Re-evaluation of transvenous lead extraction with modified standard technique: A prospective study in 229 patients

Abstract

As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients (median, 66 years) who underwent lead extraction due to infection and lead malfunction were registered and followed up prospectively with respect to clinical features, reasons for lead extraction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted transvenously by using special tools from 229 patients (male, 72.1%). Vegetations ≥1 cm were detected in six patients. Locking Stylets were applied for 398 (90.5%) leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 (45.9%) leads due to lead adhesion, and the mean implant duration of the 202 leads was longer than the other 238 leads (48.9±22.6 vs. 26.6±17.8 months; P <0.01). In addition, modified isolation and snare techniques were used for 56 leads (12.7%). Minor and major procedure-related complications occurred in three (1.3%) and four (1.7%) cases respectively, including one death (0.4%). Severe lead residue occurred in one case. Complete procedural success rate was 96.1% (423/440), and clinical success rate was 98.9% (435/440). The median follow-up period was 18 (1–76) months. No infection- and procedure-related death occurred in our series. Our data demonstrated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.

Keywords

lead / extraction / cardiac implantable electrical device / infection / complication

References

[1] FarooqiFM, TalsaniaS, HamidS, et al.. Extraction of cardiac rhythm devices: indications, techniques and outcomes for the removal of pacemaker and defibrillator leads. Int J Clin Pract, 2010, 64(8): 1140-1147

[2] NeuzilP, TaborskyM, RezekZ, et al.. Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. Europace, 2007, 9(2): 98-104

[3] DiembergerI, BiffiM, MartignaniC, et al.. Excimer laser lead extraction by femoral vein approach. Europace, 2011, 13(5): 757-759

[4] LoveCJ, WilkoffBL, ByrdCL, et al.. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. Pacing Clin Electrophysiol, 2000, 23(4Pt1): 544-551

[5] WilkoffBL, LoveCJ, ByrdCL, et al.. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm, 2009, 6(7): 1085-1104

[6] HabibG, HoenB, TornosP, et al.. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J, 2009, 30(19): 2369-2413

[7] GrammesJA, SchulzeCM, Al-BatainehM, et al.. Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram. J Am Coll Cardiol, 2010, 55(9): 886-894

[8] BaddourLM, EpsteinAE, EricksonCC, et al.. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation, 2010, 121(3): 458-477

[9] BaddourLM, BettmannMA, BolgerAF, et al.. AHA scientific statement: nonvalvular cardiovascular device-related infections. Circulation, 2003, 108(16): 2015-2031

[10] BeckerAE, BeckerMJ, ClaudonDG, et al.. Surface thrombosis and fibrous encapsulation of intravenous pacemaker catheter electrode. Circulation, 1972, 46(2): 409-412

[11] SpittellPC, HayesDL. Venous complications after insertion of a transvenous pacemaker. Mayo Clin Proc, 1992, 67(3): 258-265

[12] DeharoJC, BongiorniMG, RozkovecA, et al.. Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper. Europace, 2012, 14(1): 124-134

[13] RickardJ, WilkoffBL. Extraction of implantable cardiac electronic devices. Curr Cardiol Rep, 2011, 13(5): 407-414

[14] WilkoffBL, ByrdCL, LoveCJ, et al.. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol, 1999, 33(6): 1671-1676

[15] ByrdCL, WilkoffBL, LoveCJ, et al.. Clinical study of the laser sheath for lead extraction: The total experience in the United States. Pacing Clin Electrophysiol, 2002, 25(5): 804-808

[16] WazniO, EpsteinLM, CarrilloRG, et al.. Lead extraction in the contemporary setting: the lexicon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol, 2010, 55(6): 579-586

[17] MazzoneP, TsiachrisD, MarziA, et al.. Advanced techniques for chronic lead extraction: heading from the laser towards the evolution system. Europace, 2013

[18] MondHG. The world survey of cardiac pacing and cardioverter defibrillators: Calendar year 1997—asian pacific, middle east, south america, and canada. Pacing Clin Electrophysiol, 2001, 24(5): 856-862

[19] MondHG, ProclemerA. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: Calendar year 2009-a world society of arrhythmia’s prooject. Pacing Clin Electrophysiol, 2011, 34(8): 1013-1027

[20] MaJ, TANGK, WangFZ, et al.. Experience with intravascular lead extraction. Chin Med J, 2005, 118(14): 1217-1219

[21] ByrdCL, SchwartzSJ, HedinNB, et al.. Intravascular lead extraction using locking styles and sheaths. PACE, 1990, 13(12Pt2): 1871-1875

[22] SmithHJ, FearnotNE, ByrdCL, et al.. Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. PACE, 1994, 17(11Pt2): 2016-2020

[23] ByrdCL, WiIkoffBL, LoveCJ, et al.. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994–1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol, 1999, 22(9): 1348-1357