Laser Lead Extraction in Congenital Heart Disease: A Case‐Controlled Study

Abstract

Patients with CHD are less likely to have successful LLE than gender- and age-matched controls without CHD. LLE failures in CHD may be related to calcified adhesions. Mechanical-rotational devices and the femoral snare technique are useful for LLE failures. LLE provides an effective first-line approach for patients with CHD.

The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease

“…Several modern ICD leads are constructed to prevent fibrosis on the coils, including medical‐adhesive backfill or coating the lead with polytetrafluoroethylene, so perhaps this finding is not unexpected. And, although the foreign materials and unusual postoperative anatomy of repaired CHD pose technical challenges for lead extraction, this study is in line with several studies that show no difference in overall procedural success in CHD, provided that multiple extraction modalities can be utilized …”

“…The management of nontargeted leads has not been focused upon in the lead extraction literature. Several studies report only the leads that were actually extracted regardless if the leads were initially targeted . However, the presence of nontargeted leads may increase the complexity of lead extraction procedures through unplanned interventions on the nontargeted leads, which increase procedure time, radiation exposure for both the patient and staff, potential for infection with an open pocket, and even the possibility of vascular injury if the nontargeted lead requires extraction.…”

“…The extraction of endocardial pacing and ICD leads is among the highest risk procedures performed by electrophysiologists, even though major complications and mortality reported in modern studies remain low, ranging from 0.4% to 1.96% . Although lead extractions in pediatric patients and CHD patients can be challenging due to small patient size, complex pre‐ and postsurgical anatomy, and the frequent requirement of unusual lead positioning, series of pediatric and CHD patients have reported relatively low complication rates similar to adult studies, without significant decrease in success despite limited volume and experience …”

Efficient approach to superior vena cava baffle stenosis following the Mustard procedure: Expanding the role of a mechanical rotating dilator sheath for lead extraction

“…Complete transvenous lead extraction in CHD patients has been successful in up to 92% of patients in prior studies, with failures attributed to calcified adhesions or active fixation. 3,6,9,10 In our case, we recognized the risks associated with completely removing the nonfunctional LA lead. Therefore, extraction was halted.…”

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

“…18 The most common indications for transvenous lead extraction in children remain lead failure (76%) and venous occlusion. [237][238][239][240][241][242][243] Pediatric patients are more likely to outlive the functionality of their leads, amplifying the importance of lead durability, longevity of venous access, and long-term risks of lead dysfunction. Coupled with studies in children indicating that older lead age is an independent predictor of need for advanced extraction techniques and added complexity, greater emphasis should be given to the potential risks of lead abandonment in this population.…”