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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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Tan MC, Talaei F, Trongtorsak A, Lee JZ, Rattanawong P. Chronic kidney disease is associated with increased all-cause mortality in transvenous lead extraction: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2023; 46:66-72. [PMID: 36441922 DOI: 10.1111/pace.14631] [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: 08/12/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well-established. We performed a systematic review and meta-analysis to explore the association between CKD and all-cause mortality in TLE. METHODS We searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random-effects model. RESULTS Eight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all-cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65-2.77, I2 = 51.1%, p < .001). The risk of overall all-cause mortality increased with the severity of CKD for nonspecific CKD (HR = 2.01, 95% CI: 1.49-2.69, I2 = 53.4, p < .001) and ESRD (HR = 2.79, 95% CI: 1.85-4.23, I2 = 0%, p < .001). The risk of all-cause mortality in CKD is double at follow-up ≤1 year (HR = 1.99, 95% CI: 1.29-3.09, I2 = 50.9%, p = .002) and higher at follow-up >1 year (HR = 2.36, 95% CI: 1.63-3.42, I2 = 59.7%, p < .001). CONCLUSIONS Our meta-analysis demonstrates a significantly increased risk of overall all-cause mortality in patients with CKD who underwent TLE compared to controls.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, McLaren Flint Hospital, Flint, Michigan, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Towheed A, Smith A, Ghawanmeh M, Tsimploulis A, Hadadi C, Thomaides A. A Unique Case of Central Line Fracture Due to Laser Lead Extraction. JACC Case Rep 2022; 4:101633. [PMID: 36684034 PMCID: PMC9847237 DOI: 10.1016/j.jaccas.2022.08.044] [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: 06/26/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Transvenous laser-assisted lead extraction is successful, with a low procedural complication rate for a wide range of indications. Here, we report a case of right internal jugular triple-lumen central venous catheter fracture and subsequent embolism to the right pulmonary artery during laser lead extraction that was successfully retrieved with a gooseneck snare. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Arooge Towheed
- Department of Electrophysiology, MedStar Washington Hospital Center, Washington, DC, USA,Address for correspondence: Dr. Arooge Towheed, Department of Cardiac Electrophysiology, Medstar Washington Hospital Center, 110 Irving Street N.W., Suite 5A12-Q, Washington, DC 20010, USA.
| | - Alexander Smith
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Malik Ghawanmeh
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Apostolos Tsimploulis
- Department of Electrophysiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Cyrus Hadadi
- Department of Electrophysiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Athanasios Thomaides
- Department of Electrophysiology, MedStar Washington Hospital Center, Washington, DC, USA
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Rotational mechanical dilator sheaths for effective transvenous lead extraction. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
An exponential rise in clinical demand for cardiac implantable electronic device (CIED) therapy is observed all over the world due to the rapidly expanding lifespan. Accordingly, appropriate lead management including lead extraction is becoming increasingly essential components for the comprehensive care of patients with various CIEDs.
Main body
With a high success rate and a low complication rate, transvenous lead extraction (TLE) has now been established as first-line therapy for lead extraction. However, TLE is often challenging when there are heavily calcified fibrous adhesions between leads and cardiovascular structures. Recently, rotational mechanical dilator (RMD) sheaths were introduced to resolve this issue and facilitate TLE procedure. There are two types of commercially available RMD sheaths, Evolution® systems and TightRail™. Thorough knowledge of the proper use of the RMD devices is essential to increase success rate and to reduce complications of TLE. In the present review, mechanical features, various techniques, and clinical data of RMD sheaths will be described.
Conclusion
According to recent advancement of device technology, the clinical outcomes of TLE using the RMD sheaths are continuously improving. However, as the RMD sheath is a potentially aggressive tool, special care should be taken when used in patients with longer lead ages.
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Misra S, Mehta R. Outcomes of Lead Extraction Using the TIghtRail(TM) Sheath: An Opportunity for Increasing Access While Preserving Outcomes? J Cardiovasc Electrophysiol 2022; 33:738-740. [PMID: 35118755 DOI: 10.1111/jce.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
Transvenous lead extraction (TLE) has evolved significantly since initial techniques were described more than 30 years ago. In the present study, Artus et al describe outcomes with a commonly used extraction tool - the TightRailTM sheath - at five low-moderate volume extraction centers in France following their establishment by recently trained operators. This retrospective observational analysis offers an important contribution to the limited literature on outcomes using the TightRailTM sheath. Following training at high volume centers, operators returned to five regional medical centers to launch TLE programs. Over 6 years, 225 patients underwent TLE targeting 438 leads (22% ICD leads) with a mean lead dwell time of 10 years. Overall, clinical success was achieved in 93% of procedures with a 3% rate of major complications. This series, one of the largest using TightRailTM and the largest using it exclusively, demonstrates favorable outcomes and safety data even in centers early in their clinical experience with relatively low annual volumes, averaging 10 TLE procedures per year. This study, in addition to supporting use of the TightRailTM sheath for TLE, also indicate that with appropriate training and support it can be safely and effectively offered outside of high-volume centers using this tool without necessarily requiring availability of a more capital-intensive excimer laser sheath. Further investigation on appropriate patient selection, definition of the "learning curve," and optimal tool selection is needed to help deliver the best outcomes for patients in need of this complex procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, Atrium Health, 1001 Blythe Blvd, Ste 300, Charlotte, NC, 28203.,Division of Cardiology, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21287
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, Atrium Health, 1001 Blythe Blvd, Ste 300, Charlotte, NC, 28203
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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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