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Patel K, Toomu S, Lee E, Darden D, Jacobs K, Pollema T, Ho G, Birgersdotter-Green U. Computed tomography predictors of increased transvenous lead extraction difficulty. Pacing Clin Electrophysiol 2024. [PMID: 38967391 DOI: 10.1111/pace.15034] [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: 10/29/2023] [Revised: 05/19/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The ability of computed tomography (CT) characteristics to predict the difficulty of transvenous lead extraction (TLE) is an evolving subject. OBJECTIVE To identify CT characteristics associated with increased TLE difficulty. METHODS All consecutive patients undergoing TLE at the University of California San Diego from January 2018 to February 2022 were analyzed, utilizing the UC San Diego Lead Extraction Registry. Patients underwent cardiac-gated chest CT scans with intravenous contrast; all scans were reviewed by a single radiologist. Lead extraction was performed per standard institutional protocol with the initial use of a laser sheath and crossover to a mechanical sheath as needed. Multivariable linear and logistic regression analyses were performed to identify predictors of individual lead-removal fluoroscopy time and mechanical sheath use, as markers of extraction difficulty. RESULTS A total of 343 patients were analyzed. The mean age of the study population was 63.8 ± 15.4 years; 71% were male. The mean lead dwell-in duration was 8.6 ± 5.7 years. In multivariable linear regression analysis, venous occlusion detected on CT was independently associated with higher individual lead-removal fluoroscopy time (p = 0.004), when adjusting for clinical characteristics such as lead dwell time. In multivariable logistic regression analysis, calcification and venous occlusion were independently associated with a higher need for mechanical sheath use during TLE (odds ratio:5.08, p < 0.001, 95% CI: 2.54-10.46) and (odds ratio:3.72, p < 0.001, 95% CI: 1.89-7.35), respectively. CONCLUSION In patients undergoing TLE, venous occlusion identified by chest CT is associated with increased fluoroscopy time. Patients with lead-associated calcification or venous occlusion detected by chest CT are each five and three times more likely to require crossover from laser to a mechanical sheath.
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Affiliation(s)
- Kavisha Patel
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Sandeep Toomu
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Euyhyun Lee
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Douglas Darden
- Department of Cardiology, Kansas City Heart Rhythm Institute, Kansas City, Kansas, USA
| | - Kathleen Jacobs
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Travis Pollema
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Gordon Ho
- Department of Cardiology, University of California San Diego, La Jolla, California, USA
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Baroni M, Preda A, Carbonaro M, Fortuna M, Guarracini F, Gigli L, Mazzone P. Coronary venous lead reimplantation vs. left bundle branch area pacing crossover following cardiac resynchronization therapy defibrillator extraction: a single-centre experience. Europace 2024; 26:euae101. [PMID: 38666452 DOI: 10.1093/europace/euae101] [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: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
Abstract
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Affiliation(s)
- Matteo Baroni
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Alberto Preda
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Marco Carbonaro
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Matteo Fortuna
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Fabrizio Guarracini
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Lorenzo Gigli
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
| | - Patrizio Mazzone
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy
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Kutarski A, Jacheć W, Czajkowski M, Stefańczyk P, Kosior J, Tułecki Ł, Nowosielecka D. Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures. J Clin Med 2024; 13:2349. [PMID: 38673622 PMCID: PMC11051408 DOI: 10.3390/jcm13082349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, 26-617 Radom, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, 22-400 Zamosc, Poland
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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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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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Heck R, Peters B, Lanmüller P, Photiadis J, Berger F, Falk V, Starck C, Kramer P. Transvenous lead extraction in children with bidirectional rotational dissection sheaths. Front Cardiovasc Med 2023; 10:1256752. [PMID: 37745106 PMCID: PMC10515391 DOI: 10.3389/fcvm.2023.1256752] [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: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited. Methods We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements. Results Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017). Conclusions TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
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Affiliation(s)
- Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Peters
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Photiadis
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Felix Berger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Steinbeis Hochschule, Steinbeis-Transfer-Institut Kardiotechnik, Berlin, Germany
| | - Peter Kramer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
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Eberhardt F, Kirch M, Berenjkoub E, Bonnert A, Frey J, Bimmel D. Femoral-superior lead extraction complicated by venous dissection in chronic venous occlusion: How the alligator saved the day. HeartRhythm Case Rep 2023; 9:593-597. [PMID: 37746561 PMCID: PMC10511940 DOI: 10.1016/j.hrcr.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Frank Eberhardt
- Department of Cardiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Markus Kirch
- Department of Cardiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Ehssan Berenjkoub
- Department of Cardiology, Electrophysiology and Rhythmology, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Anna Bonnert
- Department of Cardiology, Kliniken der Stadt Köln, Standort Merheim, Cologne, Germany
| | - Juergen Frey
- Department of Gastroenterology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Dieter Bimmel
