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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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Al-Maisary S, Romano G, Karck M, De Simone R, Kremer J. The use of laser lead extraction sheath in the presence of supra-cardiac occlusion of the central veins for cardiac implantable electronic device lead upgrade or revision. PLoS One 2021; 16:e0251829. [PMID: 33989335 PMCID: PMC8121537 DOI: 10.1371/journal.pone.0251829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background The implantation of cardiac implantable electronic devices (CIED) has increased in the last decades with improvement in the quality of life of patients with cardiac rhythm disorders. The presence of bilateral subclavian, innominate or superior vena cava obstruction is a major limitation to device revision and/or upgrade. Methods and material This is retrospective study of patients who underwent laser-assisted lead extraction (LLE) (GlideLight laser sheath, Spectranetics Corporation, Colorado Springs, USA) with lead revision or upgrade using the laser sheath as a guide rail. Patients with known occlusion, severe stenosis or functional obstruction of the venous access vessels with indwelling leads were included in this study. Results 106 patients underwent percutaneous LLE with lead revision and/or upgrade. Preoperative known complete occlusion or severe stenosis of access veins was present in 23 patients (21.5%). More patients with implantable cardioverter-defibrillator (ICD) underwent LLE (64.1%) than patients with CRT-Ds (24.5%) and pacemaker patients (11.3%). In total 172 leads were extracted: 79 (45.9%) single-coil defibrillator leads, 35 (20.3%) dual-coil defibrillator leads, 31 (18.0%) right atrial leads, 24 (13.9%) right ventricular leads and three (1.7%) malfunctional coronary sinus left ventricular pacing leads. The mean age of leads was 99.2±65.6 months. The implantation of new leads after crossing the venous stenosis/obstruction was successful in 98 (92.4%) cases. Postoperative complications were pocket hematoma in two cases and wound infection in one case. No peri-operative and no immediate postoperative death was recorded. One intraoperative superior vena cava tear was treated by immediate thoracotomy and surgical repair. Conclusion In a single-center study on LLE in the presence of supra-cardiac occlusion of the central veins for CIED lead upgrade and revision we could demonstrate a low procedural complication rate with no procedural deaths. Most of the leads could be completely extracted to revise or upgrade the system. Our study showed a low complication rate, with acceptable mortality rates.
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Affiliation(s)
- Sameer Al-Maisary
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Würrtemberg, Germany
- * E-mail:
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Würrtemberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Würrtemberg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Würrtemberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Würrtemberg, Germany
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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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Sadarmin PP, Chelliah RK, Timperley J. Contralateral transvenous left ventricular lead placement of implantable devices with pre-sternal tunnelling in chronically obstructed subclavian veins. Indian Pacing Electrophysiol J 2015; 15:113-7. [PMID: 26937096 PMCID: PMC4750133 DOI: 10.1016/j.ipej.2015.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is a recognised therapy for the management of severe left ventricular dysfunction, advanced congestive cardiac failure (NYHA III or IV), ventricular dyssynchrony (either broad LBBB or mechanical dyssynchrony on echocardiography) and failure of optimal medical therapy to achieve improvement in clinical status. Upgrading right ventricular pacemakers or defibrillators to biventricular devices is common and we describe here, 2 such cases of biventricular upgrade with blocked venous access on the ipsilateral side and successful placement of left ventricular leads following pre-sternal tunnelling from the contralateral side.
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6
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Rivera NT, Bray N, Wang H, Zelnick K, Osman A, Vicuña R. Rare infection of implantable cardioverter-defibrillator lead with Candida albicans: case report and literature review. Ther Adv Cardiovasc Dis 2014; 8:193-201. [DOI: 10.1177/1753944714539406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infection of implanted cardiac devices has a low rate of occurrence. Fungal infections of such devices represent an atypical phenomenon, associated with high mortality. Both medical and surgical therapies are recommended for a successful outcome. A 60-year-old woman with past medical history of heart failure with reduced ejection fraction, implantable cardioverter-defibrillator (ICD) placement, sarcoidosis and diabetes presented with fevers and atypical pleuritic chest pain. Transthoracic echocardiogram revealed a highly mobile 2.09 cm by 4.49 cm mass associated with the ICD wire. Blood cultures were positive for Candida albicans. The patient underwent sternotomy for removal. The vegetation was 4 cm by 2 cm by 2 cm in size, attached to the right ventricle without interference with the tricuspid valve. The patient was treated with micafungin for 2 weeks and then fluconazole for 6 weeks. In this case report, we describe the rare infection of an ICD lead with C. albicans, in the form of a fungal ball. This is the 18th reported case of Candida device-related endocarditis and the first reported in a woman. Prior case reports have occurred primarily in pacemaker rather than ICD leads. The vegetation size is also one of the largest that has been reported, measuring 4 cm at its greatest length. As Candida device-related endocarditis is so rare, and as fatality occurs in half of cases, clinical management can only be derived from sporadic case reports. Therefore, the course of this patient’s disease care will be a useful adjunct to the current literature for determining treatment and prognosis in similar cases.
