Xin-Miao Huang1, Haixia Fu2, Michael J Osborn3, Samuel J Asirvatham3, Christopher J McLeod3, Michael Glickson4, Nancy G Acker3, Paul A Friedman3, Yong-Mei Cha5. 1. Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. 2. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Henan, China. 3. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. 4. Davidai Arrhythmia Center, Heart Center, Sheba Medical Center And Tel Aviv University, Tel Hashomer, Israel. 5. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: ycha@mayo.edu.
Abstract
BACKGROUND: Although increasingly more lead extraction was performed for superfluous leads, the extraction of such leads remains controversial. OBJECTIVE: The objective of this study was to determine the outcomes and complications of transvenous extraction of superfluous leads in a single center in the era of laser technology. METHODS: Four hundred eighty transvenous lead extraction procedures performed from January 2001 through October 2012 at Mayo Clinic (Rochester, Minnesota) were retrospectively reviewed. Of these, 123 procedures were performed for superfluous functional or nonfunctional leads. Data were collected from electronic medical records and an institutional database of cardiovascular implantable electronic devices. RESULTS: A total of 167 superfluous leads (mean [SD] lead duration 53 [53] months; median 34 months) were removed during the 123 procedures. Forty-one percent of procedures were for lead malfunction. The procedural complete-success rate was 96.7%. Major complications occurred in 1 patient (0.8%), who had a superior vena cava tear that required thoracotomy. Superfluous leads had been implanted for a shorter period of time than infected leads (mean [SD] 53 [53] vs 81 [59] months; P < .001). The procedural complete-success rate was higher for the removal of superfluous leads than for leads associated with infection (97% vs 92%; P = .05). CONCLUSION: Transvenous extraction of superfluous leads is highly successful, with few procedural complications. Extraction of superfluous leads at the time of device upgrade or lead revision is considered reasonable to avoid the increasing risk of extraction complications with lead aging.
BACKGROUND: Although increasingly more lead extraction was performed for superfluous leads, the extraction of such leads remains controversial. OBJECTIVE: The objective of this study was to determine the outcomes and complications of transvenous extraction of superfluous leads in a single center in the era of laser technology. METHODS: Four hundred eighty transvenous lead extraction procedures performed from January 2001 through October 2012 at Mayo Clinic (Rochester, Minnesota) were retrospectively reviewed. Of these, 123 procedures were performed for superfluous functional or nonfunctional leads. Data were collected from electronic medical records and an institutional database of cardiovascular implantable electronic devices. RESULTS: A total of 167 superfluous leads (mean [SD] lead duration 53 [53] months; median 34 months) were removed during the 123 procedures. Forty-one percent of procedures were for lead malfunction. The procedural complete-success rate was 96.7%. Major complications occurred in 1 patient (0.8%), who had a superior vena cava tear that required thoracotomy. Superfluous leads had been implanted for a shorter period of time than infected leads (mean [SD] 53 [53] vs 81 [59] months; P < .001). The procedural complete-success rate was higher for the removal of superfluous leads than for leads associated with infection (97% vs 92%; P = .05). CONCLUSION: Transvenous extraction of superfluous leads is highly successful, with few procedural complications. Extraction of superfluous leads at the time of device upgrade or lead revision is considered reasonable to avoid the increasing risk of extraction complications with lead aging.
Authors: Simon Pecha; Liesa Castro; Julia Vogler; Matthias Linder; Nils Gosau; Stephan Willems; Hermann Reichenspurner; Samer Hakmi Journal: Heart Vessels Date: 2018-04-05 Impact factor: 2.037