- Department of Cardiology, GFO-Kliniken, Bonn, Germany
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8
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Pecha S, Chung DU, Burger H, Osswald B, Ghaffari N, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. Laser lead extraction in octo- and nonagenarians. A subgroup analysis from the GALLERY registry. J Cardiovasc Electrophysiol 2023; 34:1951-1960. [PMID: 37493496 DOI: 10.1111/jce.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In an aging population with cardiac implantable electronic devices, an increasing number of octo- and even nonagenarians present for lead extraction procedures. Those patients are considered at increased risk for surgical procedures including lead extraction. Here, we investigated safety and efficacy of transvenous lead extraction in a large patient cohort of octo- and nonagenarians. METHODS AND RESULTS A subgroup analysis of all patients aged ≥80 years (n = 499) in the German Laser Lead Extraction Registry (GALLERY) was performed. Outcomes were compared to the nonoctogenarians from the registry. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. An analysis of patient- and device characteristics, as well as an assessment of predictors for adverse events via multivariate analyses was conducted. Mean patients age was 84.3 ± 3.7 years in the octogenarians group and 64.1 ± 12.4 years in the nonoctogenarians group. The median lead dwell time was 118.0 months (78; 167) and 92.0 months [60; 133], p < .001 in the octogenarians and nonoctogenarians group, respectively. Clinical procedural success rate was achieved in 97.6% of the cases in octogenarians and 97.9% in nonoctogenarians (p = .70). Overall complication rate was 4.4% in octogenarians and 4.3% in nonoctogenarians (0.91). In octogenarians procedure-related mortality was 0.8% and all-cause in-hospital mortality was 5.4%, while in nonoctogenarians, procedure related and all-cause in-hospital mortality were 0.5% and 3.1%, respectively. A body mass index (BMI) <20 kg/m2 , was the only statistically significant predictor for procedure-related complications in octogenarians, while systemic infection, BMI ≤20 kg/m2 , procedural complications and chronic kidney disease were predictors for in-hospital mortality. CONCLUSIONS Laser lead extraction in octo- and nonagenarians is safe and effective. BMI ≤20 kg/m2 was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
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Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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10
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Akhtar Z, Sohal M, Gallagher MM. Comment on 'Leadless Pacemakers: Current Achievements and Future Perspectives'. Eur Cardiol 2023; 18:e50. [PMID: 37655135 PMCID: PMC10466268 DOI: 10.15420/ecr.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 09/02/2023] Open
Affiliation(s)
- Zaki Akhtar
- Cardiology Academic Group, St George's University Hospital London, UK
| | - Manav Sohal
- Cardiology Academic Group, St George's University Hospital London, UK
| | - Mark M Gallagher
- Cardiology Academic Group, St George's University Hospital London, UK
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Haeberlin A, Noti F, Breitenstein A, Auricchio A, Reichlin T, Conte G, Klersy C, Curti M, Pruvot E, Domenichini G, Schaer B, Kühne M, Gruszczynski M, Burri H, Kobza R, Grebmer C, Regoli FD. Transvenous Lead Extraction during Cardiac Implantable Device Upgrade: Results from the Multicenter Swiss Lead Extraction Registry. J Clin Med 2023; 12:5175. [PMID: 37629216 PMCID: PMC10455660 DOI: 10.3390/jcm12165175] [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: 07/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce. METHODS This is a post hoc analysis of the investigator-initiated multicenter Swiss TLE registry. The objectives were to assess patient and procedural factors influencing TLE outcomes at the time of device upgrades. RESULTS 941 patients were included, whereof 83 (8.8%) had TLE due to a device upgrade. Rotational mechanical sheaths were more often used in upgraded patients (59% vs. 42.7%, p = 0.015) and total median procedure time was longer in these patients (160 min vs. 105 min, p < 0.001). Clinical success rates of upgraded patients compared to those who received TLE due to other reasons were not different (97.6% vs. 93.0%, p = 0.569). Moreover, multivariable analysis showed that upgrade procedures were not associated with a greater risk for complications (HR 0.48, 95% confidence interval 0.14-1.57, p = 0.224; intraprocedural complication rate of upgraded patients 7.2% vs. 5.5%). Intraprocedural complications of upgraded patients were mostly associated with the implantation and not the extraction procedure (67% vs. 33% of complications). CONCLUSIONS TLE during device upgrade is effective and does not attribute a disproportionate risk to the upgrade procedure.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | | | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Moreno Curti
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Etienne Pruvot
- Department of Cardiology, CHUV, 1011 Lausanne, Switzerland
| | | | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | | | - Haran Burri
- Department of Cardiology, HUG, 1205 Geneva, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - François D. Regoli
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Cardiology Service, San Giovanni Hospital, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
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12
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Frei C, Hofer D, Jan S, Grebmer C, Breitenstein A. Single center experience with the novel rotating dilator sheath TightRail TM Sub-C in transvenous lead extraction. J Cardiovasc Electrophysiol 2023; 34:1738-1743. [PMID: 37343057 DOI: 10.1111/jce.15970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) in transvenous lead extraction. METHODS For this retrospective single-center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at the University Heart Center Zurich. RESULTS A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45) occurred, but neither was directly related to the Sub-C. CONCLUSION This retrospective single-center analysis suggests that transvenous lead extraction with a routine use of the TightRailTM Sub-C extraction sheath is a safe strategy resulting in high success rates that may offer useful theoretical benefits. Future studies are needed to evaluate the incremental benefit of a routine use of short extraction sheaths including the Sub-C during TLE procedures.
