Giulio Zucchelli1, Andrea Di Cori1, Luca Segreti1, Cécile Laroche2, Carina Blomstrom-Lundqvist3, Andrzej Kutarski4, François Regoli5, Christian Butter6, Pascal Defaye7, Jean Luc Pasquié8, Angelo Auricchio5, Aldo P Maggioni2,9, Maria Grazia Bongiorni1. 1. Second Department of Cardiology, Cardiac Thoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Cisanello, Italy. 2. EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia, Antipolis, France. 3. Department of Medical Science and Cardiology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden. 4. Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland. 5. Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. 6. Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany. 7. Department of Arrhythmia and Cardiac Pacing, CHU Albert Michallon, University Hospital Grenoble-Alpes, BP 217, Grenoble Cedex 9, France. 8. Département de Cardiologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier. 9. ANMCO Research Center, Via La Marmora 34, Firenze, Italy.
Abstract
AIMS: We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. METHODS AND RESULTS: A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. CONCLUSIONS: In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. METHODS AND RESULTS: A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. CONCLUSIONS: In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade. Published on behalf of the European Society of Cardiology. All rights reserved.
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