1
|
Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
Collapse
Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Segreti L, Bongiorni MG, Barletta V, Parollo M, Di Cori A, Fiorentini F, Giannotti Santoro M, De Lucia R, Viani S, Grifoni G, Paperini L, Sodati E, Mazzocchetti L, Canu AM, Zucchelli G. Transvenous lead extraction: Efficacy and safety of the procedure in female patients. Heart Rhythm O2 2023; 4:625-631. [PMID: 37936665 PMCID: PMC10626182 DOI: 10.1016/j.hroo.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Existing data on the impact of sex differences on transvenous lead extraction (TLE) outcomes in cardiac device patients are limited. Objective The purpose of this study was to evaluate the safety and efficacy of mechanical TLE in female patients. Methods A retrospective evaluation was performed on 3051 TLE patients (group 1: female; group 2: male) from a single tertiary referral center. All individuals received treatment using single sheath mechanical dilation and various venous approaches as required. Results Our analysis included 3051 patients (group 1: 750; group 2: 2301), with a total of 5515 leads handled with removal. Female patients were younger, had a higher left ventricular ejection fraction, and lower prevalences of coronary artery disease and diabetes mellitus. Infection was more common in male patients, whereas lead malfunction or abandonment were more frequent in female patients. Radiologic success was lower in female patients (95.8% vs 97.5%; P = .003), but there was no significant difference in clinical success between groups (97.2% vs 97.5%; P = .872). However, major complications (1.33% vs 0.60%; P <.001) and procedural mortality (0.4% vs 0.1%; P <.001) were higher in females compared to male patients. After multivariate analysis, female sex emerged as the only predictor of major complications, including deaths (odds ratio 3.96; 95% confidence interval 1.39-11.24). Conclusion TLE using unpowered simple mechanical sheaths in female patients is safe and effective, but is associated with lower radiologic success and higher complication rates and mortality than in males. This finding underscores the importance of recognizing sex differences in TLE outcomes.
Collapse
Affiliation(s)
- Luca Segreti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Federico Fiorentini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Gino Grifoni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Ezio Sodati
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Lorenzo Mazzocchetti
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Antonio Maria Canu
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| |
Collapse
|
4
|
Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
Collapse
Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| |
Collapse
|
5
|
Tascini C, Giuliano S, Attanasio V, Segreti L, Ripoli A, Sbrana F, Severino S, Sordelli C, Weisz SH, Zanus-Fortes A, Leanza GM, Carannante N, Di Cori A, Bongiorni MG, Zucchelli G, De Vivo S. Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study. Antibiotics (Basel) 2023; 12:1001. [PMID: 37370320 DOI: 10.3390/antibiotics12061001] [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: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation.
Collapse
Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, 56124 Pisa, Italy
| | - Sergio Severino
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Chiara Sordelli
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Sara Hana Weisz
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Agnese Zanus-Fortes
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Gabriele Maria Leanza
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano De Vivo
- UOC di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, 80131 Napoli, Italy
| |
Collapse
|
6
|
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.
Collapse
|
7
|
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.
Collapse
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: ;
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Zucchelli G, Di Cori A, Segreti L, Laroche C, Blomstrom-Lundqvist C, Kutarski A, Regoli F, Butter C, Defaye P, Pasquié JL, Auricchio A, Maggioni AP, Bongiorni MG. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2020; 21:771-780. [PMID: 30590520 DOI: 10.1093/europace/euy300] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/01/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. METHODS AND RESULTS A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. CONCLUSIONS In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade.
