Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads

Two‐year extractability of novel left ventricular, active fixation leads in the sheep model

“…The passive fixation, market‐released lead (Model 4193, Medtronic) was chosen as the control LV lead, as it has been widely used in the human population. The extraction experience with the passive fixation LV lead has been reported previously . All LV lead models in this study (Figure ) have a silicone seal at the distal tip to reduce blood ingress.…”

“…The chosen study design, including species, sample size, and implant duration were directly modeled after Wilkoff The extraction experience with the passive fixation LV lead has been reported previously. 14,15 All LV lead models in this study ( Figure 1) have a silicone seal at the distal tip to reduce blood ingress. Figure 1) was concurrently implanted in the RV of all sheep to simulate lead-to-lead interactions and to permit comparison of RV and LV lead extraction data.…”

Coronary Venous Lead Extraction

“…33 This has led to failure of retraction of the lobes, even shortly after implantation. 35 In the investigational device exemption (IDE) trial, which led to approval in the United States, extraction (as defined by the Heart Rhythm Society's Consensus Statement 4 ) Overlapping reports have been omitted, and the largest or most completely reported series from each center is included. The complications reported are due to CS lead extraction, as far as it was possible to discern.…”

“…Despite the Attain Starfixt (Medtronic, Minneapolis, MN, USA) likely having a shorter implant duration (not reported, but leads in place less than six months were included), success was less (93% vs. 98.8%), major complications were twice as common, and one death occurred. 35 Several case series and reports have also described significant challenges due to fibrous ingrowth around the active fixation lobes ( Figures 1A and 1B), 33,36,37 with near-universal requirements for powered sheaths to be used for successful extraction, and a frequent necessity to advance the extraction sheath into the CS, which is much less common in cases of passive fixation leads. A small single-center comparison also found a lower success rate compared with passive fixation leads (50% vs. 100%), despite significantly shorter implant duration.…”

“…The mechanical or laser mechanisms of power sheaths should only be activated within the CS with extreme caution due to the risk of perforation and subsequent tamponade. 29,35 A further complication of Attain Starfixt (Medtronic, Minneapolis, MN, USA) lead extraction is the effect it has on reimplantation options. In our series of four leads, in which reimplantation was attempted in each case, the original implant vein was occluded in three and the main CS in the fourth case (Figure 2), and reimplantation was successful in only two (50%) cases.…”