Lead Extraction of Cardiac Rhythm Devices: A Report of a Single-Center Experience

Abstract

Introduction and objectivesThe rate of implanted cardiac electronic devices is increasing as is the need to manage long-term complications. Lead removal is becoming an effective approach to treat such complications. We present our experience in lead removal using different approaches, analyzing the predictors of the use of mechanical extractors/surgical removal.MethodsRetrospective analysis of lead extractions in a series of 76 consecutive patients (mean age 70.4 ± 13.8 years, 73.7% men) between January 2009 and November 2015.ResultsOne hundred thirty-five leads from permanent pacemakers (single chamber 19.7%; dual-chamber 61.8%), implantable cardioverter defibrillators (5.3%), and cardiac resynchronization devices (CRT-P 2.6%; CRT-D 7.9%) were removed, 72.5 ± 73.2 months after implantation. A total of 45.9% were ventricular leads, 40.0% atrial leads, 8.9% defibrillator leads, and 5.2% leads in the coronary sinus; 64.4% had passive fixation. The most common indications for removal were pocket infection (77.8%), infective endocarditis (9.6%), and lead dislodgement (3.7%). A total of 76.3% of the leads were explanted, 20.0% were extracted, and 3.7% were surgically removed. Extraction of the entire lead was achieved in 96.3% of the procedures. After logistic regression (age adjusted), time since implantation was the sole predictor of the need of mechanical extractors/surgical removal. All patients were discharged without major complications. There were no deaths at 30 days.ConclusionOur experience in lead removal was effective and safe. Performing these procedures by experienced electrophysiologists with an adequate cardiothoracic surgery team on standby to cope with any complications is required. Referral of high-risk patients to a high-volume center is recommended to optimize clinical success and minimize procedural complications.

Transvenous Lead Extraction in a European Low-Volume Center without On-Site Surgical Support

“…The technique we used was first described by Bongiorni MG et al, reporting high success rates and safety using simple extraction tools [50]. The most common indication for TLE in our study was device-related infection (74%), like reports regarding TLE and device infections in the EU and US [51,52]. We started using this approach in 2018 and have become a referral center for TLE.…”

Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques

“…On the one hand, device explantation 3 has increased globally as the prevalence of patients using pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization devices has increased. 1,2 who are at risk of device complications [5][6][7][8] requiring removal while on the other hand box change 4,9 and reuse of all properly functioning intravascular leads is a common practice in cardiology. 27 The difficulty in lead extraction is proportional to the indwelling time of the leads because of increasing fibrosis around areas of contact between the lead and surrounding vasculature and myocardium.…”

“…When we try to explants the whole hardwires then the recovery of the device is not that difficult but to explants the lead: is cumbersome most of the time. 8 It need to be made free from the surrounding tissue where the granulation tissue hold it badly and at the same time one need to take care of the vascular bundle so not to damage them unduly. 9 The lead handling also needs proper care because if the lead gets damage before explantation then the procedure of explantation become very difficult because the stylit could not be put in the lead and then it needs to be helped…”

Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies

“…The most common indication for lead extraction is device-related infection. In one study describing the transvenous removal of 135 leads, 77.8% of extracted leads were for pocket infection, followed by 9.8% for infective endocarditis [50]. Transvenous lead extraction is now a well-defined procedure frequently used for devices and lead extraction for various indications.…”

“…Cases of IE after cardiac surgery or interventional procedures in children are sporadic. It was observed that IE incidence has increased with the implantation of pacemakers, replacement of intracardiac prosthetic valves, and improved endovascular treatment of patients with IE associated with CHD in recent years [50]. In addition to being susceptible to bacterial colonization, prosthetic materials are also difficult to sterilize [50].…”