Collapse
Affiliation(s)
- Giulio Zucchelli
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Andrea Di Cori
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Luca Segreti
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France
| | | | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland
| | - François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany
| | - Pascal Defaye
- Department of Arrhythmia and Cardiac Pacing, CHU Albert Michallon, University Hospital Grenoble-Alpes, BP 217, Grenoble Cedex 9, France
| | - Jean Luc Pasquié
- Département de Cardiologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France.,ANMCO Research Center, Via La Marmora 34, Firenze, Italy
| | - Maria Grazia Bongiorni
- Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy
| | | |
Collapse
|
10
|
Isawa T, Honda T, Yamaya K, Taguri M. Predictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients. J Arrhythm 2020; 36:746-754. [PMID: 32782649 PMCID: PMC7411205 DOI: 10.1002/joa3.12395] [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: 03/26/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies on femoral approach during transvenous lead extraction (TLE) are limited. METHODS We retrospectively evaluated 75 patients undergoing TLE from September 2014 through November 2019 via supportive femoral approach (Femoral/Superior group; n = 22) and superior approach alone (Superior group; n = 53). RESULTS No significant between-group differences were observed regarding patients' baseline characteristics except for a higher incidence of access vein occlusion in the Femoral/Superior group (59.1% vs. 31.4%; P = .037). The Femoral/Superior group exhibited significantly longer dwell times of the oldest extracted lead (median: 13.4 years; interquartile range [IQR]: 8.8-21.2 years vs. median, 7.2 years; IQR: 3.7-10.8 years; P < .001) and a higher incidence of passive fixation ventricular pacemaker lead (81.8% vs. 39.6%; P = .001). Multivariate logistic analysis showed that access vein occlusion (odds ratio [OR]: 4.07, 95% confidence interval [CI]: 1.08-15.3; P < .001) and dwell time of the oldest extracted lead (per year) (OR: 1.22, 95% CI: 1.09-1.37; P = .038) were predictors of the need for supportive femoral approach. Receiver operating characteristic curve analysis revealed that 11.8 years from implant was the cutoff for the need for supportive femoral approach (sensitivity 68.2%, specificity of 81.1%, area under the curve 0.81). CONCLUSIONS Access vein occlusion and long dwell time of the oldest extracted lead predict a high probability of the need for supportive femoral approach. Supportive femoral approach may be necessary in patients with leads that are implanted for >11.8 years and whose access veins are occluded.
Collapse
Affiliation(s)
- Tsuyoshi Isawa
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Taku Honda
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Kazuhiro Yamaya
- Department of Cardiovascular SurgerySendai Kousei HospitalSendaiJapan
| | - Masataka Taguri
- Department of Data ScienceYokohama City University School of Data ScienceYokohamaJapan
| |
Collapse
|
11
|
Giannotti Santoro M, Segreti L, Zucchelli G, Barletta V, Fiorentini F, Di Cori A, De Lucia R, Bongiorni MG. Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:382-387. [PMID: 32144936 DOI: 10.1111/pace.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/09/2020] [Accepted: 03/02/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. METHODS Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2: < 80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. RESULTS Our analysis included 1316 patients (group 1: 202; group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities, more pacemakers than implantable cardioverter-defibrillators, whereas the dwelling time of the oldest lead and the number of leads were similar, irrespective of patient's age. In group 1, the radiological success rate for lead was higher (99.0% vs 95.9%; P < .001) and the fluoroscopy time lower (13.0 vs 15.0 min; P = .04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P = .36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P = .24) and with no procedure-related deaths in elderly group. CONCLUSIONS Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure.
Collapse
Affiliation(s)
| | - Luca Segreti
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Valentina Barletta
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federico Fiorentini
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Di Cori
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Raffaele De Lucia
- Cardiology Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | |
Collapse
|
12
|
Ząbek A, Boczar K, Dębski M, Ulman M, Pfitzner R, Musiał R, Lelakowski J, Małecka B. Effectiveness and safety of transvenous extraction of single- versus dual-coil implantable cardioverter-defibrillator leads at single-center experience. Medicine (Baltimore) 2019; 98:e16548. [PMID: 31348275 PMCID: PMC6709158 DOI: 10.1097/md.0000000000016548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.
