results to previously reported outcome rates. Results: A total of 346 patients underwent 350 transvenous lead extractions from January 2013 to December 2021. Combined radiological success was achieved in 97.7% and clinical success in 96.0% of interventions. Procedure-related major complications occurred in 13 patients (3.7%). Death within 30 days after transvenous lead extractions occurred in 13 patients (3.7%), with a procedure-related mortality of 1.4% (five patients). Summary: Transvenous lead extractions in newly developing high-volume centers can be performed with high clinical and radiological success rates, but procedure-related major complications may affect a relevant number of patients. Compared to large single or multicenter registries of experienced centers, the success rate may be lower and the complication rate higher in centers newly starting with lead extraction, which may have important implications for patient selection, procedural planning, proctoring, and safety measures.
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Villegas EG, Juárez Del Río JI, Carmona JCR, Valdíris UR, Peinado ÁA, Peinado RP. Efficacy and safety of the extraction of cardiostimulation leads using a mechanical dissection tool. A single center experience. Pacing Clin Electrophysiol 2023; 46:217-225. [PMID: 36401870 DOI: 10.1111/pace.14625] [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: 07/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). METHODS A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X-ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. RESULTS A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). CONCLUSION In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Transvenous lead extractions in a single high-volume center over 24 years: High success rate and low complication rate. Heart Rhythm O2 2023; 4:232-240. [PMID: 37124554 PMCID: PMC10134393 DOI: 10.1016/j.hroo.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Transvenous lead extraction (TLE) procedures can be complicated and are associated with a small but significant risk of cardiovascular complications. However, methods and tools vary among centers. Objective The purpose of this study was to the present the methods and results of pacemaker and implantable cardioverter-defibrillator TLE procedures in our center over a 24-year period. Methods From April 1997 through 2020, we attempted to extract 2964 leads in 1780 procedures and 1642 patients. We mainly utilized single sheath technique using snaring or mechanical rotational sheaths and steel sheaths when necessary. Difficult procedures were performed by an experienced cardiologist, and close supervision was emphasized. Most of the extractions were performed using local anesthesia with sedation. Results Median age of patients was 65.0 [interquartile range 20.00] years, and median dwelling time of leads was 5.0 [7.0] years. Clinical success was achieved in 1739 procedures (97.7%) and complete technical success in 2841 leads (95.8%). Clinical success (leaving <4 cm of the lead in the body and achieving the clinical goal for the patient) was achieved for 79 leads (2.7%). TLE failed in 44 leads (1.1%) and 41 procedures (2.3%) among 36 patients (2.2%). There were 23 cases (1.3%) of major complications, with only 1 death directly related to the procedure (<0.1%). In addition, 2 patients with sepsis died within the first 24 hours after the procedure. No caval tears occurred. Conclusion Single sheath lead extractions utilizing snaring or mechanical rotational sheaths were effective and safe in our high-volume center as performed by experienced operators.
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Tułecki Ł, Jacheć W, Polewczyk A, Czajkowski M, Targońska S, Tomków K, Karpeta K, Nowosielecka D, Kutarski A. Assessment of the impact of organisational model of transvenous lead extraction on the effectiveness and safety of procedure: an observational study. BMJ Open 2022; 12:e062952. [PMID: 36581437 PMCID: PMC9806044 DOI: 10.1136/bmjopen-2022-062952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the impact of the organisational model of transvenous lead extraction (TLE) on effectiveness and safety of procedures. DESIGN Post hoc analysis of patient data entered prospectively into a computer database. SETTING Data of all patients undergoing TLE in three centres in Poland between 2006 and 2021 were analysed. PARTICIPANTS 3462 patients including: 985 patients undergoing TLE in a hybrid room (HR), with cardiac surgeon (CS) as co-operator, under general anaesthesia (GA), with arterial line (AL) and with transoesophageal echocardiography (TEE) monitoring (group 1), 68 patients-TLE in HR with CS, under GA, without TEE (group 2), 406 patients-TLE in operating theatre (OT) using 'arm-C' X-ray machine with CS under GA and with TEE (group 3), 154 patients-TLE in OT with CS under GA, without TEE (group 4), 113 patients-TLE in OT with anaesthesia team, using the 'arm-C' X-ray machine, without CS (group 5), 122 patients-TLE in electrophysiology lab (EPL), with CS under intravenous analgesia without TEE and AL (group 6), 1614 patients-TLE in EPL, without CS, under intravenous analgesia without TEE and AL (group 7). KEY OUTCOME MEASURE Effectiveness and safety of TLE depending on organisational model. RESULTS The rate of major complications (MC) was higher in OT/HR than in EPL (2.66% vs 1.38%), but all MCs were treated successfully and there was no MC-related death. The use of TEE during TLE increased probability of complete procedural succemss achieving about 1.5 times (OR=1.482; p<0.034) and were connected with reduction of minor complications occurrence (OR=0.751; p=0.046). CONCLUSIONS The most important condition to avoid death due to MC is close co-operation with cardiac surgery team, which permits for urgent rescue cardiac surgery. Continuous TEE monitoring plays predominant role in immediate decision on rescue sternotomy and improves the effectiveness of procedure.
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Affiliation(s)
- Łukasz Tułecki
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Wojciech Jacheć
- Cardiology, Faculty of Medical Science, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Physiology, Patophysiology and Clinical Immunology, Jan Kochanowski University of Kielce Collegium Medicum, Kielce, Poland
- Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | | | | | - Konrad Tomków
- Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Kamil Karpeta
- Cardiac Surgery, Masovian Specialistic Hospital, Radom, Poland
| | - Dorota Nowosielecka
- Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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Akhtar Z, Gallagher MM. Transvenous lead extraction: the Subclavian to Jugular pull-through technique. HeartRhythm Case Rep 2022; 9:160-164. [PMID: 36970377 PMCID: PMC10030300 DOI: 10.1016/j.hrcr.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Zaki Akhtar
- Address reprint requests and correspondence: Dr Zaki Akhtar, St George’s University Hospital, Blackshaw Rd, Tooting, London SW17 0RE, UK.
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Kutarski A, Jacheć W, Nowosielecka D, Czajkowski M, Tułecki Ł, Polewczyk A. Repeat Transvenous Lead Extraction-Predictors, Effectiveness, Complications and Long-Term Prognostic Significance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15602. [PMID: 36497674 PMCID: PMC9740863 DOI: 10.3390/ijerph192315602] [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: 08/30/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. METHODS Retrospective analysis of a large single-center database of 3654 TLEs. RESULTS Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. CONCLUSIONS Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University, 20-059 Lublin, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
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Zsigmond EJ, Saghy L, Benak A, Miklos M, Makai A, Hegedus Z, Alacs E, Agocs S, Vamos M. A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools. Europace 2022; 25:591-599. [PMID: 36352816 PMCID: PMC9935030 DOI: 10.1093/europace/euac200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools. METHODS AND RESULTS Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 ± 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 ± 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01-0.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery. CONCLUSION The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.
