A single-centre experience of over one thousand lead extractions

Kennergren, Charles; Bjurman, Christian; Wiklund, R.; Gäbel, Jakob

doi:10.1093/europace/eup054

Cited by 192 publications

(184 citation statements)

References 17 publications

(20 reference statements)

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“…Schaut man sich die Literatur der letzten 20 Jahre an, so liegen die angegebenen Erfolgsraten bei 85% bis 100%. Wirft man einen Blick nur auf die letzten beiden Jahre, so werden in 95% bis 100% der Fälle erfolgreiche Sondenextraktionen berichtet [1,[10][11][12][13][14].…”

Section: A B Wie Hoch Ist Die Erfolgsrate?unclassified

“…Ein Mittelwert aus mehreren Studien erbringt eine Mortalität von 0,4%. Der prozentuale Anteil an schwerwiegenden Komplikationen wird in der Literatur mit 0,3-7%, im Mittel mit 1,8% angegeben [1,9,[10][11][12][13][14].…”

Section: Wie Hoch Ist Das Risiko?unclassified

“…Das Risiko hierfür liegt bei 0,35-3,7% [14,15]. Sollte eine solche Verletzung auftreten führt in der Regel kein Weg an der Thorakotomie vorbei.…”

Section: Was Sind Die Gefahren Bei Einer Sondenextraktion?unclassified

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Sondenextraktionen eine anspruchsvolle Aufgabe

2011

Cardiovasc Med

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Lead extraction, a demanding task: Every year approximately 1 0 000-15 000 pacemakerand ICD-leads are extracted worldwide with numbers continuing to rise. The increasing need for lead extractions may be explained by the evolution of pacemakerand ICD-implants during the last decade as well as by the widened spectrum of extraction devices and techniques. Last but not least, in 2009 the indications for transvenous lead extractions were broadened by the Heart Rhythm Society. Lead extraction are not simple operations at all, but instead can be very challenging with a recognisable risk profile. When carried out by specialised centres lead extractions may be performed with high success rates (>95%), and low complication rates (<2%) and mortality (<0.5%).

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Section: A B Wie Hoch Ist Die Erfolgsrate?unclassified

Section: Wie Hoch Ist Das Risiko?unclassified

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Sondenextraktionen eine anspruchsvolle Aufgabe

2011

Cardiovasc Med

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“…Reported major complication and mortality rates with TLE vary widely across studies, ranging from 0.4% to 7.3%. [3][4][5][6][7][8] The difficulty and risk of TLE of CIED is predominantly related to the body's foreign body response to the endovascular leads. The response begins immediately after implantation with thrombus development along the lead(s).…”

Section: Introductionmentioning

confidence: 99%

Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty

Maytin¹

2015

JICRM

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ABSTRACT. The challenges and risks of transvenous lead extraction (TLE) of cardiovascular implantable electronic devices (CIEDs) are principally related to the body's foreign body response to endovascular leads. Despite this understanding, predictors of severe endovascular scar formation have not been clearly identified. The aim was to evaluate if the severity of the pocket scar may help predict endovascular scar and TLE difficulty. We performed a prospective analysis of consecutive patients undergoing TLE. Patient and procedural characteristics, classification of pocket scar severity, operator assessment of TLE difficulty, extraction time, and number of extraction sheaths (ESs) used are reported. Logistic and linear regression analyses were utilized to test the adjusted association between pocket scar and the combined endpoint and subjective difficulty assessed by the operator, respectively. Between November 2010 and February 2012, 144 patients underwent TLE with assessment of pocket scar. The cohort was 63% male with mean age 62 ± 16 years. Average implant duration was 84 ± 53 months. Indications for TLE included infection 35%, malfunction 30%, upgrade 8%, and other 27%. Each incremental increase in pocket scar severity was associated with a twofold increase in TLE difficulty (OR 2.03; 95% CI 1.005-4.110). TLE difficulty endpoint correlated significantly with the operator's assessment of procedural difficulty (r ¼ 0.74, po0.001). Operator scoring of TLE difficulty (1-10) was highly correlated with severity of CIED pocket scar (p ¼ 0.001). The severity of the scar in the device pocket correlates with multiple ES use and long extraction times and operator quantification of extraction difficulty. CIED pocket scar may help predict TLE difficulty.

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“…Despite the high success rate and safety of TLE procedures [2,3], is well known how these could cause lifethreatening consequences.…”

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confidence: 99%

Mechanical Dilator Sheath Markedly Damaged by Fibrosis

2017

JCCR

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Transvenous lead extraction (TLE) procedures, despite the high success rate could esistate in life-threatening consequences. The operator experience is crucial for the procedural outcome and every procedure can hide unexpected difficulties as the one encountered in the case presented. During a double coil lead defibrillator extraction, with an apparently preserved maneuverability of the mechanical dilator, a further control of the sheath revealed its complete fracture with the risk of losing part of it inside the vein.Keywords: Transvenous lead extraction; Mechanical dialtor sheath; Fibrosis IntroductionThe need of transvenous lead extraction (TLE) procedures are steadily increasing nowadays with an estimated 10 000-15 000 pacemaker and implantable cardioverter-defibrillator (ICD) leads extracted annually worldwide. This increased number of TLE procedures is surely related to the extensive use of polypropylene dilator sheath was then used and the procedure was successful accomplished. DiscussionThe case presented suggests that during TLE procedures performed with mechanical dilator sheath in place of strong fibrosis, a continuous dilator check integrity, is desiderable even if a rotational maneuverability seems preserved to avoid dilator rupture. Mechanical dilator sheath integrity has to be checked frequently during extraction procedures. Fluoroscopic control cannot exclude sheath ruptures. In case of hard fibrosis alternative extraction methods have to be considered. Conflicts of Interest & DisclosureAntonio Curnis is a consultant of Boston Scientific, Medtronic, Biotronik, Abbott, LivaNova, Spectranetics. Luca Bontempi is a consultant of Boston Scientific, Medtronic, Biotronik, Abbott, LivaNova.

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A single-centre experience of over one thousand lead extractions

Cited by 192 publications

References 17 publications

Sondenextraktionen eine anspruchsvolle Aufgabe

Sondenextraktionen eine anspruchsvolle Aufgabe

Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty

Mechanical Dilator Sheath Markedly Damaged by Fibrosis

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