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Affiliation(s)
- Celine Frei
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Steffel Jan
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
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13
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Migliore F, Pittorru R, Dall'Aglio PB, De Lazzari M, Falzone PV, Sottini S, Dentico A, Ferrieri A, Pradegan N, Bertaglia E, Iliceto S, Gerosa G, Tarzia V, Carretta D. Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths. Pacing Clin Electrophysiol 2023; 46:960-968. [PMID: 36951180 DOI: 10.1111/pace.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid-term outcome after TLE. METHODS The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80-94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12-377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA). RESULTS The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty-day mortality after TLE was 6%. During a mean time follow-up of 22 ± 21 months, 24 patients (29%) died. No procedure-related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87-10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20-19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69-10.66; p = .002). CONCLUSIONS At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30-day and mid-term mortality are significant, especially in the present of specific comorbidities.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Raimondo Pittorru
- 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
| | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Simone Sottini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Alessia Dentico
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Alessandra Ferrieri
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Nicola Pradegan
- 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
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Carretta
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
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14
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Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Transvenous lead extraction of implantable cardioverter-defibrillators: A comprehensive outcome-and risk factor analysis. Pacing Clin Electrophysiol 2023; 46:815-823. [PMID: 37461858 DOI: 10.1111/pace.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with transvenous implantable-cardioverter-defibrillator (ICD). OBJECTIVES Aim of this study was to characterize the procedural outcome and risk-factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE. METHODS We conducted a subgroup analysis of all ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed. RESULTS We identified 842 patients with an ICD undergoing TLE with the mean age of 62.8 ± 13.8 years. A total number of 1610 leads were treated with lead dysfunction (48.5%) as leading indication for extraction, followed by device-related infection (45.4%). Lead-per-patient ratio was 1.91 ± 0.88 and 60.0% of patients had dual-coil defibrillator leads. Additional extraction tools, such as mechanical rotating dilator sheaths and snares were utilized in 6.5% of cases. Overall procedural complications occurred in 4.3% with 2.0% major complications and a procedure-related mortality of 0.8%. Clinical success rate was 97.9%. All-cause in-hospital mortality was 3.4%, with sepsis being the leading cause for mortality. Multivariate analysis revealed lead-age ≥10 years (OR:5.82, 95%CI:2.1-16.6; p = .001) as independent predictor for procedural failure. Systemic infection (OR:9.57, 95%CI:2.2-42.4; p < .001) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p < .001) were identified as risk factors for all-cause mortality. CONCLUSIONS TLE is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at the University Hospital Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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15
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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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17
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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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18
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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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Migliore F, Pittorru R, Dall'Aglio PB, De Lazzari M, Rovaris G, Piazzi E, Dentico A, Ferrieri A, D'Angelo G, Marzi A, Sawaf BE, Bertaglia E, Iliceto S, Gerosa G, Tarzia V, Carretta D, Mazzone P. Outcomes of transvenous lead extraction of very old leads using bidirectional rotational mechanical sheaths: Results of a multicentre study. J Cardiovasc Electrophysiol 2023; 34:728-737. [PMID: 36477909 DOI: 10.1111/jce.15767] [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: 10/07/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lead dwell time >10 years is a recognized predictor for transvenous lead extraction (TLE) failure and complications. Data on the efficacy and safety of TLE using the bidirectional rotational mechanical sheaths in patients with very old leads are lacking. In this multicenter study, we reported the outcomes of transvenous rotational mechanical lead extraction in patients with leads implanted for ≥10 years. METHODS A total of 441 leads (median: 159 months [135-197]; range: 120-487) in 189 consecutive patients were removed with the Evolution RL sheaths (Cook Medical, Bloomingtom, IN, USA) and mechanical ancillary tools supporting the procedures. RESULTS The main indication for TLE was infection in 74% of cases. Complete procedural success rate, clinical success rate, per lead were 94.8% and 98.2%, respectively. Failure of lead extraction was seen in 1.8% of leads. The additional use of a snare via the femoral approach was required in 9% of patients. Lead dwell time was the only predictor of incomplete led removal (odds ratio: 1.009; 95% confidence interval [CI]: 1.003-1.014; p = .002). Four major complication (2%) were encountered. During a mean time follow-up of 31 ± 27 months, 21 patients (11%) died. No procedure-related mortality occurred. Predictors of mortality included severe left ventricular systolic dysfunction (hazard ratio [HR]: 8.06; 95% CI: 2.99-21.73; p = .001), TLE for infection (HR: 8.0; 95% CI: 1.04-62.5; p = .045), diabetes (HR: 3.7; 95% CI: 1.48-9.5; p = .005), and previous systemic infection (HR: 3.1; 95% CI: 1.17-8.24; p = .022). Incomplete lead removal or failure lead extraction did not impact on survival during follow-up. CONCLUSION Our findings demonstrated that the use of bidirectional rotational TLE mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in patients with very old leads at experienced specialized centers.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Elena Piazzi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Alessia Dentico