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Affiliation(s)
- Nina Thakkar Rivera
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Natasha Bray
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Hong Wang
- Department of Pathology, Anatomic and Clinical, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Kenneth Zelnick
- Department of Cardiology, Interventional, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Ahmed Osman
- Department of Cardiology, Electrophysiology, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Ricardo Vicuña
- Department of Cardiology, Interventional, Interventional, Broward Health Medical Center, Fort Lauderdale, FL, USA
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Tereno Valente B, Conceição JM, Nogueira da Silva M, M Oliveira M, S Cunha P, Lousinha A, Galrinho A, C Ferreira R. Femoral approach: an exceptional alternative for permanent pacemaker implantation. Rev Port Cardiol 2014; 33:311.e1-5. [PMID: 24931177 DOI: 10.1016/j.repc.2014.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 01/24/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
The classic transvenous implantation of a permanent pacemaker in a pectoral location may be precluded by obstruction of venous access through the superior vena cava or recent infection at the implant site. When these barriers to the procedure are bilateral and there are also contraindications or technical difficulties to performing a thoracotomy for an epicardial approach, the femoral vein, although rarely used, can be a viable alternative. We describe the case of a patient with occlusion of both subclavian veins and a high risk for mini-thoracotomy or videothoracoscopy, who underwent implantation of a permanent single-chamber pacemaker via the right femoral vein.
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Affiliation(s)
- Bruno Tereno Valente
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - José M Conceição
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Manuel Nogueira da Silva
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Mário M Oliveira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro S Cunha
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Lousinha
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Galrinho
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui C Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Femoral approach: An exceptional alternative for permanent pacemaker implantation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mendenhall GS, Saba S. Prophylactic Lead Extraction at Implantable Cardioverter-Defibrillator Generator Change. Circ Arrhythm Electrophysiol 2014; 7:330-6. [DOI: 10.1161/circep.113.001151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Current implantable cardiac devices have a finite battery life of ≈3 to 7 years for implantable cardioverter-defibrillators. It is current practice to reuse all properly functioning intravascular leads. We tested the hypothesis that a strategy of prophylactic lead removal at the time of device change would be superior under some conditions to the current practice of lead reuse.
Methods and Results—
Using currently available data and a Monte Carlo microsimulation trial, we calculated the risks of leaving an indwelling lead until extraction is indicated because of malfunction versus an aggressive management strategy of prophylactic serial extraction at time of generator change. With a serial lead exchange strategy of leads at generator change, there is reduced overall extraction-related mortality because of fewer late complications attributable to extraction of leads with high dwell time because of infection, recall, or subsequent lead failure. This finding is limited to young patients or those with high expected indwell time of lead. This trend reverses for leads with <40 years expected dwell time. Sensitivity analysis shows high dependence on extraction performance and device longevity. In all cases, serial extraction would be expected to lead to increased adverse events related to the more complex procedure.
Conclusions—
A strategy of serial lead extraction, given best available current parameters, yields a lower procedural mortality risk in the long-term management of indwelling implantable cardioverter-defibrillator leads in young patients (>40-year estimated dwell time) driven by high aggregate anticipated risk of lifetime lead complication.
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Affiliation(s)
- G. Stuart Mendenhall
- From the Department of Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Samir Saba
- From the Department of Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
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10
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Sohal M, Williams S, Akhtar M, Shah A, Chen Z, Wright M, O'Neill M, Patel N, Hamid S, Cooklin M, Bucknall C, Bostock J, Gill J, Rinaldi CA. Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction. Europace 2013; 16:81-7. [PMID: 23794614 PMCID: PMC3864757 DOI: 10.1093/europace/eut163] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction. Methods and results Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 ± 19 months. Conclusion Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.
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Affiliation(s)
- Manav Sohal
- Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, London SE1 7EH, UK
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11
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Acute and long-term feasibility of contralateral transvenous lead placement with subcutaneous, pre-sternal tunnelling in patients with chronically implanted rhythm devices. Europace 2011; 13:1004-8. [DOI: 10.1093/europace/eur072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maytin M, Epstein LM. Lead Extraction Is Preferred for Lead Revisions and System Upgrades: When Less Is More. Circ Arrhythm Electrophysiol 2010; 3:413-24; discussion 424. [DOI: 10.1161/circep.110.954107] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bracke F, Ozdemir I, van Gelder B. The femoral route revisited: an alternative for pectoral pacing lead implantation. Neth Heart J 2010; 18:42-4. [PMID: 20111643 PMCID: PMC2810035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We describe the implantation via the femoral vein of a dual-chamber pacing system with lumenless, catheter-delivered pacing leads in a patient in whom subclavian access on both sides was obstructed. (Neth Heart J 2010;18:42-4.).