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Affiliation(s)
- Elod-Janos Zsigmond
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Laszlo Saghy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Attila Benak
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Marton Miklos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Attila Makai
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Zoltan Hegedus
- Heart Surgery Department, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Endre Alacs
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis str. 6, 6725 Szeged, Hungary
| | - Szilvia Agocs
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis str. 6, 6725 Szeged, Hungary
| | - Mate Vamos
- Corresponding author. Tel: +36 62 341 559; Fax: +36 62 342 538, E-mails address: ;
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Kutarski A, Jacheć W, Polewczyk A, Nowosielecka D, Miszczak-Knecht M, Brzezinska M, Bieganowska K. Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14594. [PMID: 36361474 PMCID: PMC9657280 DOI: 10.3390/ijerph192114594] [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: 09/12/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lead management in children and young adults is still a matter of debate. METHODS To assess the course of transvenous lead extraction (TLE) in adults with pacemakers implanted in childhood (CIP) we compared 98 CIP patients with a control group consisting of adults with pacemakers implanted in adulthood (AIP). RESULTS CIP patients differed from AIP patients with respect to indications for TLE and pacing history. CIP patients were four-eight times more likely to require second-line or advanced tools. Furthermore, CIP patients more often than AIP were prone to developing complications: major complications (MC) (any) 2.6 times; hemopericardium 3.2 times; severe tricuspid valve damage 4.4 times; need for rescue cardiac surgery 3.7 times. The rate of procedural success was 11% lower because of 4.8 times more common lead remnants and 3.1 times more frequent permanently disabling complications. CONCLUSIONS Due to system-related risk factors TLE in CIP patients is more difficult and complex. TLE in CIP is associated with an increased risk of MC and incomplete lead removal. A conservative strategy of lead management, acceptable in very old patients seems to be less suitable in CIP because it creates a subpopulation of patients at high risk of major complications during TLE in the future.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University, 41-800 Katowice, Poland
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Maria Miszczak-Knecht
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Monika Brzezinska
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Katarzyna Bieganowska
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
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Kutarski A, Głowniak A, Kosior J, Jacheć W, Nowosielecka D, Czajkowski M, Polewczyk A. Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years-A Large Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14184. [PMID: 36361063 PMCID: PMC9655673 DOI: 10.3390/ijerph192114184] [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: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. METHODS Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10-20 years, 20-30 years (old) and over 30 years (very old). RESULTS Rate of removal of old and very old leads almost doubles with successive five-year periods (3-6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium-from 0.3 to 12.1%, severe tricuspid valve damage-from 0.2 to 2.1%, need for rescue cardiac surgery-from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10-20 years increases 6.7 times, aged 20-30 years-14.3 times (amounting to 8.4%), and aged 30 and more years-20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. CONCLUSIONS 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital in Radom, 20-617 Radom, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, Pope John Paul II Hospital of Zamość, 22-400 Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
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Akhtar Z, Zaman KU, Leung LW, Zuberi Z, Sohal M, Gallagher MM. Triple access transvenous lead extraction: Pull-through of a lead from subclavian to jugular access to facilitate extraction. Pacing Clin Electrophysiol 2022; 45:1295-1298. [PMID: 35687737 DOI: 10.1111/pace.14547] [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: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
A 39-years old ventricular lead of a right-sided single-chamber pacemaker required extraction for infection. Angulation at the right subclavian-superior vena cava junction coupled with calcified fibrotic encapsulating tissue prevented advancement of a rotational dissecting sheath. To straighten the lead, it was pulled from the subclavian and out of the right internal jugular vein, whilst the Needle's-Eye Snare via the femoral access provided counter-traction. A 13-french rotational dissecting sheath was successfully advanced over the lead via the jugular access to complete the lead extraction without any complication.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Khiast Ullah Zaman
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Lisa Wm Leung
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, UK
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Akhtar Z, Gallagher MM, Elbatran AI, Starck CT, Gonzalez E, Al-Razzo O, Mazzone P, Delnoy PP, Breitenstein A, Steffel J, Eulert-Grehn J, Lanmüller P, Melillo F, Marzi A, Leung LW, Domenichini G, Sohal M. Patient Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: A comparison of two professions. Pacing Clin Electrophysiol 2022; 45:658-665. [PMID: 35417049 DOI: 10.1111/pace.14501] [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: 01/07/2022] [Revised: 03/09/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND With an increasing number of cardiac implantable electronic devices, there has been a paralleled increase in demand for transvenous lead extraction (TLE). Cardiac surgeons (CS) and cardiologists perform TLE; however, data comparing the two groups of operators is scarce. OBJECTIVE We compared the outcomes of TLE performed by cardiologists and CS from six European lead extraction units. METHOD Data was collected retrospectively of 2205 patients who had 3849 leads extracted (PROMET) between 2005-2018. Patient demographics and procedural outcomes were compared between the CS and cardiologist groups, using propensity score matching. A multivariate regression analysis was also performed for variables associated with 30-day mortality. RESULTS Cardiac surgeons performed the majority of extractions (59.8%), of leads with longer dwell times (90 [57-129 interquartile range (IQR)] vs 62 [31-102 IQR] months, CS vs cardiologists, p < 0.001) and with pre-dominantly non-infectious indications (57.4% vs 50.2%, CS vs cardiologists, p < 0.001). Cardiac surgeons achieved a higher complete success per lead than the cardiologists (98.1% vs 95.7%, respectively, p < 0.01), with a higher number of minor complications (5.51% vs 2.1%, p < 0.01) and similar number of major complications (0.47% vs 1.3%, p = 0.12). Thirty-day mortality was similarly low in the CS and cardiologist groups (1.76% vs 0.94%,p = 0.21). Unmatched data multivariate analysis revealed infection indication (OR 6.12 [1.9-20.3], p < 0.01), procedure duration (OR 1.01 [1.01-1.02], p < 0.01) and CS operator (OR 2.67, [1.12-6.37], p = 0.027) were associated with 30-day mortality. CONCLUSION Transvenous lead extraction by CS was performed with similar safety and higher efficacy compared to cardiologists in high and medium-volume lead extraction centres. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zaki Akhtar
- St. George's University Hospitals NHS Foundation Trust, London
| | | | - Ahmed I Elbatran
- St. George's University Hospitals NHS Foundation Trust, London.,Ain Shams University, Cairo, Egypt
| | - Christoph T Starck
- German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany.,German Center of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | | | | | | | | | | | | | - Jürgen Eulert-Grehn
- German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany.,German Center of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Pia Lanmüller
- German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany
| | | | | | - Lisa Wm Leung
- St. George's University Hospitals NHS Foundation Trust, London
| | | | - Manav Sohal
- St. George's University Hospitals NHS Foundation Trust, London
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21
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Witte OA, Delnoy PPH, Ghani A, Smit JJJ, Ramdat Misier AR, Elvan A, Adiyaman A. Lead extractions: dissecting adhesions up to the lead-tip of the right ventricle: safety and success-rates. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:132-140. [PMID: 34875112 DOI: 10.1111/pace.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV-lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV-lead extraction requiring dissection up to the myocardium. METHODS AND RESULTS From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand-powered mechanical Evolution system to extract RV-leads (n = 185) were examined from a prospective registry. We assessed 4 groups: TLE with the first generation Evolution (n = 43) with (A1,n = 18) and without (A2,n = 25) adhesions up to the myocardium and TLE with the Novel R/L type (n = 142) of sheath with (B1, n = 59) and without (B2, n = 83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p = 0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p = 0.0067). There were no deaths. Overall major complication rates were low (2/185; 1.1%) and there was no statistically significant difference in major and minor complications between the two groups. CONCLUSION Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.