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Alessandra Ferrieri
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Giuseppe D'Angelo
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Alessandra Marzi
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Basma El Sawaf
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Carretta
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Patrizio Mazzone
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
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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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Patail H, Cheema M, McKay R, Ingrassia J. Characteristics and outcomes of angiovac-assisted debulking of intracardiac masses, thrombi, and endocarditis. Clin Res Cardiol 2022; 112:626-632. [PMID: 36583764 DOI: 10.1007/s00392-022-02146-4] [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: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traditional management for right-sided infective endocarditis and other adherent masses centers around balancing the risks and benefits of open surgical removal against medical therapy. METHODS Single-center study analysis of 19 patients who underwent vacuum-assisted debulking and/or en bloc removal of right-sided infective endocarditis and other adherent masses between September 2017 and November 2021. Clinical outcomes during the perioperative period, postoperative period, hospital course, and post-discharge were analyzed. RESULTS We included 12 male and 7 female patients with an average age 47.4 ± 16.8. Relevant risk factors included 47.4% of patients with active intravenous drug use (IVDU), 21.1% of patients with a history of permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD), and 5.3% of prior malignancy with mediastinal radiation. 31.6% of patients had documented right-sided masses from a non-infectious etiology, while 68.4% of patients were noted to have right-sided infective endocarditis (RSIE). All patients were found to have large, mobile masses or vegetations at high risk for embolization to the pulmonary vasculature. Average in-hospital length of stay was 17.8 ± 12.2 days, blood cultures cleared postoperatively in 8.9 ± 7.3 days, periprocedural mortality was 0%, subsequent open surgical valvular repair during the same admission was 5.3%, and in-hospital mortality was 5.3%. Within 6 weeks of follow-up, 15.8% of patients were readmitted for recurrence of bacteremia, 10.5% of patients were found to have new pulmonary embolism, and 15.8% of patients underwent open surgical valvular repair. Total death after 1-year and 2-years was 15.8% and 5.3%, respectively. Recurrence of bacteremia was 21.1% within 1-year. CONCLUSION AngioVac is a viable therapeutic strategy for select patients with intravascular and intracardiac right-sided masses including thrombi, emboli, or infective masses such as endocarditis.
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Affiliation(s)
- Haris Patail
- Department Internal Medicine, University of Connecticut, Farmington, USA.
| | | | - Raymond McKay
- Department of Cardiology, Hartford Hospital, Hartford, USA
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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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Salazar P, Pérez-Silva A, Villablanca A, Bello F, Pérez O, Beaser A, Nayak H. Feasibility and safety of a transvenous lead extraction program implementation in South America: Challenges, early outcomes, and global collaboration-A single-center experience. Heart Rhythm O2 2022; 3:731-735. [PMID: 36589010 PMCID: PMC9795241 DOI: 10.1016/j.hroo.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Transvenous lead extraction is the standard of care for cardiac implantable electronic device (CIED) malfunction/infection-related removal. However, data on its performance and results in underdeveloped countries are limited. Objective The purpose of this study was to report the feasibility and efficacy of a lead extraction program in a tertiary hospital in Chile, South America. Methods Patients requiring CIED removal at the Electrophysiology Division of the Hospital las Higuera's were retrospectively analyzed. Outcomes including procedure-related mortality, procedural success and failure, and cardiac and vascular complications were reported. Results A total of 15 patients were analyzed (median age 68 [interquartile range 52-75] years; 80% male). Patients with lead extraction difficulty index >10 represented 33% of patients. Infection was the indication for removal in all patients, with pocket infection (80%). Mechanical rotational tools were used in 66% of cases, and a total of 29 leads were removed. Procedural success was accomplished in 93% of cases. There was 1 (7%) intraprocedural complication and no procedure-related mortality. Conclusions The development of a lead management program is feasible, safe, and effective in underdeveloped countries.
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Affiliation(s)
- Pablo Salazar
- Department of Cardiology, Electrophysiology Division, Hospital las Higuera’s, Talcahuano, Chile,Address reprint requests and correspondence: Dr Pablo Salazar, Cardiovascular Medicine Division, Las Higuera’s Hospital, Alto Horno 777, Region Bio-Bio, Talcahuano, Chile.