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Affiliation(s)
- F.A. Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - I. Ozdemir
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - B. van Gelder
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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14
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Rizvi AZ, Kalra M, Bjarnason H, Bower TC, Schleck C, Gloviczki P. Benign superior vena cava syndrome: Stenting is now the first line of treatment. J Vasc Surg 2008; 47:372-80. [DOI: 10.1016/j.jvs.2007.09.071] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/11/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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Moak JP, Freedenberg V, Ramwell C, Skeete A. Effectiveness of Excimer Laser-Assisted Pacing and ICD Lead Extraction in Children and Young Adults. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:461-6. [PMID: 16689839 DOI: 10.1111/j.1540-8159.2006.00376.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND High capture thresholds, decreased electrical sensing, and lead fractures continue to be a problem in children undergoing transvenous pacing. The clinician must therefore decide at the time of pacing system revision to either abandon chronically implanted transvenous pacing leads or extract them. METHODS We report our experience using an excimer laser-assisted (LA) strategy for removing chronically implanted pacing (36) and implantable cardioverter/defibrillator (ICD) (7) leads in children and young adults. The study population consisted of 25 patients, in whom 29 procedures were performed. The patients ranged in age from 8.4 to 39.9 years, median age was 13.9 years, at the time of the extraction procedure. In all procedures, a Spectranectics locking stylet and excimer laser sheath were used to assist in lead extraction. RESULTS Lead removal was complete for 39 (91%) leads, and partial for four leads. In two patients, the pacing lead tip was retained and in two, the ring electrode from a bipolar pacing lead was left in situ. All ICD leads were removed completely. Two major complications occurred--cardiac perforation and tamponade (1), and thrombosis of the left subclavian/innominate vein (1). LA extraction facilitated the implantation of new pacing or ICD leads in three patients with obstructed venous access. CONCLUSIONS Removal of pacing and ICD leads using an excimer LA technique was highly successful. Lead removal was complete in 91%. The most common indication for lead removal in our study was lead fracture. Complications were few, but may be significant.
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Affiliation(s)
- Jeffrey P Moak
- Department of Cardiology, Children's National Medical Center, George Washington School of Medicine, Washington, DC 20010, USA.
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Gula LJ, Ames A, Woodburn A, Matkins J, McCormick M, Bell J, Sink D, McConville J, Epstein LM. Central Venous Occlusion Is Not an Obstacle to Device Upgrade with the Assistance of Laser Extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:661-6. [PMID: 16008801 DOI: 10.1111/j.1540-8159.2005.00163.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of laser-assisted lead extraction for upgrade of existing pacemakers and defibrillators in patients with central venous obstruction. BACKGROUND Implantable cardiac defibrillators and biventricular pacing have become the accepted therapeutic measures for patients with congestive heart failure. Many patients who are candidates for device therapy, however, already have existing right ventricular leads and the presence of central venous obstruction. Upgrade of existing devices in these patients is a dilemma, which is increasingly encountered by device-implanting physicians. Laser-assisted extraction of existing leads can facilitate access for device upgrade and provide an alternative to lead abandonment and contralateral implant. METHODS We review our experience with laser-assisted lead extraction in patients, referred for upgrade of existing devices, who were found to have, or known to have, ipsilateral subclavian vein occlusion. RESULTS Over the past 3 years, 18 patients (13 men, 5 women; mean age 63.9 +/- 16 years) with subclavian vein occlusion underwent successful laser-assisted lead extraction (total 29 leads) and upgrade of existing leads to defibrillators and/or biventricular systems. Mean implant duration prior to extraction was 70.8 +/- 43.5 (11-192) months. Cannulation of the coronary sinus and placement of a transvenous left ventricular lead were achieved in all 13 patients in whom it was attempted. No complications occurred. CONCLUSIONS Laser-assisted lead extraction is a safe and effective approach, allowing for ipsilateral device upgrade in patients with existing devices and central venous obstruction.
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Affiliation(s)
- Lorne J Gula
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Abstract
There are special challenges associated with the use of transvenous pacemakers in children. For example, a child's chest cavity or vascular dimensions could be too small to host the generator and leads available or required. If leads are implanted, they may stretch as the child grows. This increases the risk that the leads will later dislodge or fracture. Moreover, children requiring pacemakers often have coexisting congenital heart defects and the structural abnormalities of those could hinder easy placement of the pacing system. This article will first review the indications for permanent pacing in children and will then describe the unique challenges associated with such use.
