Effectiveness and safety of transvenous extraction of single- versus dual-coil implantable cardioverter-defibrillator leads at single-center experience

Abstract

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead. This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.

Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

“…As reported in the literature, removing ICD leads, particularly the dual -coil ones, increases fluoroscopy time and requires more advanced equipment. 13 The fluoroscopy time only during the PPM lead extraction was similar in both groups. As shown in our previous study, the older age of leads is also a major predictor of long fluoroscopy during TLE, 17 whereas in the current study, we observed a similar age of extracted leads in both groups.…”

“…In line with these findings, our previous analysis showed that the extraction of dual -coil ICD leads was as safe and effective as the extraction of a single -coil ICD lead, but it required longer fluoroscopy time and frequent use of advanced tools. 13 Importantly, the number of extracted leads at the index procedure was associated with an increased all -cause mortality rate within 30 days after TLE both in univariable and multivariable analyses.…”

“…1-3 transvenous lead extraction The description of TLE was presented elsewhere. 13 Pacemaker--dependent patients who underwent TLE due to infection were bridged to reimplantation with a temporary active fixation lead implanted on the ipsilateral side of the chest and connected to an external permanent pacemaker generator. 14 Furthermore, in patients at a very high risk of sudden cardiac death, we implanted a temporary external ICD as a bridge to the ICD reimplantation.…”

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

“…The observed low rate of TLE due to infection is consistent with our strategy to rigorously treat pacing-related complications. 3,9,12,13 This approach aligns with the current expert consensus statement. 5 However, in other studies, especially those concerning older electrodes, the dominant indication was infectious complications.…”

“…10,14 In our previous study, we demonstrated that extraction of dual-coil ICD leads required more advanced tools and longer fluoroscopy time. 12 Pecha et al showed that extraction of dual-coil ICD leads was associated with longer laser treatment times. 17 Additionally, as proved by The GermAn Laser Lead Extraction RegistrY: GALLERY a lead dwell time ≥10 years was identified as an independent risk factor for procedural failure during laser lead extraction.…”