| | - Armando Pérez-Silva
- Department of Cardiology, Electrophysiology Division, Hospital las Higuera’s, Talcahuano, Chile
| | - Alex Villablanca
- Department of Cardiology, Electrophysiology Division, Hospital las Higuera’s, Talcahuano, Chile
| | - Francisco Bello
- Department of Cardiology, Electrophysiology Division, Hospital las Higuera’s, Talcahuano, Chile
| | - Osvaldo Pérez
- Department of Cardiology, Electrophysiology Division, Hospital las Higuera’s, Talcahuano, Chile
| | - Andrew Beaser
- Department of Cardiology, Center for Arrhythmia Care, The University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Hemal Nayak
- Department of Cardiology, Center for Arrhythmia Care, The University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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Lee JZ, Tan MC, Karikalan S, Deshmukh AJ, Sorajja D, Valverde A, Srivathsan K, Scott L, Kusumoto FM, Friedman PA, Asirvatham SJ, Mulpuru SK, Cha YM. Causes of Early Mortality After Transvenous Lead Removal. JACC Clin Electrophysiol 2022; 8:1566-1575. [PMID: 36543507 DOI: 10.1016/j.jacep.2022.08.006] [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: 04/26/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. OBJECTIVES This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. METHODS A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. RESULTS A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. CONCLUSIONS The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Fred M Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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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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Chung DU, Pecha S, Burger H, Anwar O, Eickholt C, Nägele H, Reichenspurner H, Gessler N, Willems S, Butter C, Hakmi S. Atrial Fibrillation and Transvenous Lead Extraction-A Comprehensive Subgroup Analysis of the GermAn Laser Lead Extraction RegistrY (GALLERY). MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111685. [PMID: 36422224 PMCID: PMC9697767 DOI: 10.3390/medicina58111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the procedural outcome and risk-factors of patients with atrial fibrillation (AF) undergoing TLE. Methods: We performed a subgroup analysis of all AF patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for all-cause mortality were assessed. Results: A total number of 510 patients with AF were identified with a mean age of 74.0 ± 10.3 years. Systemic infection (38.4%) was the leading cause for TLE, followed by local infection (37.5%) and lead dysfunction (20.4%). Most of the patients (45.9%) presented with pacemaker systems to be extracted. The total number of leads was 1181 with a 2.3 ± 0.96 leads/patient. Clinical procedural success was achieved in 97.1%. Occurrence of major complications was 1.8% with a procedure-related mortality of 1.0%. All-cause mortality was high with 5.9% and septic shock being the most common cause. Systemic device infection (OR: 49.73; 95% CI: 6.56−377.09, p < 0.001), chronic kidney disease (CKD; OR: 2.67; 95% CI: 1.01−7.03, p = 0.048) and a body mass index < 21 kg/m2 (OR: 6.6; 95% CI: 1.68−25.87, p = 0.007) were identified as independent predictors for all-cause mortality. Conclusions: TLE in AF patients is effective and safe, but in patients with systemic infection the mortality due to septic shock is high. Systemic infection, CKD and body mass index <21 kg/m2 are risk factors for death in patient with AF undergoing TLE.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, 61231 Bad Nauheim, Germany
| | - Omar Anwar
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Christian Eickholt
- Department of Internal Medicine & Cardiology, Hospital Itzehoe, 25524 Itzehoe, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, 22457 Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lubeck, 20249 Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, 16816 Neuruppin, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Correspondence:
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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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Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature. J Clin Med 2022; 11:jcm11195898. [PMID: 36233765 PMCID: PMC9570622 DOI: 10.3390/jcm11195898] [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: 09/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022] Open
Abstract
The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially in recent years. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. The aim of this review is to investigate the pathogenesis, stratification, diagnostic tools and management of CIED infections.
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Czajkowski M, Jacheć W, Polewczyk A, Kosior J, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction. Vasc Health Risk Manag 2022; 18:629-642. [PMID: 36003848 PMCID: PMC9393197 DOI: 10.2147/vhrm.s369342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO. Methods We performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO. Results Mild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees. Conclusion A total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Wojciech Jacheć
- Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland.,Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Kielce, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, 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
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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Step by Step through the Years-High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques. J Clin Med 2022; 11:jcm11164884. [PMID: 36013123 PMCID: PMC9410501 DOI: 10.3390/jcm11164884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 12/07/2022] Open
Abstract
Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the stepwise approach. Baseline characteristics, procedural details and outcome of patients with high energy lead (ICD group) vs. without high energy lead (non-ICD group) were compared. Results: Out of 667 extractions, 991 leads were extracted in 405 procedures (60.7%) in the ICD group and 439 leads in 262 procedures (39.3%) in the non-ICD group. ICD patients were significantly younger (median 67 vs. 74 years) and were significantly less often female (18.1% vs. 27.7%, p < 0.005 for both). Advanced extraction tools were used significantly more often in the ICD group (73.2% vs. 37.5%, p < 0.001), but there were no significant differences in the successful removal (98.8% vs. 99.2%) or complications (4.7% vs. 3.1%) between the groups (p > 0.2 for both). Discussion: Using the stepwise approach, overall procedural success was high and complication rate was low in a high-volume centre. In patients with a high energy lead, the TLE procedure was more complex, but outcome was similar to comparator patients.
