Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads—A Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Protocol
2.2. Lead Extraction Technique
2.3. Definitions
2.4. Definition of Success
2.4.1. Complete Operative Success
2.4.2. Clinical Procedural Success
2.4.3. Operative Failure
2.4.4. Complete Lead Extraction
2.4.5. Incomplete Lead Extraction
2.5. Description of Complications
2.5.1. Intraoperative Complications
2.5.2. Early Postoperative Complications
2.5.3. Late Postoperative Complications
2.5.4. Major Complications/Critical Adverse Results
2.5.5. Minor Complications
2.6. Statistical Analysis
3. Results
4. Discussion
Study Limitations
5. Conclusions
Highlights
- (1)
- The number of cardiovascular implantable devices has increased significantly over the last decades and this increase has led to an increase in device-related complications, such as infection and lead dysfunction, requiring device extraction.
- (2)
- We presented our single-center clinic experience with an observational retrospective cohort study of 93 patients for the transvenous extraction of a total of 163 endocardial leads.
- (3)
- Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications.
- (4)
- The simple manual traction method has a high rate of procedural success rate, despite the old age of the lead.
- (5)
- Transvenous lead extraction, when performed by experienced operators, using normal procedures, is a safe and feasible therapy with few operative complications and rarely life-threatening complications.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameters | n = 93 (%) Mean ± SD; Median (IQR) |
---|---|
Age, years | 68.6 ± 11.6 |
Gender—Men n (%) | 67 (72%) |
Women n (%) | 26 (28%) |
Coronary artery disease, n (%) | 43 (46%) |
Diabetes mellitus, n (%) | 33 (35%) |
Congestive heart failure, n (%) | 74 (80%) |
Atrial fibrillation, n (%) | 28 (30%) |
LVEF (%) | 35.3 ± 13.2 |
NYHA Class I–IV | |
Class I–II, n (%) | 48 (52%) |
Class III, n (%) | 45 (48%) |
Previous battery replacement, n (%) | 22 (24%) |
Interval between the battery replacement and lead extraction time (month) | 30.5 (8.75–69.5) |
Type of First Device Implanted | n = 93 (%) |
---|---|
CRT-D | 31 (33%) |
ICD-VR | 24 (26%) |
DDD | 18 (19%) |
ICD-DR | 8 (9%) |
VVI | 7 (8%) |
VDD | 3 (3%) |
CRT-P | 2 (2%) |
Indications for first device implantation | n = 93 (%) |
Cardiac resynchronization therapy | 33 (35%) |
Primary prevention, ICD | 23 (25%) |
Third degree AV block | 19 (20%) |
Secondary prevention, ICD | 9 (10%) |
Sick sinus syndrome | 9 (10%) |
Indications for Lead Extraction | n = 93 (%) |
---|---|
Lead dysfunction | 33 (35.5%) |
Pacemaker pocket infection | 33 (35.5%) |
System upgrade | 21 (23%) |
Lead endocarditis | 6 (6%) |
Characteristics of patients undergoing lead extraction | Median (IQR) |
Month | 43 (24–87) |
Year | 3 (2–7) |
Retracted lead characteristics | n = 163 Median (IQR) |
Retracted lead number | 2 (1–2) |
Number of leads per patient | n = 93 (%) |
1 lead | 46 (49%) |
2 leads | 25 (27%) |
3 leads | 21 (23%) |
4 leads | 1 (1%) |
Lead types | n = 163 (%) |
Atrial lead | 45 (28%) |
RV pace lead | 29 (18%) |
RV defibrillator lead | 58 (35%) |
Single coil | 4 (2%) |
Double coil | 54 (33%) |
LV lead | 31 (19%) |
Lead fixation | n = 163 (%) |
Active lead | 100 (61%) |
Passive lead | 63 (38%) |
Extraction technique | n = 93 (%) |
Simple manual traction method | 79 (85%) |
Use of extraction system | 5 (5%) |
Use of snare loop | 9 (10%) |
New Device Reimplantation after Lead Extraction | n = 74 (80%) |
---|---|
Reimplantation at time of extraction (at the same session) | 49 (66%) |
same pectoral area | 30 (61%) |
other pectoral area | 19 (39%) |
Reimplantation day after extraction, day Median (IQR) | 3 (0–8) |
Frequencies of implanted device types after extraction | n = 74 (%) |
CRT-D | 45 (61%) |
DDD | 10 (14%) |
ICD-VR | 8 (11%) |
ICD-DR | 4 (5%) |
VVI | 4 (5%) |
CRT-P | 2 (3%) |
VDD | 1 (1%) |
Follow-up after extraction | n = 93 Median (IQR) |
Follow-up after extraction, (month) | 17 (8–36) |
(year) | 1 (0–2.75) |
Death during follow-up, n (%) | 18 (19%) |
Total follow-up after implantation | n = 91 |
Total duration of follow-up after implantation (month) | 66 (46–108) |
(year) | 5 (3–9) |
Extraction data of patients | n = 93 Median (IQR) |
Duration of hospitalization for extraction (day) | 6 (3–14) |
Success and complications | n = 93 (%) |
Complete procedural success | 78 (84%) |
Clinical procedural success | 83 (89%) |
Procedural failure | 15 (16%) |
Complete lead removal | 85 (%91) |
Intra-procedural complications | 1 (1%) |
Early post-procedure complications | 9 (10%) |
Late post-procedure complications | 7 (7.5%) |
Major complications | 10 (11%) |
Minor complications | 6 (6.5%) |
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Akcay, M.; Yuksel, S. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads—A Single-Center Experience. Medicina 2024, 60, 1360. https://doi.org/10.3390/medicina60081360
Akcay M, Yuksel S. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads—A Single-Center Experience. Medicina. 2024; 60(8):1360. https://doi.org/10.3390/medicina60081360
Chicago/Turabian StyleAkcay, Murat, and Serkan Yuksel. 2024. "Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads—A Single-Center Experience" Medicina 60, no. 8: 1360. https://doi.org/10.3390/medicina60081360