James Gabriels1, David Chang2, Melanie Maytin3, Thomas Tadros3, Roy M John2, Piotr Sobieszczyk4, Andrew Eisenhauer5, Laurence M Epstein2. 1. Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York. Electronic address: jamesgabriels@gmail.com. 2. Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York. 3. Department of Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Interventional Cardiology, Brigham and Women's Hospital, Boston, Massachusetts. 5. Department of Cardiology, Central Maine Medical Center, Lewiston, Maine.
Abstract
BACKGROUND: There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome. OBJECTIVE: We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome. METHODS: We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome. Patient characteristics, extraction details, percutaneous management of SVC occlusions, and clinical follow up data were analyzed. RESULTS: Over a 14-year period, more than 1600 TLEs were performed. Of these, 16 patients underwent TLE for symptomatic SVC syndrome. The mean age was 53.1 ± 12.8 years, and 9 (56.3%) were men. Thirty-seven leads, with a mean dwell time of 5.8 years (range 2-12 years), were extracted. After extraction, 6 patients (37.5%) received an SVC stent. Balloon angioplasty was performed before stenting in 5 cases (31.3%). There was 1 major complication (6.3%) due to an SVC tear that was managed surgically with a favorable outcome. Eleven patients underwent reimplantation of a CIED. Over a median follow-up of 5.5 years (interquartile range 2.0-8.5 years), 12 patients (75%) remained free of symptoms. CONCLUSION: Combining TLE with the percutaneous treatment of symptomatic SVC syndrome is a safe and viable treatment strategy.
BACKGROUND: There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome. OBJECTIVE: We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome. METHODS: We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome. Patient characteristics, extraction details, percutaneous management of SVC occlusions, and clinical follow up data were analyzed. RESULTS: Over a 14-year period, more than 1600 TLEs were performed. Of these, 16 patients underwent TLE for symptomatic SVC syndrome. The mean age was 53.1 ± 12.8 years, and 9 (56.3%) were men. Thirty-seven leads, with a mean dwell time of 5.8 years (range 2-12 years), were extracted. After extraction, 6 patients (37.5%) received an SVC stent. Balloon angioplasty was performed before stenting in 5 cases (31.3%). There was 1 major complication (6.3%) due to an SVC tear that was managed surgically with a favorable outcome. Eleven patients underwent reimplantation of a CIED. Over a median follow-up of 5.5 years (interquartile range 2.0-8.5 years), 12 patients (75%) remained free of symptoms. CONCLUSION: Combining TLE with the percutaneous treatment of symptomatic SVC syndrome is a safe and viable treatment strategy.
Authors: Andrew H Locke; David J Shim; Jessica Burr; Tyler Mehegan; Kelsey Murphy; André D'Avila; Marc L Schermerhorn; Peter Zimetbaum Journal: J Innov Card Rhythm Manag Date: 2021-04-15
Authors: Samuel Griffiths; Jonathan M Behar; Daniel B Kramer; Mike T Debney; Christopher Monkhouse; Alicia Y Lefas; Martin Lowe; Fouad Amin; Emily Cantor; Vennela Boyalla; Nabeela Karim; Jan Till; Vias Markides; Jonathan R Clague; Tom Wong Journal: Pacing Clin Electrophysiol Date: 2022-02-08 Impact factor: 1.912