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Pecha S, Burger H, Chung DU, Möller V, Madej T, Maali A, Osswald B, De Simone R, Monsefi N, Ziaukas V, Erler S, Elfarra H, Perthel M, Wehbe MS, Ghaffari N, Sandhaus T, Busk H, Schmitto JD, Bärsch V, Easo J, Albert M, Treede H, Nägele H, Zenker D, Hegazy Y, Ahmadi D, Gessler N, Ehrlich W, Romano G, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. The GermAn Laser Lead Extraction GallerY: GALLERY. Europace 2022; 24:1627-1635. [PMID: 35718878 DOI: 10.1093/europace/euac056] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS The GermAn Laser Lead Extraction GallerY (GALLERY) is a retrospective, national multicentre registry, investigating the safety and efficacy of laser lead extraction procedures in Germany. METHODS AND RESULTS Twenty-four German centres that are performing laser lead extraction have participated in the registry. All patients, treated with a laser lead extraction procedure between January 2013 and March 2017, were consecutively enrolled. Safety and efficacy of laser lead extraction were investigated. A total number of 2524 consecutive patients with 6117 leads were included into the registry. About 5499 leads with a median lead dwell time of 96 (62-141) months were treated. The mean number of treated leads per patient was 2.18 ± 1.02. The clinical procedural success rate was 97.86% and the complete lead removal was observed in 94.85%. Additional extraction tools were used in 6.65% of cases. The rate of procedural failure was 2.14% with lead age ≥10 years being its only predictor. The overall complication rate was 4.32%, including 2.06% major and 2.26% minor complications. Procedure-related mortality was 0.55%. Female sex and the presence of abandoned leads were predictors for procedure-related complications. The all-cause in-hospital mortality was 3.56% with systemic infection being the strongest predictor, followed by age ≥75 years and chronic kidney disease. CONCLUSION In the GALLERY, a high success- and low procedure-related complication rates have been demonstrated. In multivariate analysis, female sex and the presence of abandoned leads were predictors for procedure-related complications, while the presence of systemic infection, age ≥75 years, and chronic kidney disease were independent predictors for all-cause mortality.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Viviane Möller
- Department of Cardiology, Heart Center Brandenburg and Brandenburg Medical School, Bernau, Germany
| | - Tomas Madej
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Alaa Maali
- Department of Cardiovascular Surgery, MediClin Heart Center, Coswig, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadeja Monsefi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Virgilijus Ziaukas
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Stefan Erler
- Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany
| | - Hamdi Elfarra
- Department for Cardiovascular Surgery, Hospital of the Philipps-University of Marburg, Marburg, Germany
| | - Mathias Perthel
- Department of Cardiac Surgery, Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - Mahmoud S Wehbe
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Henning Busk
- Division of Cardiothoracic Surgery, University Hospital of Magdeburg, Magdeburg, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Volker Bärsch
- Department of Cardiology, St Marien Hospital, Siegen, Germany
| | - Jerry Easo
- Department of Cardiac Surgery, University Hospital Essen, Essen, Germany
| | - Marc Albert
- Department of Cardiac Surgery, Robert-Bosch Hospital, Stuttgart, Germany
| | - Hendrik Treede
- Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | - Dieter Zenker
- Department of Thoracic and Cardiovascular Surgery, Georg August University Medical Center, Göttingen, Germany
| | - Yasser Hegazy
- Department of Cardiac Surgery, MediClin Heart Institute, Lahr/Baden, Germany
| | - Donja Ahmadi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Wolfgang Ehrlich
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knaut
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg and Brandenburg Medical School, Bernau, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St Georg, Hamburg, Germany
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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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Empfehlungen zur Sondenextraktion – Gemeinsame Empfehlungen der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muhlestein JB, Dranow E, Chaney J, Navaravong L, Steinberg BA, Freedman RA. Successful Avoidance of Superior Vena Cava Injury During Transvenous Lead Extraction Utilizing Tandem Femoral-Superior Approach. Heart Rhythm 2022; 19:1104-1108. [PMID: 35245690 DOI: 10.1016/j.hrthm.2022.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique which incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein. OBJECTIVE We sought to evaluate the safety and efficacy of a tandem femoral-superior approach to lead extraction. METHODS Consecutive patients undergoing transvenous extraction of at least 1 pacemaker or defibrillator lead with implant duration >1 year in which a tandem femoral-superior technique was used as the initial extraction strategy were included. The registry spanned 2010-2018 and consisted of procedures performed by a single primary operator. RESULTS A total of 131 patients were included. A total of 267 leads with mean implant duration of 9.8 years, including 90 (33.7%) defibrillator leads, were targeted for extraction. No superior vena cava perforation or other vascular damage occurred. Clinical procedural success was achieved in 96.2 % of cases. There were 5 major complications (3.8% of patients) with 3 being pericardial effusion requiring intervention. There were no deaths. CONCLUSION A tandem femoral-superior approach to lead extraction effectively eliminated superior vena cava injury. This is a safe and effective technique for transvenous lead extraction.
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Soontornmanokati N, Sirikhamkorn C, Methachittiphan N, Chintanavilas K, Apakuppakul S, Ngarmukos T, Apiyasawat S, Lohawijarn W, Chandanamattha P. Transvenous Lead Extraction (TLE) Procedure: Experience from a Tertiary Care Center in Thailand. Indian Pacing Electrophysiol J 2022; 22:123-128. [PMID: 35219811 PMCID: PMC9091722 DOI: 10.1016/j.ipej.2022.02.021] [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: 11/05/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transvenous Lead Extraction (TLE) is a standard treatment for some late Cardiac Implantable Electronics Device (CIED) complications. The outcome of transvenous lead extraction procedure in Thailand is not robust. Methods A Single-center retrospective cohort of TLE procedures performed at Ramathibodi hospital between January 2008 and December 2020 was studied. Results There were 157 leads from 105 patients who underwent lead removal procedure during the specified period. Data analysis was performed from 79 TLE patients due to incomplete data and lead explant procedure of the excluded subjects. Mean patients’ age was 57.7 ± 18.7 years, with 70.9% male. There were 82 pacemaker leads, 35 ICD leads, and 5 CS leads (mean number of leads were 1.54 ± 0.66 per patient), with mean implanted duration of 87.8 ± 68.2 months. Main indication for TLE was infection-related, which accounted for 67.1% of the cases. Overall clinical success rate was 97.5%. Mean operative time was 163.8 ± 69.5 min. Major complications occurred in 4 patients (5.1%) with one in-hospital mortality from severe sepsis. Conclusion TLE using laser sheath and rotating mechanical sheath for transvenous lead extraction is effective and safe, even outside high-volume center.
