Outcomes of Sprint Fidelis and Riata lead extraction: Data from 2 high-volume centers

El‐Chami, Mikhael F.; Merchant, Faisal M.; Levy, Mathew; Alam, Mian Bilal; Rattan, Rishi; Hoskins, Michael; Langberg, Jonathan J.; Delurgio, David B.; Lloyd, Michael S.; León, Angel R.; Saba, Samir

doi:10.1016/j.hrthm.2015.02.031

Cited by 28 publications

(17 citation statements)

References 19 publications

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“…This coupled with several high-profile device recalls and an increased rate of device infection have led to a greater need for transvenous lead extraction (TLE). [1][2][3][4][5] The consensus report from 2009 estimated that 10 to 15 000 TLEs occur globally per year, but this number is almost certainly larger now. 6 TLE has the potential for infrequent but serious complications; in their worst form, these complications are characterized by cardiac or vascular perforation.…”

mentioning

confidence: 99%

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Bashir

Fedoruk

Ofiesh

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Injuries to cardiac and venous structures during pacemaker and defibrillator lead extraction are serious complications that have been studied poorly. The incidence of these injuries is unknown but likely underestimated. No systematic multicenter review of these injuries or their management has been undertaken. Methods and Results-We interrogated our mandatory administrative database for all excimer laser extractions that sustained a cardiac or venous injury in the province of British Columbia. Injuries were classified according to presentation and compared with respect to nature of injury, type of repair, utilization of cardiopulmonary bypass, and outcome. Of 1082 excimer laser extractions over 19 years, 33 sustained an injury (3.0%). The majority of injuries occurred in women (21/33; 63.6%), and median age of oldest lead extracted was 10.8 (7.5, 12.2) years. A type 1 presentation, defined as circulatory collapse, was found in 12/33 patients (36.4%). A type 2 presentation, defined as progressive hypotension responsive to treatment, was found in 20/33 patients (60.6%). Over half the patients had a moderate or large injury, and cardiopulmonary bypass was required in 13 patients with extensive injury. Despite the presence of devastating injuries, the immediate availability of aggressive salvage measures resulted in a survival of 87.9% of patients at 30 days. Conclusions-The immediate availability of a cardiovascular surgeon, perfusionist, and cardiopulmonary bypass pump facilitates lifesaving repair of injuries sustained during laser lead extraction. The size and complexity of injury correlates closely with the presentation, blood loss, and need for cardiopulmonary bypass to facilitate repair. (Circ Arrhythm Electrophysiol. 2016;9:e003741.

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confidence: 99%

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Bashir

Fedoruk

Ofiesh

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Functional leads supports this high success rate for both superfluous and infected leads [17][18][19]. Although TLE is generally considered a safe procedure, life-threatening complications may occur.…”

Section: Procedural Outcomes and Complicationsmentioning

confidence: 59%

Cardiovascular implantable electronic device lead extraction

Sadek

Goldstein

Epstein

et al. 2016

Current Opinion in Cardiology

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“…We retrospectively identified a consecutive series of patients undergoing CIED lead extraction for the indication of endovascular infection, including those undergoing VD prior to extraction, between January 2012 and March 2018, at a single institution experienced in CIED extractions . The cohort was divided into two groups: those undergoing adjunctive VD of lead‐associated vegetations prior to extraction, and those who underwent lead extraction without VD (no‐VD).…”

Section: Methodsmentioning

confidence: 99%

Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction

Kiani

Sabayon

Lloyd

et al. 2019

Pacing Clinical Electrophis

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Background: Consensus statements on lead extraction give consideration to open surgicalremoval in the setting of large vegetations, to mitigate the risk of massive embolism that may occur with percutaneous lead removal. Vacuum-assisted debulking (VD) of large vegetations as an adjunct to percutaneous lead extraction may provide an opportunity to mitigate these risks. Methods:We retrospectively identified all patients undergoing lead extraction at our institution for endovascular infection from 2012 to 2018 and stratified them into two groups based on presence of adjunctive VD (n = 6) or without VD (no-VD, n = 39). VD was performed with the AngioVac system (Angio-Dynamics, Latham, NY, USA).Results: Across the cohort, mean age was 62 ± 15 years, ejection fraction was 41 ± 16%, and 39% had end-stage renal disease on dialysis. Defibrillator systems were present in 71%, and 22% had cardiac resynchronization devices. Mean duration of the oldest extracted lead was 6.3 ± 4.9 years. There were no significant differences in baseline covariates between groups. Those in the VD group were significantly less likely to have Staphylococcus aureus as a causative organism (P = .04). In the VD group, vegetations targeted for debulking ranged in size from 1.8 to 6 cm (longest dimension). There were no operative deaths or clinically evident embolic events in either group. The overall nonfatal complication rate in the VD group was higher (33.3% vs 2.3%, P = .043). Conclusion:: VD can be performed as an adjunct to percutaneous lead extraction with a reasonable safety profile. The relative safety and efficacy of this approach removal requires further study. K E Y W O R D S electrophysiology-clinical, instrumentation, new technology

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Outcomes of Sprint Fidelis and Riata lead extraction: Data from 2 high-volume centers

Cited by 28 publications

References 19 publications

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Cardiovascular implantable electronic device lead extraction

Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction

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