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Affiliation(s)
- Olivier A Witte
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Abdul Ghani
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
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22
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Lachlan T, He H, Aggour H, Sahota P, Harvey S, Patel K, Foster W, Yusuf S, Panikker S, Dhanjal T, Dandekar U, Barker T, Parmar J, Kuehl M, Osman F. Safety and feasibility of trans-venous cardiac device extraction using conscious sedation alone-Implications for the post-COVID-19 era. J Arrhythm 2021; 37:1522-1531. [PMID: 34887957 PMCID: PMC8637087 DOI: 10.1002/joa3.12637] [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: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) for implantable cardiac-devices is traditionally performed under general anesthesia (GA). This can lead to greater risk of exposure to COVID-19, longer recovery-times and increased procedural-costs. We report the feasibility/safety of TLE using conscious-sedation alone with immediate GA/cardiac-surgery back-up if needed. METHODS Retrospective case-series of consecutive TLEs performed using conscious-sedation alone between March 2016 and December 2019. All were performed in the electrophysiology-laboratory using intravenous Fentanyl, Midazolam/Diazepam with a stepwise approach using locking-stylets/cutting-sheaths, including mechanical-sheaths. Baseline patient-characteristics, procedural-details and TLE outcomes (including procedure-related complications/death) were recorded. RESULTS A total of 130 leads were targeted in 54 patients, mean age ± SD 74.6 ± 11.8years, 47(87%) males; dual-chamber pacemakers (n = 26; 48%), cardiac resynchronization therapy-defibrillators (n = 17; 31%) and defibrillators (n = 8; 15%) were commonest extracted devices. Mean ± SD/median (range) lead-dwell times were 11.0 ± 8.8/8.3 (0.3-37) years, respectively. Extraction indications included systemic infection (n = 23; 43%) and lead/pulse-generator erosion (n = 27; 50%); mean 2.1 ± 2.0 leads were removed per procedure/mean procedure-time was 100 ± 54 min. Local anesthetic (LA) was used for all (mean-dose: 33 ± 8 ml 1% lidocaine), IV drug-doses used (mean ± SD) were: midazolam: 3.95 ± 2.44 mg, diazepam: 4.69 ± 0.89 mg and fentanyl: 57 ± 40 µg. Complete lead-extraction was achieved in 110 (85%) leads, partial lead-extraction (<4 cm-fragment remaining) in 5 (4%) leads. Sedation-related hypotension requiring IV fluids occurred in 2 (managed without adverse-consequences) and hypoxia requiring additional airway-management in none. No procedural deaths occurred, one patient required emergency cardiac surgery for localized ventricular perforation, nine had minor complications (transient hypotension/bradycardia/pericardial effusion not requiring intervention). CONCLUSION TLE undertaken using LA/conscious-sedation was safe/feasible in our series and associated with good clinical outcome/low procedural complications. Reduced risk of aerosolization of COVID-19 and quicker patient recovery/reduced anesthetic risk are potential benefits that warrant further study.
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Affiliation(s)
- Thomas Lachlan
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hejie He
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hesham Aggour
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Preet Sahota
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Samuel Harvey
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Kiran Patel
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Will Foster
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- Worcester Royal HospitalWorcesterUK
| | - Shamil Yusuf
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Sandeep Panikker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Tarv Dhanjal
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Uday Dandekar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Thomas Barker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Jitendra Parmar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Michael Kuehl
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Faizel Osman
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
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23
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Migliore F, Tarzia V, Dall'Aglio PB, Falzone PV, De Lazzari M, Bottio T, D'Onofrio A, Padalino M, Vida V, Rosso J, Leoni L, Pittarello D, Bertaglia E, Iliceto S, Gerosa G. The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction. Pacing Clin Electrophysiol 2021; 45:92-102. [PMID: 34699079 DOI: 10.1111/pace.14396] [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: 07/17/2021] [Revised: 09/23/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical,USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration. METHODS The study population comprised 84 patients (77%male;mean age 65±18 years) undergoing TLE.After multidisciplinary evaluation, a combined procedure was considered. RESULTS The main indication for TLE was infection in 54 cases (64%).Overall,152 leads were extracted with a mean implant duration of 94±63 months (range 12-421).Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6 % (77/84),97.6% (82/84), and 98.6%(150/152), respectively.Eighteen combined procedure were performed in 12 patients (14%), such as "hybrid approach" (n = 2) or TLE concomitant to:1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1).One major complication (1.2%) and 11 (13%) minor complications were encountered.No injury to the superior vena cava occurred and no procedure-related deaths were reported. During a mean time follow-up of 21±18 months, 17 patients (20%) died.They were more often diabetics (P = 0.02), and they underwent TLE more often for infection (P = 0.004). CONCLUSIONS Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Padalino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Vladimiro Vida
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Jacopo Rosso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Demetrio Pittarello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
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24
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Stefańczyk P, Nowosielecka D, Tułecki Ł, Tomków K, Polewczyk A, Jacheć W, Kleinrok A, Borzęcki W, Kutarski A. Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience. Vasc Health Risk Manag 2021; 17:445-459. [PMID: 34385818 PMCID: PMC8352641 DOI: 10.2147/vhrm.s318205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Transvenous lead extraction (TLE) is now a first-line technique for the treatment of complications related to cardiac implantable electronic devices. The aim of the study was to demonstrate that it is possible to safely perform difficult TLE procedures with a maximum reduction of peri-procedural major complications. Methods A total of 1000 consecutive patients undergoing TLE in a single high-volume center from 2016 to 2019 were studied. All procedures were performed in a hybrid room or operating room by a specialized TLE team. TLE was performed under general anesthesia and monitored by transesophageal echocardiography, and the operating room was suitably equipped for immediate surgical intervention. The effectiveness and safety of the procedures were assessed, with particular emphasis on major complications. Results In all, 1952 leads with the mean implant duration of 111.7 ± 77.6 months had been extracted. Complete procedural success of patients was achieved in 95.9% and clinical success in 99.1%. Major complications, predominantly cardiac tamponade (63.3%), occurred in 22 patients (2.2%). Rapid diagnosis and immediate intervention were the key to a 100% survival in patients with this complication. Conclusion Performing procedures in a hybrid operating room under general anesthesia in the presence of a cardiac surgeon and with the use of transesophageal echocardiography significantly improves the safety of transvenous lead extraction.