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Affiliation(s)
- Natcha Soontornmanokati
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Chulaporn Sirikhamkorn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Nilubon Methachittiphan
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Kumpol Chintanavilas
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sanatcha Apakuppakul
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Tachapong Ngarmukos
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirin Apiyasawat
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wachara Lohawijarn
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Pakorn Chandanamattha
- Cardiology Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Domenichini G, Le Bloa M, Carroz P, Graf D, Herrera-Siklody C, Teres C, Porretta AP, Pascale P, Pruvot E. New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions. Front Cardiovasc Med 2022; 9:783576. [PMID: 35282352 PMCID: PMC8904723 DOI: 10.3389/fcvm.2022.783576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
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Artus A, Mansourati J, Fatemi M, Pierre B, Schatz A, Badoz M, Laurent G, Guenancia C, Garnier F. Efficacy and safety of the new TightRail™ mechanical sheath for transvenous lead extraction: Results of a French multicenter study. J Cardiovasc Electrophysiol 2022; 33:731-737. [PMID: 35138039 DOI: 10.1111/jce.15399] [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: 08/15/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to assess the safety and efficacy of the TightRail™ sheath for pacemaker/defibrillator transvenous lead extraction (TLE). METHODS Multicenter observational study including patients who underwent a TLE with the TightRail™ sheath in five French university hospitals from September 2014 to January 2020. RESULTS Two hundred and twenty-five patients (76% males, 71 ± 12 years) underwent a TLE procedure with the TightRail™. A total of 438 leads were extracted using the TightRail™, and the mean age of the extracted leads was 128 ± 85 months; of these, 344 (79%) were pacing leads and 94 (21%) were implantable cardioverter defibrillator leads. The overall clinical success of the extraction procedures was 93%. Overall, 410 of the 438 leads (95%) were extracted (complete or incomplete removal). After multilevel mixed-effects logistic regression model, we found that lead age (odds ratio [OR], 95% confidence interval [CI] for a 1 year increase: 1.11 [1.07-1.15], p < .001) and number of leads extracted (OR, 95% CI: 2.09 [1.50-2.96], p < .001) were the two independent factors associated with complete lead removal failure. Finally, there were 7 (3%) cases of major complications but no per-procedural death. CONCLUSION This is the first large-scale survey assessing the efficacy and safety profile of the Tightrail™ mechanical sheath. The clinical success rate was 93%, and the lead removal failure was dependent on the age and number of leads. We show a satisfactory safety profile in this cohort of patients from primarily low-volume centers with older leads.
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Affiliation(s)
- Adrien Artus
- Cardiology Department, Dijon Bourgogne University Hospital, Dijon, France
| | | | - Marjaneh Fatemi
- Cardiology Department, University Hospital of Brest, Brest, France
| | - Bertrand Pierre
- Cardiology Department, Trousseau Hospital-University of Tours, Chambray les Tours, France
| | | | - Marc Badoz
- Cardiology Department, University Hospital Center Jean Minjoz, Besançon, France
| | - Gabriel Laurent
- Cardiology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Charles Guenancia
- Cardiology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Fabien Garnier
- Cardiology Department, Dijon Bourgogne University Hospital, Dijon, France
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Arora Y, Carrillo R. Data Driven Observations in Superior Vena Cava Injuries: A Call to Action. Ann Thorac Surg 2021; 114:1524-1525. [PMID: 34953786 DOI: 10.1016/j.athoracsur.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Yingyot Arora
- Miller School of Medicine, University of Miami, 1600 NW 10th Ave, #1140, Miami, FL 33136.
| | - Roger Carrillo
- The Heart Institute, Palmetto General Hospital, Hialeah, Florida
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Gallagher MM, Akhtar Z, Starck CT. Preventing fatal injury to the Superior Vena Cava. Ann Thorac Surg 2021; 114:1523-1524. [PMID: 34793763 DOI: 10.1016/j.athoracsur.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 11/01/2022]
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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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Levi N, Bongiorni MG, Rav Acha M, Tovia-Brodie O, Kennergren C, Auricchio A, Maggioni AP, Rinaldi CA, Nof E, Ilan M, Blomstrom-Lundqvist C, Deharo JC, Leclercq C, Glikson M, Michowitz Y. Lead fixation mechanism impacts outcome of transvenous lead extraction: Data from the European Lead Extraction ConTRolled Registry. Europace 2021; 24:817-827. [PMID: 34652415 DOI: 10.1093/europace/euab240] [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] [Received: 05/04/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS The aims of this study is to characterize the transvenous lead extraction (TLE) population with active (A) compared with passive fixation (PFix) leads and to compare the safety, efficacy, and ease of extracting active fixation (AFix) compared with PFix right atrial (RA) and right ventricular (RV) leads. METHODS AND RESULTS The European Lead Extraction ConTRolled Registry (ELECTRa) was analysed. Patients were divided into three groups; those with only AFix, only PFix, and combined Fix leads. Three outcomes were defined. Difficult extraction, complete radiological, and clinical success. Multivariate model was used to analyse the independent effect of Fix mechanism on these outcomes. The study included 2815 patients, 1456 (51.7%) with only AFix leads, 982 (34.9%) with only PFix leads, and 377 (13.4%) with combined Fix leads. Patients with AFix leads were younger with shorter lead dwelling time. Infection was the leading cause for TLE among the combined Fix group with lowest rates among AFix group. No difference in complications rates was noted between patients with only AFix vs. PFix leads. Overall, there were 1689 RA (1046 AFix and 643 PFix) and 2617 RV leads (1441 AFix and 1176 PFix). Multivariate model demonstrated that PFix is independently associated with more difficult extraction for both RA and RV leads, lower radiological success in the RA but has no effect on clinical success. CONCLUSION Mechanism of Fix impact the ease of TLE of RA and RV leads and rates of complete radiological success in the RA but not clinical success. These findings should be considered during implantation and TLE procedures.
