Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Stefańczyk, Paweł; Nowosielecka, Dorota; Tułecki, Łukasz; Tomków, Konrad; Polewczyk, Anna; Jacheć, Wojciech; Kleinrok, Andrzej; Borzęcki, Wojciech; Kutarski, Andrzej

doi:10.2147/vhrm.s318205

Cited by 12 publications

(29 citation statements)

References 46 publications

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“…Procedural and acute post-procedural mortality were also favourable (0.1% each). These outcomes are in line with previous studies, which showed a complete removal rate of 94–96% with a procedural major complication rate of 1.0–7.8% [ 15 , 17 , 18 , 19 , 20 , 21 , 22 ]. The results of our analysis showed lower complication rates than the multicentric ELECTRa study (with a major complication rate of 1.7% and death rate of 0.5%) [ 9 ], which may be explained by the high experience and strict standard operating procedure of our high-volume centre.…”

Section: Discussionsupporting

confidence: 92%

“…An indication for ICD implantation according to current guidelines [ 12 ] and the evaluation of alternatives to transvenous defibrillation systems [ 13 ] is, therefore, crucial, also after TLE [ 14 ]. In recent publications of high-volume centres [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], baseline characteristics were similar, but the proportion of TLE patients with ICD was lower than in this analysis (58.5%) with a range from 24 [ 15 ] to 48% [ 19 ]. Infection represented the main indication in most studies [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 48%

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Step by Step through the Years—High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques

Zweiker

Sawaf

D’Angelo

et al. 2022

JCM

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Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the stepwise approach. Baseline characteristics, procedural details and outcome of patients with high energy lead (ICD group) vs. without high energy lead (non-ICD group) were compared. Results: Out of 667 extractions, 991 leads were extracted in 405 procedures (60.7%) in the ICD group and 439 leads in 262 procedures (39.3%) in the non-ICD group. ICD patients were significantly younger (median 67 vs. 74 years) and were significantly less often female (18.1% vs. 27.7%, p < 0.005 for both). Advanced extraction tools were used significantly more often in the ICD group (73.2% vs. 37.5%, p < 0.001), but there were no significant differences in the successful removal (98.8% vs. 99.2%) or complications (4.7% vs. 3.1%) between the groups (p > 0.2 for both). Discussion: Using the stepwise approach, overall procedural success was high and complication rate was low in a high-volume centre. In patients with a high energy lead, the TLE procedure was more complex, but outcome was similar to comparator patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 48%

Step by Step through the Years—High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques

Zweiker

Sawaf

D’Angelo

et al. 2022

JCM

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“…A combined approach, using two or more different (jugular, subclavian, femoral) access sites, was selected when conventional methods could not be effective (proximal lead ending in cardiovascular space or in case of break of extracted lead). Laser and electrosurgical dissection sheaths were not used [ 10 , 21 , 24 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…Considering well-populated reports on TLE outcomes in over 1000 patients, an increasing average lead dwell time can be noticed: from 63 months in 1999–2014 to 82 months in 2018–2021 [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Despite the increase in lead dwell time, the incidence of procedure-related deaths has rather decreased.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the increase in lead dwell time, the incidence of procedure-related deaths has rather decreased. The authors of the abovementioned reports did not analyze in detail the effectiveness and safety of transvenous lead extraction of leads older than 20 and 30 years [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. To the best of our knowledge, there are only two studies assessing the outcomes of lead extraction older than 30 years in 124 and 43 patients [ 29 , 30 ] and in a population of 16 young patients with an average age of removed lead close to 20 years [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Kutarski

Główniak

Kosior

et al. 2022

IJERPH

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Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.

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A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools

et al. 2022

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Aims During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools. Methods and results Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 ± 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 ± 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01–0.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery. Conclusion The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.

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Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

Cited by 12 publications

References 46 publications

Step by Step through the Years—High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques

Step by Step through the Years—High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools

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