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Gładysz-Wańha S, Joniec M, Wańha W, Piłat E, Drzewiecka A, Gardas R, Biernat J, Węglarzy A, Gołba KS. Transvenous lead extraction safety and efficacy in infected and noninfected patients using mechanical-only tools: Prospective registry from a high-volume center. Heart Rhythm 2024; 21:427-435. [PMID: 38157921 DOI: 10.1016/j.hrthm.2023.12.015] [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: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a well-established treatment option for patients with cardiac implantable electronic devices (CIED) complications. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of TLE in CIED infection and non-CIED infection patients. METHODS Consecutive patients who underwent TLE between 2016 and 2022 entered the EXTRACT Registry. Models of prediction were constructed for periprocedural clinical and procedural success and the incidence of major complications, including death in 30 days. RESULTS The registry enrolled 504 patients (mean age 66.6 ± 12.8 years; 65.7% male). Complete procedural success was achieved in 474 patients (94.0%) and clinical success in 492 patients (97.6%). The total number of major and minor complications was 16 (3.2%) and 51 (10%), respectively. Three patients (0.6%) died during the procedure. New York Heart Association functional class IV and C-reactive protein levels defined before the procedure were independent predictors of any major complication, including death in 30 days in CIED infection patients. The time since the last preceding procedure and platelet count before the procedure were independent predictors of any major complication, including death in 30 days in non-CIED infection patients. CONCLUSIONS TLE is safe and successfully performed in most patients, with a low major complication rate. CIED infection patients demonstrate better periprocedural clinical success and complete procedural success. However, CIED infection predicts higher 30-day mortality compared with non-CIED infection patients. Predictors of any major complication, including death in 30 days, differ between CIED infection and non-CIED infection patients.
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Affiliation(s)
- Sylwia Gładysz-Wańha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland.
| | - Michał Joniec
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Eugeniusz Piłat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Anna Drzewiecka
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Andrzej Węglarzy
- Department of Anaesthesiology and Intensive Care with Cardiac Supervision, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
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Villegas EG, Torres JN, Domingo EJB, Dorrego MDP, del Rio JIJ, Valdiris UR, Carmona JCR, Fernandez IF, Peinado RP. Superior vena cava syndrome and pacemaker leads. Explant by mechanical dissection system of extraction and percutaneous recanalization with stents for new device implantation. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Stefańczyk P, Nowosielecka D, Polewczyk A, Jacheć W, Głowniak A, Kosior J, Kutarski A. Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:291. [PMID: 36612613 PMCID: PMC9819767 DOI: 10.3390/ijerph20010291] [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: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. METHODS We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. RESULTS The need for an upgrade was the leading indication for TLE in only 36-66% of patients. In 42.0-57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1-76.4% of patients, functional leads were retained in 20.2-31.9%, non-functional leads were left in place in 0.0-1.1%, and non-functional superfluous leads were extracted in 3.6-8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). CONCLUSIONS Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.
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Affiliation(s)
- Paweł Stefańczyk
- Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
- Department of Cardiac Surgery, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University in Katowice, 41-800 Zabrze, Poland
| | - Andrzej Głowniak
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital, 26-617 Radom, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
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Witte OA, Delnoy PPH, Ghani A, Smit JJJ, Ramdat Misier AR, Elvan A, Adiyaman A. Lead extractions: dissecting adhesions up to the lead-tip of the right ventricle: safety and success-rates. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:132-140. [PMID: 34875112 DOI: 10.1111/pace.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV-lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV-lead extraction requiring dissection up to the myocardium. METHODS AND RESULTS From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand-powered mechanical Evolution system to extract RV-leads (n = 185) were examined from a prospective registry. We assessed 4 groups: TLE with the first generation Evolution (n = 43) with (A1,n = 18) and without (A2,n = 25) adhesions up to the myocardium and TLE with the Novel R/L type (n = 142) of sheath with (B1, n = 59) and without (B2, n = 83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p = 0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p = 0.0067). There were no deaths. Overall major complication rates were low (2/185; 1.1%) and there was no statistically significant difference in major and minor complications between the two groups. CONCLUSION Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.
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Affiliation(s)
- Olivier A Witte
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Abdul Ghani
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
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Ayvazyan SA, Gamzaev AB, Palagina AA, Gorshenin KG, Buslaeva SI, Seregin AA, Konovalov NS, Sapelnikov OV. The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications. Sovrem Tekhnologii Med 2021; 13:66-69. [PMID: 34513068 PMCID: PMC8353688 DOI: 10.17691/stm2021.13.1.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of the investigation was to study the issue of making challenging decisions concerning abandonment or removal of non-infected superfluous leads during lead revisions or cardiac implantable electronic device upgrades.
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Affiliation(s)
- S A Ayvazyan
- Cardiovascular Surgeon, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - A B Gamzaev
- Professor, Department of X-ray Surgical Methods of Diagnosis and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Palagina
- Resident, Department of X-ray Endovascular Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - K G Gorshenin
- Cardiologist, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - S I Buslaeva
- Cardiologist, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - A A Seregin
- Endovascular Surgeon, Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment, Volga District Medical Centre of Federal Medical Biological Agency of Russia, 2 Nizhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603001, Russia
| | - N S Konovalov
- Resident, Department of X-ray Surgical Methods of Diagnosis and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - O V Sapelnikov
- Cardiovascular Surgeon, Department of Cardiovascular Surgery, National Medical Research Center of Cardiology, 15a, 3 Cherepkovskaya St., Moscow, 121552, Russia
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Kella DK, Isath A, Yasin O, Padmanabhan D, Webster T, Mulpuru S, Cha Y, Friedman PA. Fibroplasty (venoplasty) to facilitate transvenous lead placement: A single‐center experience. J Cardiovasc Electrophysiol 2020; 31:2425-2430. [DOI: 10.1111/jce.14655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/31/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Danesh K. Kella
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | - Ameesh Isath
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | - Omar Yasin
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | | | - Tracy Webster
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | - Siva Mulpuru
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | - Yong‐Mei Cha
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
| | - Paul A. Friedman
- Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA
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Imnadze G, Awad K, Kranig W, Giorgberidze I. Modified Pull-Through Technique for Cardiac Resynchronization Therapy Upgrades in Patients with Occluded Access Veins. Tex Heart Inst J 2020; 47:23-26. [PMID: 32148448 DOI: 10.14503/thij-18-6713] [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] [Indexed: 11/23/2022]
Abstract
The number of procedures for upgrading implantable devices for cardiac resynchronization therapy has increased considerably during the last decade. A major challenge that operators face in these circumstances is occlusion of the access vein. We have modified a pull-through method to overcome this obstacle. Six consecutive patients with occluded access veins and well-developed collateral networks underwent a procedure in which the occluded vein was recanalized by snaring the existing atrial lead via transfemoral access. Upgrading the device was successful in all patients; none had intraprocedural complications. Our experience shows that our modified pull-through technique may be a feasible alternative for upgrading cardiac resynchronization therapy in patients with venous occlusion.
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Higuchi S, Shoda M, Saito S, Kanai M, Kataoka S, Yazaki K, Yagishita D, Ejima K, Hagiwara N. Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience. Pacing Clin Electrophysiol 2019; 42:1517-1523. [DOI: 10.1111/pace.13806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Satoshi Higuchi
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Satoshi Saito
- Department of Cardiovascular SurgeryTokyo Women's Medical University Tokyo Japan
| | - Miwa Kanai
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Kyoichiro Yazaki
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of CardiologyTokyo Women's Medical University Tokyo Japan
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