Coronary Venous Lead Extraction

Transvenous extraction of quadripolar coronary sinus pacing leads

BACKGROUND

Quadripolar coronary sinus (CS) leads are commonly employed to achieve left ventricular pacing. There are limited data on extraction of these leads relative to traditional unipolar or bipolar CS pacing leads.

OBJECTIVE

The purpose of this study was to examine the safety and efficacy of quadripolar CS lead extraction and CS lead reimplantation and to compare outcomes with extraction of non-quadripolar CS leads.

METHODS

Patients who underwent extraction of CS leads between 2013 and 2024 were included. Outcomes of interest were rates of complete CS lead removal, complete procedural success, major adverse events, and successful reimplantation in the CS.

RESULTS

A total of 182 patients were included (102 quadripolar leads and 80 non-quadripolar leads). The mean age of the patients was 68.0 ± 11.6 years, and 22% were female. The mean CS lead age was significantly lower in the quadripolar group (3.0 ± 2.7 years vs 8.2 ± 4.3 years; P < .001). The complete procedural success rate was significantly higher in the quadripolar group (99% vs 90%; P = .01); there was no difference between groups after accounting for lead age. There was no significant difference in complete CS lead removal rates between groups (99% vs 95%; P = .17). Two major adverse events occurred in the non-quadripolar group and were directly related to lead extraction. In the quadripolar group, manual traction alone was successful in 59%, laser sheaths were used in 39%, and rotational cutting tools were used in 9%. In the non-quadripolar group, manual traction alone was successful in 19%, laser sheaths were used in 79%, and rotational cutting tools were used in 26%. There was no significant difference in reimplantation success rates between groups (82% vs 90%; P = .30).

CONCLUSION

Quadripolar CS lead extraction had a high success rate and low rate of major adverse events. Reimplantation in the CS was possible with a good success rate but was often limited by CS branch stenosis or occlusion.

Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients

AIMS

While numerous studies have demonstrated favourable safety and efficacy of the excimer laser sheath for transvenous lead extraction (TLE) in smaller cohorts, comprehensive large-scale investigations with contemporary data remain scarce. This study aims to evaluate the safety and performance of laser-assisted TLE through a meta-analysis of contemporary data.

METHODS AND RESULTS

A systematic literature search was conducted to identify articles that assessed the safety and performance of the spectranetics laser sheath (SLS) II and GlideLight Excimer laser sheaths in TLE procedures between 1 April 2016 and 31 March 2021. Safety outcomes included procedure-related death and major/minor complications. Performance outcomes included procedural and clinical success rates. A random-effects, inverse-variance-weighting meta-analysis was performed to obtain the weighted average of the evaluated outcomes. In total, 17 articles were identified and evaluated, including 1729 patients with 2887 leads. Each patient, on average, had 2.3 ± 0.3 leads with a dwell time of 7.9 ± 3.0 years. The TLE procedural successes rate was 96.8% [1440/1505; 95% CI: (94.9-98.2%)] per patient and 96.3% [1447/1501; 95% CI: (94.8-97.4%)] per lead, and the clinical success rate per patient was 98.3% [989/1010, 95% CI: (97.4-99.0%)]. The procedure-related death rate was 0.08% [7/1729, 95% CI: (0.00%, 0.34%)], with major and minor complication rates of 1.9% [41/1729; 95% CI: (1.2-2.8%)] and 1.9% [58/1729; 95% CI: (0.8-3.6%)], respectively.

CONCLUSION

This meta-analysis demonstrated that excimer laser sheath-assisted TLE has high success and low procedural mortality rates. It provides clinicians with a reliable and valuable resource for extracting indwelling cardiac leads which require advanced extraction techniques.

Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: A case series

Background

Transvenous lead extraction is the standard therapy for cardiac device‐related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary.

Methods and Results

We present three cases who underwent transvenous lead extraction for an infected CRT‐D system. In all cases the CS lead could not be retrieved transvenously due to extensive fibrosis. The lead was successfully extracted through left minithoracotomy in two patients and midline sternotomy in one patient.

Conclusion

In cases where the coronary sinus lead shows severe fibrosis, a transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically through a limited thoracic incision.