Collapse
Affiliation(s)
| | | | | | | | - Roman Pfitzner
- Department of Cardiac and Vascular Surgery, The John Paul II Hospital
- Institute of Cardiology, Jagiellonian University Medical College
| | - Robert Musiał
- Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Krakow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology
- Institute of Cardiology, Jagiellonian University Medical College
| | - Barbara Małecka
- Department of Electrocardiology
- Institute of Cardiology, Jagiellonian University Medical College
| |
Collapse
|
13
|
Segreti L, Giannotti Santoro M, Di Cori A, Zucchelli G, Viani S, De Lucia R, Della Tommasina V, Barletta V, Paperini L, Soldati E, Bongiorni MG. Utility of risk scores to predict adverse events in cardiac lead extraction. Expert Rev Cardiovasc Ther 2018; 16:695-705. [DOI: 10.1080/14779072.2018.1513325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Luca Segreti
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Veronica Della Tommasina
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| |
Collapse
|
14
|
Perez AA, Woo FW, Tsang DC, Carrillo RG. Transvenous Lead Extractions: Current Approaches and Future Trends. Arrhythm Electrophysiol Rev 2018; 7:210-217. [PMID: 30416735 PMCID: PMC6141917 DOI: 10.15420/aer.2018.33.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
The use of cardiac implantable electronic devices (CIEDs) has continued to rise along with indications for their removal. When confronted with challenging clinical scenarios such as device infection, malfunction or vessel occlusion, patients often require the prompt removal of CIED hardware, including associated leads. Recent advancements in percutaneous methods have enabled physicians to face a myriad of complex lead extractions with efficiency and safety. Looking ahead, emerging technologies hold great promise in making extractions safer and more accessible for patients worldwide. This review will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this novel field.
Collapse
Affiliation(s)
- Adryan A Perez
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Frank W Woo
- University of Miami Miller School of Medicine Miami, FL, USA
| | - Darren C Tsang
- University of Miami Miller School of Medicine Miami, FL, USA
| | | |
Collapse
|
15
|
Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy L, Rao A, Tascini C, Lever N, Kutarski A, Fernandez Lozano I, Strathmore N, Costa R, Epstein L, Love C, Blomstrom-Lundqvist C, Fauchier L, Defaye P, Arnar DO, Klug D, Boveda S, Nielsen JC, Boriani G, Zhang S, Martin AP, Prutkin JM, de Zuloaga C. 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace 2018; 20:1217. [DOI: 10.1093/europace/euy050] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Jean C Deharo
- Department of Cardiology, CHU la Timone, Marseilles, France
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laszlo Saghy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Nigel Lever
- APHRS Reviewer, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Neil Strathmore
- APHRS Reviewer, Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Roberto Costa
- LAHRS Reviewer, Hospital das Clínicas, São Paulo, Brazil
| | - Laurence Epstein
- HRS Reviewer, Clinical Cardiac Electrophysiology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Love
- HRS Reviewer, Division of Cardiovascular Medicine, the Ohio State University Medical Center Columbus, Ohio, USA
| | | | | | - Pascal Defaye
- CHU Hopital Albert Michallon, Unite de Rythmologie Service De Cardiologie, Grenoble, France
| | - David O Arnar
- Landspitali University Hospital, Cardiology Department, Reykjavik, Iceland
| | - Didier Klug
- Hopital Cardiologique, Chru Lille, Service De Cardiologie A, Lille, France
| | - Serge Boveda
- Clinique Pasteur, Cardiology Department, Toulouse, France
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aaehus, Denmark
| | | | - Shu Zhang
- Beijing Fuwai Hospital, Cardiology Department, Beijing, China
| | | | | | | | | |
Collapse
|
16
|
Bongiorni MG, Segreti L, Di Cori A, Zucchelli G, Paperini L, Viani S, Soldati E. Overcoming the current issues surrounding device leads: reducing the complications during extraction. Expert Rev Med Devices 2018; 14:469-480. [PMID: 28521596 DOI: 10.1080/17434440.2017.1332990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The implantation rate of cardiac implantable electronic devices has consistently increased in the last 20 years, as have the related complication rates. The most relevant issue is the removal of pacing and implantable cardioverter defibrillator (ICD) leads, which a few months after implantation tend to develop intravascular fibrosis, often making extraction a challenging and risky procedure. Areas covered: The transvenous lead extraction (TLE) scenario is constantly evolving. TLE is a key procedure in lead management strategies. Many efforts have been made to develop new TLE approaches and techniques allowing a safe and effective procedure for patients. The increasing rate of cardiac implantable electronic device (CIED) implantations and of CIED related complications highlight the importance of TLE. Lead related- and patient-related factors may change the future of extractions. We review the current status of TLE, focusing on the strategies available to perform the optimal procedure in the right patient and reducing procedure related complications. Expert commentary: Understanding the importance of an accurate TLE risk stratification is mandatory to optimize the procedural risk-to-benefits ratio. The use of adequate tools, techniques and approaches, and appropriate training are cornerstones for the achievement of safer procedures.