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Eyal Nof
- Leviev Heart Institute, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Michael Ilan
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Jean-Claude Deharo
- Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille University, C2VN Marseille, France
| | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
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Bencardino G, Ruscio E, Scacciavillani R. Powered sheaths for lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1769-1780. [PMID: 34486141 DOI: 10.1111/pace.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 11/27/2022]
Abstract
Transvenous lead extraction (TLE) has seen a rapid expansion in the past 20 years. The procedure has changed from early techniques involving simple manual traction that frequently proved themselves ineffective for chronically implanted leads, and carried significant periprocedural risks including death, to the availability of a wide range of more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. The reduction in morbidity and mortality associated with these new extraction techniques has widened indications to TLE from prevalent use in life-threatening situations, such as infection and sepsis, to a more widespread use even in noninfectious situations such as malfunctioning leads. Powered sheaths have been a remarkable step forward in this improvement in TLE procedures and recent registries at high-volume centers report high success rates with exceedingly low complication rates. This review is aimed at describing technical features of powered sheaths as well as reported performance during TLE procedures.
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Affiliation(s)
- Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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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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Pecha S, Ziegelhoeffer T, Yildirim Y, Choi YH, Willems S, Reichenspurner H, Burger H, Hakmi S. Safety and efficacy of transvenous lead extraction of very old leads. Interact Cardiovasc Thorac Surg 2021; 32:402-407. [PMID: 33257960 DOI: 10.1093/icvts/ivaa278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Transvenous lead extraction using mechanical rotational- or laser sheaths is an established procedure. Lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications. We therefore investigated the safety and efficacy of transvenous extraction of leads with an implant duration of more than 10 years. METHODS Between January 2013 and March 2017, a total of 403 patients underwent lead extraction in 2 high-volume lead extraction centres. One hundred and fifty-four patients with extraction of at least 1 lead aged over 10 years were included in this analysis. Laser lead extraction was the primary extraction method, with additional use of mechanical rotational sheaths or femoral snares, if necessary. All procedural- and patient-based data were collected into a database and retrospectively analysed. RESULTS Mean patient's age was 65.8 ± 15.8 years, 68.2% were male. Three hundred and sixty-two leads had to be extracted. The mean lead dwell time of treated leads was 14.0 ± 6.1 years. Complete procedural success was achieved in 91.6% of cases, while clinical success was achieved in 96.8%. Failure of extraction occurred in 3.2%. Leads that could not be completely removed had a significantly longer lead dwell time (18.2 vs 13.2 years; P = 0.016). Additional mechanical rotational sheaths or femoral snares were used in 26 (16.9%) patients. Overall complication rate was 4.6%, including 5 (3.3%) major and 2 (1.3%) minor complications. There was no procedure-related mortality. CONCLUSIONS Transvenous lead extraction in leads aged over 10 years is safe and effective when performed in specialized centres and with use of multiple tools and techniques. Leads that could not be completely extracted had a statistically significant longer lead dwell time.
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Affiliation(s)
- Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.,Justus-Liebig-University Gießen, Campus Kerckhoff-Klinik, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt/Main, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Diaz JC, Romero J, Costa R, Cuesta A, Biase LD, Alviz I, Velasco A, Gabr M, Duque M, Marin JE, Aristizabal J, Velasquez J, Niño CD, Mazzetti H. Current practice in transvenous lead extraction in Latin America: Latin American Heart Rhythm Association survey. J Cardiovasc Electrophysiol 2021; 32:2715-2721. [PMID: 34288220 DOI: 10.1111/jce.15180] [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: 05/06/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead-related complications. Currently, objective data on TLE in Latin America is lacking. OBJECTIVE To describe the current practice standards in Latin American centers performing TLE. METHODS An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. RESULTS A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty-nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. CONCLUSION This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.
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Affiliation(s)
| | - Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alejandro Cuesta
- Facultad de Medicina, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Luigi D Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Jorge E Marin
- Hospital Universitario San Vicente Fundación, Rionegro, Colombia
| | | | | | | | - Hector Mazzetti
- Sanatorio de La Trinidad de San Isidro, Buenos Aires, Argentina
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Starck CT, Burger H, Osswald B, Hakmi S, Knaut M, Bimmel D, Bärsch V, Eitz T, Mierzwa M, Ghaffari N, Siebel A. HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Shah K, Pollema T, Birgersdotter-Green U. Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, global clinical study-"An evolution in extraction". Heart Rhythm O2 2021; 2:122-123. [PMID: 34115052 PMCID: PMC8183959 DOI: 10.1016/j.hroo.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kunal Shah
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Travis Pollema
- Division of Cardiothoracic surgery, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
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