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Affiliation(s)
- Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Konrad Tomków
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology, and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- Silesian Medical University, 2nd Department of Cardiology, Zabrze, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Wojciech Borzęcki
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
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25
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Nowosielecka D, Jacheć W, Polewczyk A, Tułecki Ł, Kleinrok A, Kutarski A. The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures. Clin Cardiol 2021; 44:1233-1242. [PMID: 34302377 PMCID: PMC8427997 DOI: 10.1002/clc.23660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE). Hypothesis Echocardiographic phenomena may determine the difficulty and safety of the procedure. Methods Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. Results TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead‐to‐lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%) and lead‐dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate analysis were: fibrous tissue binding the lead to atrial wall (OR = 1.738; p < 0.05), to right ventricular wall (OR = 2.167; p < 0.001), lead‐to‐lead binding sites (OR = 1.628; p < 0.01) and excess lead loops (OR = 1.488; p < 0.05). Lead‐to‐lead binding sites increased probability of major complications (OR = 3.034; p < 0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR = 0.296; p < 0.05), right atrial wall (OR = 323; p < 0.05) and right ventricular wall (OR = 0.297; p < 0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR = 0.307; p < 0.05). Conclusions Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Wojciech Jacheć
- Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland.,Department of Physiotherapy, Medical College, University of Information Technology and Management, Rzeszów, Poland
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26
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Segreti L, Giannotti Santoro M, Di Cori A, Fiorentini F, Zucchelli G, Bernini G, De Lucia R, Viani S, Paperini L, Barletta V, Soldati E, Bongiorni MG. Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads. Europace 2021; 22:1401-1408. [PMID: 32681177 DOI: 10.1093/europace/euaa134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. METHODS AND RESULTS Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07-11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01-1.02; P < 0.001) were associated with a higher risk of clinical failure. CONCLUSION Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.
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Affiliation(s)
- Luca Segreti
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | | | - Andrea Di Cori
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulia Bernini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano Viani
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Luca Paperini
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ezio Soldati
- Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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27
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Imaeda S, Katsumata Y, Kimura T, Takatsuki S. Successful percutaneous extraction of a remnant floating pacemaker lead. BMJ Case Rep 2021; 14:14/5/e243128. [PMID: 33980569 PMCID: PMC8118042 DOI: 10.1136/bcr-2021-243128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shohei Imaeda
- Department of Cardiology, Keio University, Tokyo, Japan
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28
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Nubila BCLSD, Lacerda GDC, Rey HCV, Barbosa RM. Percutaneous Removal of Cardiac Leads in a Single Center in South America. Arq Bras Cardiol 2021; 116:908-916. [PMID: 34008813 PMCID: PMC8121483 DOI: 10.36660/abc.20190726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/29/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the last decade, the number of cardiac electronic devices has risen considerably and consequently the occasional need for their removal. Concurrently, the transvenous lead removal became a safe procedure that could prevent open-heart surgery. OBJECTIVE The primary objective of this study was to describe the successful performance and the complication rates of pacemaker removals in a Brazilian public hospital. Our secondary aim was to describe the variables associated to successes and complications. METHODS A retrospective case series was conducted in patients submitted to pacemaker removal in a Brazilian public hospital from January 2013 to June 2018. Removal, explant, extraction, success and complication rates were defined by the 2017 Heart Rhythm Society Guideline. Categorical variables were compared using x2 or Fisher's tests, while continuous variables were compared by unpaired tests. A p-value of 0.05 was considered statistically significant. RESULTS Cardiac device removals were performed in 61 patients, of which 51 were submitted to lead extractions and 10 to lead explants. In total, 128 leads were removed. Our clinical success rate was 100% in the explant group and 90.2% in the extraction one (p=0.58). Major complications were observed in 6.6% patients. Procedure failure was associated to older right ventricle (p=0.05) and atrial leads (p=0,04). Procedure duration (p=0.003) and need for blood transfusion (p<0,001) were associated to more complications. CONCLUSION Complications and clinical success were observed in 11.5% and 91.8% of the population, respectively. Removal of older atrial and ventricular leads were associated with lower success rates. Longer procedures and blood transfusions were associated with complications.
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Affiliation(s)
- Bruna Costa Lemos Silva Di Nubila
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
- Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
| | - Gustavo de Castro Lacerda
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Helena Cramer Veiga Rey
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Rodrigo Minati Barbosa
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
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Nowosielecka D, Jacheć W, Polewczyk A, Kleinrok A, Tułecki Ł, Kutarski A. The prognostic value of transesophageal echocardiography after transvenous lead extraction: landscape after battle. Cardiovasc Diagn Ther 2021; 11:394-410. [PMID: 33968618 DOI: 10.21037/cdt-20-871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure. Methods We analyzed data from 936 TEE performed in patients undergoing TLE between 2015 and 2019 (mean follow-up 566.23±224.47 days) and assessed the role of echocardiographic phenomena after procedure. Results Increment in tricuspid regurgitation (TR) was observed in 9% of patients after TLE. Factors increasing the risk of TR were: binding sites between lead and right ventricle (RV) (OR: 5.429), tricuspid valve (TV) (OR: 3.42), superior vena cava (SVC) (OR: 3.30) and lead-to-lead adhesions (OR: 2.88). Predisposing factors of residual structures after TLE were: asymptomatic masses on the leads (AMEL) (OR: 1.68), binding sites between SVC and cardiac structures (OR: 1.72), and multiple leads (OR: 1.30). Probability of vegetation remnants increased in the presence of abandoned leads (OR: 7.91). The risk factors of tamponade were: dwell time of the oldest lead (OR: 1.17), lead-to-lead adhesion (OR: 22.47), binding sites between lead and TV (OR: 6.08), RA (OR: 11.50), SVC (OR: 4.47), higher LVEF (OR: 2.35; P=0.006), female gender (OR: 5.43), multiple leads (OR: 2.11), looped leads (OR: 4.90) and AMEL (OR: 6.42). The risk of lead fracture was increased by: lead-to-lead adhesion (OR: 5.69), fibrosis binding the lead to RV (OR: 5.16), RA (OR: 2.39) and dwell time of the oldest lead (OR: 1.068). The mortality rate was 11.97% during follow-up. The risk of death was increased by: severe TR and vegetation remnants. Conclusions The most important phenomena evaluated after TLE are: tricuspid valve function, residual fibrosis and vegetation remnants, progression of pericardial effusion and retained lead fragments. Postoperative TEE provides information about the results of TLE and helps establish further management.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Anna Polewczyk
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland.,Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland
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Usefulness of right ventriculography compared with computed tomography for ruling out the possibility of lead perforation before lead extraction. PLoS One 2021; 16:e0245502. [PMID: 33661956 PMCID: PMC7932068 DOI: 10.1371/journal.pone.0245502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose High-risk patients can be identified by preprocedural computed tomography (CT) before lead extraction. However, CT evaluation may be difficult especially for lead tip identification due to artifacts in the leads. Selective right ventriculography (RVG) may enable preprocedural evaluation of lead perforation. We investigated the efficacy of RVG for identifying right ventricular (RV) lead perforation compared with CT in patients who underwent lead extraction. Methods Ninety-five consecutive patients who were examined by thin-section non-ECG-gated multidetector CT and RVG before lead extraction were investigated retrospectively. Newly recognized pericardial effusion after lead extraction was used as a reference standard for lead perforation. We analyzed the prevalence of RV lead perforation diagnosed by each method. The difference in the detection rates of lead perforation by RVG and CT was evaluated. Results Of the 115 RV leads in the 95 patients, lead perforation was diagnosed for 35 leads using CT, but the leads for 29 (83%) of those 35 leads diagnosed as lead perforation by CT were shown to be within the right ventricle by RVG. Three patients with 5 leads could not be evaluated by CT due to motion artifacts. The diagnostic accuracies of RVG and CT were significantly different (p < 0.001). There was no complication of pericardial effusion caused by RV lead extraction. Conclusion RVG for identification of RV lead perforation leads to fewer false-positives compared to non-ECG-gated CT. However, even in cases in which lead perforation is diagnosed, most leads may be safely extracted by transvenous lead extraction.
