Effectiveness, safety, and long-term outcomes of non-powered mechanical sheaths for transvenous lead extraction

Kutarski, Andrzej; Czajkowski, Marek; Pietura, Radosław; Obszański, Bogdan; Polewczyk, Anna; Jacheć, Wojciech; Młynarczyk, Krzysztof; Grabowski, Marcin; Opolski, Grzegorz

doi:10.1093/europace/eux218

Cited by 38 publications

(81 citation statements)

References 24 publications

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“…Furthermore, the authors reported that cardiac tamponade was the most common procedural complication. In multivariate analysis, the total age of the extracted leads was an important factor increasing tamponade risk by about 17% for every 5‐year lead dwell time interval . Kutarski et al reported 95% of complete procedural success and 1.8% of major complications, which is similar to our results.…”

Section: Discussionsupporting

confidence: 90%

“…Kutarski et al in a multivariate analysis identified the total age of extracted leads as a risk factor for major TLE complications. Such a risk increased by about 20% for every 5‐year lead dwell time interval . Furthermore, the authors reported that cardiac tamponade was the most common procedural complication.…”

Section: Discussionmentioning

confidence: 99%

“…Our observations may slightly differ from the data gathered in other registries. However, to our knowledge, there are no published reports of TLE in patients with a lead dwell time of greater than 20 years . The estimation of the risk of complications during TLE of old leads was based on data from large registries that included much younger leads.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, a group of Polish authors showed in multivariate analysis that the total age of the removed leads was a risk factor for major complications during and after TLE. The risk increased every 5 years by approximately 20% . Based on the assumption from the above‐mentioned study, one could predict that the removal of leads older than 20 years was associated with a nearly 59% relative risk of major complications, rendering such procedures ethically questionable.…”

Section: Introductionmentioning

confidence: 99%

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Transvenous extraction of very old (over 20‐year‐old) pacemaker leads using mechanical systems: Effectiveness and safety

Ząbek

Boczar

Dębski

et al. 2019

Pacing Clinical Electrophis

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Objective:To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) with mechanical systems of pacing leads older than 20 years (group A) versus younger leads (group B). Methods:We performed TLE of 591 pacing leads in 377 patients. Fifty (8.5%) leads in 43 (11.4%) patients were implanted for equal to or more than 20 years. The mean dwell time of all extracted leads was 8.9 years (range, 0.1-36.0). Infection related to cardiovascular implantable electronic device was an indication for TLE in 18.3% of patients. Results:Complete lead removal and complete procedural success rates were similar between both groups (94.7% in group A vs 97.1% in group B, P = 0.445, and 90.7% in group A vs 95.8% in group B, P = 0.329, respectively). Incomplete lead removal in group A was observed only in leads older than 20 years. Removal of leads in group A was associated with significantly longer fluoroscopy time compared with group B (4.6 vs 1.9 minutes, P < 0.001). We did not find a significant difference in major and minor complication rates between groups (2.3% in group A vs 0.9% in group B and 2.3% in group A vs 2.2% in group B, P = 0.687, respectively). There were no deaths associated with the TLE procedure within 30 days after the procedure in either group. Conclusion:This study shows that TLE of leads older than 20 years conducted at an experienced center seems to be comparably safe and effective as extraction of younger leads but requires longer fluoroscopy time. K E Y W O R D Scardiovascular implantable electronic devices, effectiveness, safety, transvenous lead extraction

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Transvenous extraction of very old (over 20‐year‐old) pacemaker leads using mechanical systems: Effectiveness and safety

Ząbek

Boczar

Dębski

et al. 2019

Pacing Clinical Electrophis

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“…The tendency toward a high frequency of noninfectious indications for TLE in some centers from Poland has previously been noted . In a recent paper, based on data from 2,049 patients, noninfective indications for TLE were observed in 60.2% of patients, which was higher than the incidence reported in previous studies from Europe and the United States (47.3% of the patients in the ELECTRa study and 57.3% of the patients in the data published by the Cleveland Clinic) . We have confirmed that the venous access technique has a strong influence on the electrical function of the leads in the long term.…”

Section: Discussionmentioning

confidence: 98%

Analysis of electrical lead failures in patients referred for transvenous lead extraction procedures

Ząbek

Boczar

Dębski

et al. 2018

Pacing Clinical Electrophis

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The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures

Nowosielecka

Jacheć

Polewczyk

et al. 2021

Clinical Cardiology

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Background Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE). Hypothesis Echocardiographic phenomena may determine the difficulty and safety of the procedure. Methods Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. Results TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead‐to‐lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%) and lead‐dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate analysis were: fibrous tissue binding the lead to atrial wall (OR = 1.738; p < 0.05), to right ventricular wall (OR = 2.167; p < 0.001), lead‐to‐lead binding sites (OR = 1.628; p < 0.01) and excess lead loops (OR = 1.488; p < 0.05). Lead‐to‐lead binding sites increased probability of major complications (OR = 3.034; p < 0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR = 0.296; p < 0.05), right atrial wall (OR = 323; p < 0.05) and right ventricular wall (OR = 0.297; p < 0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR = 0.307; p < 0.05). Conclusions Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.

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Effectiveness, safety, and long-term outcomes of non-powered mechanical sheaths for transvenous lead extraction

Abstract: Using conventional non-powered mechanical sheaths, TLE was effective even in patients at high risk of complications.

Cited by 38 publications

References 24 publications

Transvenous extraction of very old (over 20‐year‐old) pacemaker leads using mechanical systems: Effectiveness and safety

Transvenous extraction of very old (over 20‐year‐old) pacemaker leads using mechanical systems: Effectiveness and safety

Analysis of electrical lead failures in patients referred for transvenous lead extraction procedures

The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures

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