Collapse
Affiliation(s)
- Maria Grazia Bongiorni
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Luca Segreti
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Andrea Di Cori
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Giulio Zucchelli
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Luca Paperini
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Stefano Viani
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| | - Ezio Soldati
- a Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department , New Santa Chiara Hospital, University of Pisa , Pisa , Italy
| |
Collapse
|
17
|
Fender EA, Killu AM, Cannon BC, Friedman PA, Mcleod CJ, Hodge DO, Broberg CS, Henrikson CA, Cha YM. Lead extraction outcomes in patients with congenital heart disease. Europace 2017; 19:441-446. [PMID: 27738059 DOI: 10.1093/europace/euw049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/06/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Patients with congenital heart disease (CHD) are at increased risk for intracardiac device malfunction and infection that may necessitate extraction; however, the risk of extraction is poorly understood. This study addresses the safety of extraction in patients with structural heart disease and previous cardiac surgery. Methods and results This retrospective study included 40 CHD and 80 matched control patients, who underwent transvenous lead extractions between 2001 and 2014. Only leads >12 months were included. There were 77 leads in CHD patients and 146 in controls. The mean age was 38 ± 16 years in CHD patients. Ninety per cent of CHD patients had ≥1 cardiac surgeries when compared with 21% of controls (P < 0.001). The number of abandoned leads was significantly different (17 vs. 3, P < 0.001). Lead age was similar with an average duration of 83 ± 87 months in CHD patients and 62 ± 65 months in controls (P = 0.24). There was no significant difference in extraction techniques. Manual traction was successful in 40% of CHD patients and 47% of controls, and advanced techniques were used in 60 and 53% of CHD patients and controls, respectively. Complete extraction was achieved in 94% of the patients in both groups. There was no significant difference in complications. Conclusion Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and longer implantation times, the difficulty of lead extraction in patients with CHD is comparable with controls.
Collapse
Affiliation(s)
- Erin A Fender
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Ammar M Killu
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Bryan C Cannon
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Paul A Friedman
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Christopher J Mcleod
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - David O Hodge
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Craig S Broberg
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Charles A Henrikson
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Yong-Mei Cha
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| |
Collapse
|
18
|
Domenichini G, Gonna H, Sharma R, Conti S, Fiorista L, Jones S, Arthur M, Adhya S, Jahangiri M, Rowland E, Gallagher MM. Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress. Europace 2017; 19:1521-1526. [DOI: 10.1093/europace/euw162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
|
19
|
Gaubert M, Giorgi R, Franceschi F, Koutbi-Franceschi L, Gitenay E, Maille B, Deharo JC. Outcomes and costs associated with two different lead-extraction approaches: a single-centre study. Europace 2016; 19:1710-1716. [DOI: 10.1093/europace/euw254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
|
20
|
Bongiorni MG, Di Cori A, Segreti L, Zucchelli G, Viani S, Paperini L, Menichetti F, Coluccia G, Soldati E. Where is the future of cardiac lead extraction heading? Expert Rev Cardiovasc Ther 2016; 14:1197-203. [DOI: 10.1080/14779072.2016.1220832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
21
|
Starck CT, Falk V. Lead extraction technology and techniques: a surgeon's perspective. Multimed Man Cardiothorac Surg 2016; 2016:mmw009. [PMID: 27354462 DOI: 10.1093/mmcts/mmw009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/09/2016] [Indexed: 11/12/2022]
Abstract
Transvenous lead extraction procedures have gained substantial clinical importance during the past decade. With current tools and techniques, high success rates in combination with low complication rates can be achieved by experienced centres. Even in experienced hands, life-threatening complications can occur, and every physician performing such procedures must be prepared for this scenario. This necessitates immediately available access to extracorporeal circulation, and if the operator is a cardiologist, cardiac surgical standby is mandatory.
