Multicenter Experience With Extraction of the Sprint Fidelis Implantable Cardioverter-Defibrillator Lead

Maytin, Melanie; Love, Charles J.; Fischer, Avi; Carrillo, Roger G.; Garisto, Juan; Bongiorni, Maria Grazia; Segreti, Luca; John, Roy M.; Michaud, Gregory F.; Chen, Albert; Epstein, Laurence M.

doi:10.1016/j.jacc.2010.03.058

Cited by 88 publications

(44 citation statements)

References 25 publications

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“…Predictors of TLE difficulty have been evaluated in several prior single and multicenter studies. 5,[16][17][18] Many variables previously identified as predictors of TLE difficulty were confirmed in this study, including implant duration 3,5,[16][17][18] and the number of leads extracted. 13 In contrast to prior studies, both local and systemic infection were associated with more severe pocket scar and increased TLE difficulty.…”

Section: Discussionsupporting

confidence: 77%

Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty

Maytin¹

2015

JICRM

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ABSTRACT. The challenges and risks of transvenous lead extraction (TLE) of cardiovascular implantable electronic devices (CIEDs) are principally related to the body's foreign body response to endovascular leads. Despite this understanding, predictors of severe endovascular scar formation have not been clearly identified. The aim was to evaluate if the severity of the pocket scar may help predict endovascular scar and TLE difficulty. We performed a prospective analysis of consecutive patients undergoing TLE. Patient and procedural characteristics, classification of pocket scar severity, operator assessment of TLE difficulty, extraction time, and number of extraction sheaths (ESs) used are reported. Logistic and linear regression analyses were utilized to test the adjusted association between pocket scar and the combined endpoint and subjective difficulty assessed by the operator, respectively. Between November 2010 and February 2012, 144 patients underwent TLE with assessment of pocket scar. The cohort was 63% male with mean age 62 ± 16 years. Average implant duration was 84 ± 53 months. Indications for TLE included infection 35%, malfunction 30%, upgrade 8%, and other 27%. Each incremental increase in pocket scar severity was associated with a twofold increase in TLE difficulty (OR 2.03; 95% CI 1.005-4.110). TLE difficulty endpoint correlated significantly with the operator's assessment of procedural difficulty (r ¼ 0.74, po0.001). Operator scoring of TLE difficulty (1-10) was highly correlated with severity of CIED pocket scar (p ¼ 0.001). The severity of the scar in the device pocket correlates with multiple ES use and long extraction times and operator quantification of extraction difficulty. CIED pocket scar may help predict TLE difficulty.

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Section: Discussionsupporting

confidence: 77%

Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty

Maytin¹

2015

JICRM

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“…In our multicenter experience of Fidelis lead extraction we removed 557 leads with 100% complete success, no intraprocedural deaths or major complications, and a minor complication rate of 0.34%. 3 We believe that our data support the contention that Fidelis extraction can be a safe procedure in experienced hands.…”

Section: To the Editorsupporting

confidence: 79%

Letter by Maytin and Epstein et al Regarding Article, “Complications Associated With Revision of Sprint Fidelis Leads: Report From the Canadian Heart Rhythm Society Device Advisory Committee”

Maytin

Epstein

2011

Circulation

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“…If traction was attempted, but the lead was abandoned, the patient was classified as lead abandoned. The data reported by Maytin et al 4 have significant potential referral bias, as patients with a higher degree of comorbid illness may not have been referred. In addition, the long-term complications of this complex procedure, where a greater degree of infection may be expected and which may lead to a significant degree of morbidity or mortality, were not reported.…”

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confidence: 95%