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Costa R, Silva KRD, Crevelari ES, Nascimento WTJ, Nagumo MM, Martinelli Filho M, Jatene FB. Effectiveness and Safety of Transvenous Removal of Cardiac Pacing and Implantable Cardioverter-defibrillator Leads in the Real Clinical Scenario. Arq Bras Cardiol 2021; 115:1114-1124. [PMID: 33470310 PMCID: PMC8133723 DOI: 10.36660/abc.20200476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Fundamento Remoção de cabos-eletrodos de dispositivos cardíacos eletrônicos implantáveis (DCEI) é procedimento pouco frequente e sua realização exige longo treinamento profissional e infraestrutura adequada. Objetivos Avaliar a efetividade e a segurança da remoção de cabos-eletrodos de DCEI e determinar fatores de risco para complicações cirúrgicas e mortalidade em 30 dias. Métodos Estudo prospectivo com dados derivados da prática clínica. De janeiro/2014 a abril/2020, foram incluídos, consecutivamente, 365 pacientes submetidos à remoção de cabos-eletrodos, independentemente da indicação e técnica cirúrgica utilizada. Os desfechos primários foram: taxa de sucesso do procedimento, taxa combinada de complicações maiores e morte intraoperatória. Os desfechos secundários foram: fatores de risco para complicações intraoperatórias maiores e morte em 30 dias. Empregou-se análise univariada e multivariada, com nível de significância de 5%. Resultados A taxa de sucesso do procedimento foi de 96,7%, sendo 90,1% de sucesso completo e 6,6% de sucesso clínico. Complicações maiores intraoperatórias ocorreram em 15 (4,1%) pacientes. Fatores preditores de complicações maiores foram: tempo de implante dos cabos-eletrodos ≥ 7 anos (OR= 3,78, p= 0,046) e mudança de estratégia cirúrgica (OR= 5,30, p= 0,023). Classe funcional III-IV (OR= 6,98, p<0,001), insuficiência renal (OR= 5,75, p=0,001), infecção no DCEI (OR= 13,30, p<0,001), número de procedimentos realizados (OR= 77,32, p<0,001) e complicações maiores intraoperatórias (OR= 38,84, p<0,001) foram fatores preditores para mortalidade em 30 dias. Conclusões Os resultados desse estudo, que é o maior registro prospectivo de remoção de cabos-eletrodos da América Latina, confirmam a segurança e a efetividade desse procedimento no cenário da prática clínica real. (Arq Bras Cardiol. 2020; 115(6):1114-1124)
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Affiliation(s)
- Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Katia Regina da Silva
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Elizabeth Sartori Crevelari
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Marcia Mitie Nagumo
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Prognosis of patients with severe left ventricular dysfunction after transvenous lead extraction and the need for additional hemodynamic support in the perioperative period. Heart Rhythm 2021; 18:962-969. [PMID: 33516947 DOI: 10.1016/j.hrthm.2021.01.026] [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: 12/28/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is necessary because of system infection, lead malfunction, or system upgrade. Patients with severe left ventricular dysfunction (SLVD) undergoing TLE may be at a higher risk because hemodynamic parameters may change unfavorably during or after TLE; however, this has not yet been clarified. OBJECTIVE The purpose of this study was to examine whether patients with SLVD undergoing TLE have higher mortality. METHODS All patients who underwent TLE were stratified as follows: patients with ejection fraction ≤ 35% (SLVD group) and those with ejection fraction > 35% (non-SLVD group). RESULTS We assessed the data of 200 patients [SLVD group, 36 (18%); non-SLVD group, 164 (82%)]). Brain natriuretic peptide level and cardiac resynchronization therapy rate were higher in the SLVD group than in the non-SLVD group. There were no significant between-group differences in major complications and clinical success rates. Patients with SLVD were more likely to require additional hemodynamic support, such as catecholamine infusion, temporary atrium-ventricle sequential pacing, and temporary cardiac resynchronization therapy pacing (27.8% vs 1.2%; P < .001). The survival rate was not significantly different between the groups at 30 days and 1 year after TLE (SLVD vs non-SLVD: 30 days: 97.2% vs 99.4%; P = .215; 1 year: 80.6% vs 91.5%; P = .053). Multivariate Cox regression analysis revealed log brain natriuretic peptide and serum hemoglobin levels as predictors for 1-year mortality. CONCLUSION The prognosis after TLE was comparable between patients with and without SLVD. However, additional hemodynamic support was often necessary for patients with SLVD.