Collapse
Affiliation(s)
- Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| |
Collapse
|
22
|
|
23
|
|
24
|
Bongiorni MG, Segreti L, Di Cori A, Bonner M, Eggen M, Omdahl P. Retrieval of a transcatheter pacemaker in sheep after a mid-term implantation time. HeartRhythm Case Rep 2015; 2:43-46. [PMID: 28491630 PMCID: PMC5412636 DOI: 10.1016/j.hrcr.2015.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac-Thoracic and Vascular Department, Cisanello Hospital, University of Pisa, Italy
| | - Luca Segreti
- Second Division of Cardiovascular Diseases, Cardiac-Thoracic and Vascular Department, Cisanello Hospital, University of Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac-Thoracic and Vascular Department, Cisanello Hospital, University of Pisa, Italy
| | - Matthew Bonner
- Medtronic Cardiac Rhythm and Heart Failure Research, Mounds View, Minnesota
| | - Michael Eggen
- Medtronic Cardiac Rhythm and Heart Failure Research, Mounds View, Minnesota
| | - Pamela Omdahl
- Cardiac Rhythm and Heart Failure Procedure Development, Mounds View, Minnesota
| |
Collapse
|
25
|
Abstract
Implantable cardioverter-defibrillator (ICD) leads have to fulfill particular requirements: safe pacing and sensing, detection, and termination of ventricular tachyarrhythmias, if necessary by (multiple) high-energy shocks. At the same time, their implantation has to be simple, they need to provide excellent long-term stability and they must be completely and safely extractable. Numerous technical developments have enabled currently available ICD leads to fulfill these expectations to a high extent. However, some changes of lead design, materials, and manufacturing processes have led to increased lead failure, especially in two lead models (Medtronic Sprint Fidelis®, St. Jude Medical Riata®). The high rate of lead failure was identified only several years after market release, in part because there are no appropriate registries of ICD leads. This review presents background and developments of ICD lead technology and their association with the clinical usage of ICD therapy. To also benefit patients with only slightly-to-moderately increased risk of ventricular tachyarrhythmia, optimum ICD therapy requires optimal leads and sufficiently experienced implanters.
Collapse
Affiliation(s)
- Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland,
| | | |
Collapse
|
26
|
Morin DP. Laser-assisted extraction of a pacing lead with a supraclavicular course. HeartRhythm Case Rep 2015; 1:120-122. [PMID: 28491527 PMCID: PMC5418612 DOI: 10.1016/j.hrcr.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
27
|
Segreti L, Di Cori A, Zucchelli G, Soldati E, Coluccia G, Viani S, Paperini L, Bongiorni MG. A Questionable Indication For ICD Extraction After Successful VT Ablation. J Atr Fibrillation 2015; 7:1172. [PMID: 27957158 DOI: 10.4022/jafib.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD). In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. To date, no control data have been published on transvenous lead extraction in the setting of VT ablation. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.
Collapse
Affiliation(s)
- Luca Segreti
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Coluccia
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
28
|
Bongiorni MG, Di Cori A, Segreti L, Zucchelli G, Viani S, Paperini L, De Lucia R, Levorato D, Boem A, Soldati E. Transvenous extraction profile of Riata leads: Procedural outcomes and technical complexity of mechanical removal. Heart Rhythm 2015; 12:580-587. [DOI: 10.1016/j.hrthm.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 11/25/2022]
|
29
|
Buiten MS, van der Heijden AC, Schalij MJ, van Erven L. How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods. Europace 2015; 17:689-700. [DOI: 10.1093/europace/euu378] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/02/2014] [Indexed: 12/30/2022] Open
|
30
|
Key Words
- HIV, human immunodeficiency virus
- ICD, implantable cardioverter-defibrillator
- ICE, intracardiac echocardiography
- IJ, internal jugular
- LVEF, left ventricular ejection fraction
- RV, right ventricular
- SVC, superior vena cava
- TR, tricuspid regurgitation
- TTE, transthoracic echocardiogram
- TV, tricuspid valve
Collapse
|
31
|
Segreti L, Di Cori A, Soldati E, Zucchelli G, Viani S, Paperini L, De Lucia R, Coluccia G, Valsecchi S, Bongiorni MG. Major predictors of fibrous adherences in transvenous implantable cardioverter-defibrillator lead extraction. Heart Rhythm 2014; 11:2196-201. [DOI: 10.1016/j.hrthm.2014.08.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/30/2022]
|