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Affiliation(s)
- Charles I Berul
- Department of Cardiology, Children's Hospital Boston, MA 02115, USA.
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18
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Staniforth AD, Schilling RJ. Reuse of occluded veins during permanent pacemaker lead extraction: a new indication for femoral lead extraction. Indian Pacing Electrophysiol J 2002; 2:97-103. [PMID: 16951725 PMCID: PMC1557418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the utility of a novel technique for reuse of thrombosed veins when extracting permanent pacemaker leads via a femoral vein approach. BACKGROUND Although lead extraction permanent pacemaker using a femoral approach has advantages over the subclavian approach, it cannot be used to provide access for a new lead using currently employed techniques. This is important because up to 23% of patients have occluded veins after permanent pacemaker implantation. METHODS The pacemaker lead to be extracted was released from the generator and retaining sutures at the implantation site. The lead was then grabbed from below using a needle-eye-snare or basket. The lead was then cut short and a drag through technique performed where a guide wire was pushed into the gap between the insulation and the coil. This guide wire was then drawn into the right atrium as the lead was pulled down from below. This guide wire was then used to introduce a sheath through which a replacement lead could be inserted. RESULTS A total of 34 consecutive patients (21 male, aged 63+/-14 years, mean+/-SD) had 57 (1.7/patient) leads extracted. Fourteen patients required implantation of a new system and were suitable for immediate lead replacement using the drag through technique. All leads were successfully extracted, with 5 partial successes (9.1% of leads). The drag-through technique was successful in all, including 4 with subclavian vein occlusion. Procedure and fluoroscopy times, including the time required for implantation of a new system, were 143+/-65 mins and 31+/-23 mins respectively. There were no complications and hospital stay was 1.6+/-1.2 days for patients undergoing the drag-through procedure. CONCLUSION The drag-through technique can be successfully used to provide access in order to replace pacemaker leads removed using a femoral approach.
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Udink ten Cate F, Breur J, Boramanand N, Crosson J, Friedman A, Brenner J, Meijboom E, Sreeram N. Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group. Heart 2002; 88:392-6. [PMID: 12231599 PMCID: PMC1767358 DOI: 10.1136/heart.88.4.392] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
AIM To compare the performance of steroid eluting epicardial and endocardial leads in infants and children requiring permanent pacing. METHODS Evaluation of pacing and sensing characteristics, impedances, and longevity of 159 steroid eluting leads implanted in 95 children. Group A consisted of 24 children weighing less than 15 kg with 15 endocardial leads (five atrial, 10 ventricular) and 19 epicardial leads (five atrial, 14 ventricular). Group B consisted of 71 children weighing more than 15 kg with 106 endocardial leads (56 atrial, 58 ventricular) and 19 epicardial leads (nine atrial, 10 ventricular). RESULTS Group A: Stimulation thresholds were lower for ventricular endocardial leads at implant (mean (SD) 0.84 (0.54) v 1.59 (0.64) V, p < 0.014) and at two year follow up (ventricular 0.64 (0.24) v 1.65 (0.69) V, p < 0.003). Impedance and sensing thresholds did not differ significantly at implant and follow up. Group B: Stimulation thresholds were lower for ventricular endocardial leads at implant (0.72 (0.48) v 1.48 (0.58) V, p < 0.001) and at follow up (0.88 (0.46) v 1.55 (0.96) V, p < 0.009). Impedance did not differ. Sensing thresholds were also better for ventricular endocardial leads at follow up (9.1 (5.2) v 14.2 (6.4) mV, p < 0.02). Complications requiring intervention occurred in both groups (n = 7 for endocardial v n = 18 for epicardial leads). CONCLUSIONS Endocardial and epicardial steroid eluting leads have comparable performance in the paediatric population.
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Gupta AK. Lead extraction: "drag through" technique. Indian Pacing Electrophysiol J 2002; 2:95-6. [PMID: 16951724 PMCID: PMC1557417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schilling RJ. Replacement of extracted permanent pacemaker or defibrillator leads by cannulation of veins using the femoral "drag through" technique. Heart 2002; 87:276-8. [PMID: 11847172 PMCID: PMC1767014 DOI: 10.1136/heart.87.3.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bracke FA, Meijer A, van Gelder LM. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001; 85:254-9. [PMID: 11179258 PMCID: PMC1729652 DOI: 10.1136/heart.85.3.254] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- F A Bracke
- Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, Netherlands.
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