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Safe and effective transvenous lead extraction for elderly patients utilizing non-laser and laser tools: a single-center experience in Japan. Heart Vessels 2021; 36:882-889. [PMID: 33394103 DOI: 10.1007/s00380-020-01761-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Transvenous lead extraction (TLE) for cardiac implantable electric device (CIED) infection is becoming increasingly common, but is believed to be particularly risky in elderly patients. This study aimed to clarify the safety and effectiveness of TLE in the elderly, evaluating the use of both non-laser and laser extraction tools. We retrospectively analyzed the characteristics, device type, indications, procedures, and clinical results in younger (YG; age: 15-79 years; n = 48) and elderly groups (EG; age: ≥ 80 years; n = 27) of patients who underwent percutaneous TLE between April 2014 and December 2019 at our hospital. The average age was 68 and 88 years in the YG and EG, respectively. Indications for TLE were infection in 33 (68.8%) patients and other in 15 (30.6%) patients in the YG, and infection in all 27 (100%) EG patients. Bloodstream infection was detected in 9 and 4 patients in the YG and EG, respectively, with methicillin-resistant Staphylococcus epidermidis being the most common causative pathogen. All TLE procedures were performed under general anesthesia in an operating room with cardiovascular surgeon backup. An excimer laser sheath (76 leads), a laser followed by a mechanical sheath (45 leads), Evolution RL® (17 leads), a mechanical sheath (9 leads), and manual traction (one lead) were employed to extract a total of 148 leads (98 and 50 in the YG and EG, respectively). A mechanical sheath or Evolution RL® was more frequently used in the YG. The respective average implantation durations in the YG and EG were 5.3 and 5.0 years, respectively, which were comparable (p = 0.46). Procedural success rates were identical between the YG and EG (99% vs. 100%, respectively). There was only one procedure-related complication in the entire cohort (cardiac tamponade in a YG patient). Taken together, the success rates of TLE were high in the EG, with no complications, with extraction being the indication for infection in all EG patients. Percutaneous TLE was safe and effective in elderly patients using both non-laser and laser techniques.
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Blichfeldt-Ærø SC, Knutsen TM, Hagen HM, Diep LM, Trondalen G, Halvorsen S. Music therapy as an adjunct in cardiac device lead extraction procedures: A randomized controlled trial. Appl Nurs Res 2020; 56:151376. [DOI: 10.1016/j.apnr.2020.151376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
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Di Cori A, Auricchio A, Regoli F, Blomström-Lundqvist C, Butter C, Dagres N, Deharo JC, Maggioni AP, Kutarski A, Kennergren C, Laroche C, Rinaldi CA, Dovellini EV, Golzio PG, Thøgersen AM, Bongiorni MG. Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry. Europace 2020; 21:1096-1105. [PMID: 31505593 DOI: 10.1093/europace/euz062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/11/2019] [Indexed: 01/12/2023] Open
Abstract
AIMS A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. METHODS AND RESULTS ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was 'interrupted without bridging' in 696 (54%) and 'interrupted with bridging' in 504 (39%) about 3.3 ± 2.3 days before TLE, and 'continued' in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC 'continued' (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01). CONCLUSIONS AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome.
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Affiliation(s)
- Andrea Di Cori
- Second Division of Cardiology, Department of Cardiac-Thoracic & Vascular, Azienda Ospedaliera Pisana, Via Paradisa 2, Pisa, Italy
| | | | - François Regoli
- Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Italy
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Germany
| | - Jean-Claude Deharo
- CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, Marseille, France
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia Antipolis, France.,ANMCO Research Center, Florence, Italy
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, Goteborg, Sweden
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia Antipolis, France
| | | | - Emilio Vincenzo Dovellini
- Department of Interventional Cardiology, Cardiothoracic and Vascular, Careggi University Hospital, Florence, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, A.O.U. Citta della Salute e della Scienza di Torino Molinette, Corso Bramente 88, Torino, Italy
| | | | - Maria Grazia Bongiorni
- Second Division of Cardiology, Department of Cardiac-Thoracic & Vascular, Azienda Ospedaliera Pisana, Via Paradisa 2, Pisa, Italy
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Efficacy and safety of transvenous lead extraction using a liberal combined superior and femoral approach. J Interv Card Electrophysiol 2020; 62:239-248. [PMID: 33029695 PMCID: PMC8536565 DOI: 10.1007/s10840-020-00889-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Purpose During transvenous lead extraction (TLE), the femoral snare has mainly been used as a bail-out procedure. The purpose of the present study is to evaluate the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach. Methods This is a single-center observational study including all TLE procedures between 2012 till 2019. Results A total of 264 procedures (median age 63 (51–71) years, 67.0% male) were performed in the study period. The main indications for TLE were lead malfunction (67.0%), isolated pocket infection (17.0%) and systemic infection (11.7%). The median dwelling time of the oldest targeted lead was 6.8 (4.0–9.7) years. The techniques used to perform the procedure were the use of a femoral snare only (30%), combined rotational powered sheath and femoral snare (25%), manual traction only (20%), rotational powered sheath only (17%) and locking stylet only (8%). The complete and clinical procedural success rate was 90.2% and 97.7%, respectively, and complete lead removal rate was 94.1% of all targeted leads. The major and minor procedure-related complication rates were 1.1% and 10.2%, respectively. There was one case (0.4%) of emergent sternotomy for management of cardiac avulsion. Furthermore, there were 5 in-hospital non-procedure-related deaths (1.9%), of whom 4 were related to septic shock due to a Staphylococcus aureus endocarditis after an uncomplicated TLE with complete removal of all leads. Conclusion An effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach.
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Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Kleinrok A, Kutarski A. Echocardiographic findings in patients with cardiac implantable electronic devices-analysis of factors predisposing to lead-associated changes. Clin Physiol Funct Imaging 2020; 41:25-41. [PMID: 32949059 DOI: 10.1111/cpf.12662] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined. METHODS We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high-volume centre between 2015 and 2019. RESULTS The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead-to-lead adhesions, excessive lead loops, lead-dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR = 1.771; p < .01) and lead dwell time (OR = 1.111; p < .001). Women were more likely to have excessive lead loops (OR = 1.639; p < .01), and the occurrence of loops increase with the number of implanted leads (OR = 2.557; p < .001). Heart failure (OR = 4.016; p < .001), lead looping (OR = 2.603; p < .01) and longer cumulative lead dwell time (OR = 1.017; p < .05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR = 1.043; p < .001). CONCLUSIONS Lead dwell time is the main factor predisposing to the occurrence of most lead-associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead-associated masses.
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Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland
| | - Anna Polewczyk
- Department of Physiology and Patophysiology, Collegium Medicum The Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamosc, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland.,University of Information Technology and Management, Rzeszow, Poland
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Zucchelli G, Di Cori A, Segreti L, Laroche C, Blomstrom-Lundqvist C, Kutarski A, Regoli F, Butter C, Defaye P, Pasquié JL, Auricchio A, Maggioni AP, Bongiorni MG. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2020; 21:771-780. [PMID: 30590520 DOI: 10.1093/europace/euy300] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/01/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. METHODS AND RESULTS A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. CONCLUSIONS In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade.
