Introduction: Transvenous extraction of implantable electric devices is a well known procedure, almost described and documented for pacing leads, with small series for implantable cardioverter defibrillator (ICD) leads. Aim of our study was to describe a large single center experience in implantable cardioverter defibrillator (ICD) leads extraction by transvenous mechanical technique. Methods: Since 1997 to June 2010, 352 consecutive patients (309 men, mean age 62.1 years, range 8-92) with 378 ventricular ICD leads (mean implantation time 42.2 months, range 1-204) underwent a mechanical transvenous removal. System features included almost left side implanted systems (92%) with passive fixation (76%) and dual coil (74%) leads. The most common indication for lead extraction was local infection (174 patients, 49%), followed by sepsis (95 patients, 27%) and lead malfunction (83 patients, 24%). Results: Removal was feasible with a complete success in all the approached leads (100%). 23 leads (6%) were removed by manual traction, 355 by mechanical dilatation, whose 321 (85%) using the venous entry site approach and 34 (9 %) by the transvenous jugular approach crossover. Mean extraction time was 21±31.7 min (range 1-210). No major complications occurred. Dual coil compared with single coil leads showed an higher rate of fibrous adherences at the innominate vein (69% vs 52%, respectively) and superior vena cava (70% vs 51 %, respectively), without differences in the other sites. Comparing the easy ("traction" group) with the complex approach ("transjugular" group), all baseline patient and leads features resulted comparable (p =NS), with the only exception for the lead implantation time that resulted statistically longer in the second group (10.4±10.3 vs 64.3±36.7 min, p<0.01, respectively). Conclusions: Our large experience shows that transvenous ICD leads removal is a feasible, safe procedure with an high success rate. However, even if the mean dwell time is usually lower than pacing leads, manual traction is rare effective and often transjugular approach may be required.
Mechanical transvenous extraction of endocardial implantable cardioverter defibrillator leads: feasibility, safety and determinants of success in the pisa experience
L. Segreti;E. Soldati;G. Zucchelli;A. Di Cori;L. Paperini;MG. Bongiorni
2011-01-01
Abstract
Introduction: Transvenous extraction of implantable electric devices is a well known procedure, almost described and documented for pacing leads, with small series for implantable cardioverter defibrillator (ICD) leads. Aim of our study was to describe a large single center experience in implantable cardioverter defibrillator (ICD) leads extraction by transvenous mechanical technique. Methods: Since 1997 to June 2010, 352 consecutive patients (309 men, mean age 62.1 years, range 8-92) with 378 ventricular ICD leads (mean implantation time 42.2 months, range 1-204) underwent a mechanical transvenous removal. System features included almost left side implanted systems (92%) with passive fixation (76%) and dual coil (74%) leads. The most common indication for lead extraction was local infection (174 patients, 49%), followed by sepsis (95 patients, 27%) and lead malfunction (83 patients, 24%). Results: Removal was feasible with a complete success in all the approached leads (100%). 23 leads (6%) were removed by manual traction, 355 by mechanical dilatation, whose 321 (85%) using the venous entry site approach and 34 (9 %) by the transvenous jugular approach crossover. Mean extraction time was 21±31.7 min (range 1-210). No major complications occurred. Dual coil compared with single coil leads showed an higher rate of fibrous adherences at the innominate vein (69% vs 52%, respectively) and superior vena cava (70% vs 51 %, respectively), without differences in the other sites. Comparing the easy ("traction" group) with the complex approach ("transjugular" group), all baseline patient and leads features resulted comparable (p =NS), with the only exception for the lead implantation time that resulted statistically longer in the second group (10.4±10.3 vs 64.3±36.7 min, p<0.01, respectively). Conclusions: Our large experience shows that transvenous ICD leads removal is a feasible, safe procedure with an high success rate. However, even if the mean dwell time is usually lower than pacing leads, manual traction is rare effective and often transjugular approach may be required.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