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Affiliation(s)
- Giulio Zucchelli
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Andrea Di Cori
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Luca Segreti
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France
| | | | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland
| | - François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany
| | - Pascal Defaye
- Department of Arrhythmia and Cardiac Pacing, CHU Albert Michallon, University Hospital Grenoble-Alpes, BP 217, Grenoble Cedex 9, France
| | - Jean Luc Pasquié
- Département de Cardiologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France.,ANMCO Research Center, Via La Marmora 34, Firenze, Italy
| | - Maria Grazia Bongiorni
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
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Uslu A, Küp A, Kanar BG, Balaban I, Demir S, Gülşen K, Kepez A, Doğan C, Candan Ö, Akgün T, Altıntas B, Sadıc BO. Transvenous extraction of pacemaker leads via femoral approach using a gooseneck snare. Herz 2020; 46:82-88. [PMID: 33009623 DOI: 10.1007/s00059-020-04987-z] [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: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction (TLE) via simple manual traction (SMT) is the first-line therapy. When SMT is not successful, TLE from the femoral vein using a gooseneck snare (GS) with a radiofrequency ablation catheter (RFAC) may be an alternative option. The aim of our study was to evaluate the success rate of transvenous extraction of chronically implanted leads via the femoral approach using a GS with RFCA in cases of failure with SMT. METHODS The study included 94 consecutive patients who were referred for lead extraction due to pocket erosion and infection (71 patients) and to lead malfunction (23 patients). Initially, SMT was attempted for all patients. If SMT was not successful, patients underwent TLE using a GS with RFAC. RESULTS Leads were extracted successfully with SMT in 34 patients (54 leads), while 60 patients (83 leads) underwent TLE using a GS with RFAC. The mean indwelling time of the leads was longer in the femoral approach with GS (87.5 ± 37.9 vs. 31.3 ± 25.8 months; p < 0.001). The procedural success rate was 96.7% in the femoral approach with GS. A preceding implantation lead duration of >51 months predicted an unsuccessful SMT necessitating alternative TLE using a GS with RFAC with 86% sensitivity and 78% specificity (p < 0.001). CONCLUSION Transvenous lead extraction via the femoral approach using GS with RFAC may be an alternative approach to SMT with a high success rate, especially when the indwelling time of the leads is long.
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Affiliation(s)
- Abdülkadir Uslu
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Batur Gönenç Kanar
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey.
| | - Ismail Balaban
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Kamil Gülşen
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Alper Kepez
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey
| | - Cem Doğan
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Özkan Candan
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Taylan Akgün
- Cardiology Department, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Bernas Altıntas
- Cardiology Department, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Beste Ozben Sadıc
- Faculty of Medicine, Cardiology Department, Marmara University, Istanbul, Turkey
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A Novel Clinical Perspective on New Masses after Lead Extraction (Ghosts) by Means of Intracardiac Echocardiography. J Clin Med 2020; 9:jcm9082571. [PMID: 32784437 PMCID: PMC7465795 DOI: 10.3390/jcm9082571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background: A lead-reactive fibrous capsule (FC) identified by ultrasounds as an atrial or ventricular lead thickness of more than 1 mm above the vendor-declared lead diameter (TL) and its local fibrotic attachment to the cardiac wall (FAC) have never been investigated in vivo, so their relationship with post-extraction masses (ghost) is not known. Methods: Intracardiac echocardiography (ICE) was performed twice during the same extraction procedure in 40 consecutive patients: before and immediately after infected lead extraction Results: The ghost detection rate was high: 60% (24/40 patients); ICE could identify both TL and FAC, TL being noted in 25/40 (62%) patients and FAC in 12/40 patients (30%). Both TL and FAC were significantly associated with ghosts (p < 0.001 and p = 0.002, respectively), but TL had a higher prediction power. The specificity was similar: 94% (15/16) and 100% (16/16), respectively, but TL showed a much higher sensitivity: 100%, (24/24) vs 50% (12/24) (p = 0.016). The ghost group did not show a higher event rate in the follow-up (mean follow-up time = 20 ± 17 months). Conclusion: ICE is able to evaluate both TL and FAC in vivo; ghosts are mostly benign remnants of fibrotic lead capsule cut off during extraction and retained inside the heart by FAC.
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Lin AY, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Safety and Efficacy of Cardiovascular Implantable Electronic Device Extraction in Elderly Patients: A Meta-Analysis and Systematic Review. Heart Rhythm O2 2020; 1:250-258. [PMID: 33604584 PMCID: PMC7889020 DOI: 10.1016/j.hroo.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 - 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 - 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 - 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 - 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 - 2.29, p = 0.13). Conclusion In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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Zucchelli G, Tolve S, Barletta V, Di Cori A, Parollo M, De Lucia R, Della Tommasina V, Giannotti Santoro M, Viani S, Cellamaro T, Segreti L, Paperini L, Soldati E, Bongiorni MG. Comparison between leadless and transvenous single-chamber pacemaker therapy in a referral centre for lead extraction. J Interv Card Electrophysiol 2020; 61:395-404. [DOI: 10.1007/s10840-020-00832-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/17/2020] [Indexed: 01/28/2023]
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Giannotti Santoro M, Segreti L, Zucchelli G, Barletta V, Fiorentini F, Di Cori A, De Lucia R, Bongiorni MG. Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:382-387. [PMID: 32144936 DOI: 10.1111/pace.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/09/2020] [Accepted: 03/02/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. METHODS Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2: < 80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. RESULTS Our analysis included 1316 patients (group 1: 202; group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities, more pacemakers than implantable cardioverter-defibrillators, whereas the dwelling time of the oldest lead and the number of leads were similar, irrespective of patient's age. In group 1, the radiological success rate for lead was higher (99.0% vs 95.9%; P < .001) and the fluoroscopy time lower (13.0 vs 15.0 min; P = .04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P = .36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P = .24) and with no procedure-related deaths in elderly group. CONCLUSIONS Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure.
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Affiliation(s)
| | - Luca Segreti
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Di Cori
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Tomków K, Stefańczyk P, Kleinrok A, Kutarski A. A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures. Echocardiography 2020; 37:601-611. [DOI: 10.1111/echo.14628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Anna Polewczyk
- Collegium Medicum The Jan Kochanowski University Kielce Poland
- Department of Cardiac Surgery Swietokrzyskie Cardiology Center Kielce Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology Silesian Medical University Zabrze Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Paweł Stefańczyk
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Andrzej Kleinrok
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
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Parasrampuria S, Patloori SCS, Karuppusami R, Chase D, Roshan J. Cardiovascular implantable electronic device lead removal in a resource-constrained setting: A single-center experience from India. Indian Pacing Electrophysiol J 2020; 20:8-13. [PMID: 31843556 PMCID: PMC6994293 DOI: 10.1016/j.ipej.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/13/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Background Data from large-volume centers in developed countries, using dedicated tools, show a high success rate with a good safety record for the percutaneous lead removal procedure. However, there are constraints to replicate the results in a resource-poor setting and there is limited data from India. Methods We retrospectively analyzed lead removal procedures performed in our institution from 2008 to 2019. Results Seventy-five patients underwent percutaneous removal of 138 leads. Of these, 44 procedures and 80 leads qualified as extraction with a median dwell time of 52.1 (IQR 28.2–117.2) months. Overall, 33/44 (75.0%) procedures were successful and 65/80 (81.2%) leads were successfully extracted. Manual traction was successful in the extraction of 44/57 (77.2%) leads. All leads implanted less than 2.7 years could be removed with manual traction alone. Specialized tools were used in 23 leads and 21 (91.3%) of those could be successfully extracted. Inability to use dedicated tools was an independent predictor of procedural failure (adjusted OR 14.0; 95% CI 1.8–110.2; p-value 0.012). Right-sided implant (adjusted OR 12.6; 95% CI 1.3–119.5; p-value 0.027) was also independently associated with failure. There was 1 death (1.3%) and minor complications occurred in 6 (8.0%) patients. Conclusions In a resource-limited setting, percutaneous lead extraction of predominantly pacemaker leads by manual traction methods achieved success in extracting about three-fourths of the leads. Inability to use specialized tools was the main factor limiting success. The complication rate was low.
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46
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Caiati C, Pollice P, Lepera ME, Favale S. Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction. Antibiotics (Basel) 2019; 8:antibiotics8040228. [PMID: 31752363 PMCID: PMC6963371 DOI: 10.3390/antibiotics8040228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Lead pacemaker infection is a complication on the rise. An infected oscillating mass attached to the leads (ILV) is a common finding in this setting. Percutaneous extraction of the leads and of the device is the best curative option. However, extraction of leads with large masses can be complicated by pulmonary embolism. The aim of this study was to understand the factors associated with large ILV using a sophisticated ultrasound technique to visualize the masses, namely intracardiac echocardiography (ICE), and investigate whether larger masses induce more complications during and after extraction. Percutaneous lead extraction and peri-procedural ICE were done in 36 patients (pts) (75 ± 11 years old, 74% males). Vegetations (max dimension = 8.2 ± 4.1 mm) in the right cavity were found in 26 of them, mostly adhering to the leads. We subdivided the patients into 2 groups: with vegetation size < 1 cm (18 pts) and vegetation size ≥ 1 cm (8 pts). By univariate analysis, we found that patients in group 1 were more often taking anticoagulation therapy (p = 0.03, Phi (Phi coefficient) = −0.5, OR [odds ratio] 0.071) and had signs of local pocket infection (p = 0.02, Phi = −0.52, OR 0.059) while significantly more patients in group 2 had diabetes (p = 0.08, Phi = 0.566, OR 15); moreover the patients in group 2 showed a trend toward a more frequent positive blood culture (p = 0.08, Phi = 0.39, OR 5.8) and infection with coagulase negative staphylococci (p = 0.06, Phi = 0.46, OR 8.3). At multivariate analysis, only 3 factors (diabetes, younger age and anticoagulation therapy) were independently associated with ILV size: diabetes, associated with larger vegetations (group 2), showed the largest beta value (0.44, p = 0.008); age was inversely correlated with ILV size (beta value = −32, p = 0.038), and anticoagulation therapy (beta value = −029, p = 0.048) was more commonly associated with smaller vegetations (group 1). Larger ILV were not associated with more complications or death during or after the extraction. Conclusion: diabetes, anticoagulation therapy and age are independent predictors of lead vegetation size. The embolic potential of large ILV during extraction was modest, so ILVs >1cm are not a contraindication to percutaneous extraction of infected leads.
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Affiliation(s)
- Carlo Caiati
- Correspondence: ; Tel.: +39-080-5592-117; Fax: +39-080-5478796
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Poterała M, Kutarski A, Brzozowski W, Tomaszewski M, Gromadziński L, Tomaszewski A. Echocardiographic assessment of residuals after transvenous intracardiac lead extraction. Int J Cardiovasc Imaging 2019; 36:423-430. [PMID: 31734932 DOI: 10.1007/s10554-019-01731-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Abstract
Detection of residual fibrotic tissue, called ghosts, after lead extraction is a new phenomenon in cardiology. This paper aims at describing the phenomenon of ghosts and determining their characteristic features. The study group consisted of 580 consecutive patients who underwent transvenous lead extraction (TLE) due to local infection, endocarditis and a superfluous lead. Each patient was clinically examined with the application of transthoracic echocardiography and transesophageal echocardiography directly before and after TLE. In the study population ghosts were detected in 110 patients (19%), and in 470 cases (81%) fibrotic tissue residuals were not found. Ghosts were most often located along the originally implanted lead's route. Longer ghosts were found after the removal of cardiac resynchronization therapy (CRT) and dual chamber pacing (DDD) devices. The local infection and infective endocarditis are associated with a larger number of ghosts revealed after the removal procedure (p = 0.006). The type of the implanted device: CRT/ICD/double chamber pacemaker/single chamber pacemaker, similar to the number of leads, did not impact on the number of the detected ghosts. The relationship between abrasions of the leads and the presence of ghosts proved significant, however (p = 0.043). TLE is associated with the presence of fibrotic tissue residuals in approx. 19% of patients. Indications for lead extraction due to local infection and endocarditis yielded significantly more cases of ghosts than in the entire patient population. The presence of abrasions is a good predictor for the presence of ghosts on the leads.
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Affiliation(s)
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | | | - Leszek Gromadziński
- II Department of Cardiology and Internal Medicine, Collegium Medicum, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland. .,II Department of Cardiology and Internal Medicine, University Clinical Hospital in Olsztyn, Warszawska 30, 10-082, Olsztyn, Poland.
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Hasumi E, Fujiu K, Masae U, Hoshino Y, Kinoshita O, Ono M, Komuro I. Hybrid Lead Extraction Technique: Combined Transatrial Laser Lead Extraction and Surgical Removal of Calcified Lesions. JACC Case Rep 2019; 1:281-286. [PMID: 34316808 PMCID: PMC8289155 DOI: 10.1016/j.jaccas.2019.09.004] [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: 05/14/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 06/13/2023]
Abstract
This report presents a new hybrid lead extraction technique combined with transatrial laser lead extraction and surgical removal of calcified lesions in a 50-year-old man with superior vena cava syndrome and bilateral subclavian vein occlusion caused by an abandoned lead, which had been infected for 11 years. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Eriko Hasumi
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Uehara Masae
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiro Hoshino
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Gould J, Sidhu B, Porter B, Sieniewicz BJ, Teall T, Williams S, Shetty A, Bosco P, Blauth C, Gill J, Rinaldi CA. Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1355-1364. [DOI: 10.1111/pace.13791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 08/18/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Justin Gould
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Baldeep.S. Sidhu
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Bradley Porter
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Benjamin. J. Sieniewicz
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Thomas Teall
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Steven.E. Williams
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Anoop Shetty
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Paolo Bosco
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Christopher Blauth
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Jaswinder Gill
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Christopher. A. Rinaldi
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
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Bracke F, Verberkmoes N, van 't Veer M, van Gelder B. Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads. Europace 2019; 21:1378-1384. [PMID: 31324910 DOI: 10.1093/europace/euz197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/26/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection. METHODS AND RESULTS All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6-38.2) and 11.6 (5.6-17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration. CONCLUSION Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.
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Affiliation(s)
- Frank Bracke
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Niels Verberkmoes
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Marcel van 't Veer
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Berry van Gelder
- Department of Cardiology and Cardiopulmonary Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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