Introduction: How to manage malfunctioning ICD leads is still a debated issue. The increasing number of implants and the poor performance of some lead models will increase the importance of this topic in the next future. At present the risk/benefit ratio of removal all abandoned ICD leads is unclear, mainly because the risk is supposed to be high. Indications to removal could be probably expanded by the availability of effective and safe Transvenous Lead Removal (TLR) techniques. We aim to report our experience in transvenous removal of not infected ICD leads. Methods:since January 1997 to November 2011, 520 ICD leads (495 ventricular, 9 atrial, 16 superior vena cava leads) were submitted to TLR at our Institution. Among these not infected malfunctioning ventricular leads were 122 (mean implant period 48+35 months, range 1-159), implanted in 112 patients (89 men, mean age 53+18 years, range 8-83). System features included almost left side implanted systems (94%) with passive fixation (75%) and dual coil (74%) leads. Indications to removal were inappropriate shocks in 46 patients (41%), while the remaining lead malfunctions were detected during routine follow. We performed mechanical dilation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and an Internal Trans-Jugular Approach (ITA) through the internal jugular vein was employed in case of failure of standard approach. Results:Removal was feasible with a complete success in all the approached leads (100%). Simple manual traction was effective in 12 leads (10 %), mechanical dilatation using the venous entry site was performed in 102 (83 %), the ITA was required to remove the remaining 8 leads (7 %). No major complications were observed. Comparing the easy ("traction" group) with the complex approach ("tansjugular" group), all baseline patients and lead features resulted comparable (p=NS) with the only exception for the lead implantation time that was statistically longer in the second group (9+13 vs 67+32 months, p<0.05). Conclusions:Our results suggest that in high volume centers, TLR of malfunctioning ICD leads using mechanical dilatation is effective and safe. According to these results the indication to removal could be extended to all of malfunctioning ICD leads.
Transvenous removal of malfunctioning ICD leads: large single center experience.
L. Segreti;E. Soldati;A. Di Cori;G. Zucchelli;L. Paperini;MG. Bongiorni
2012-01-01
Abstract
Introduction: How to manage malfunctioning ICD leads is still a debated issue. The increasing number of implants and the poor performance of some lead models will increase the importance of this topic in the next future. At present the risk/benefit ratio of removal all abandoned ICD leads is unclear, mainly because the risk is supposed to be high. Indications to removal could be probably expanded by the availability of effective and safe Transvenous Lead Removal (TLR) techniques. We aim to report our experience in transvenous removal of not infected ICD leads. Methods:since January 1997 to November 2011, 520 ICD leads (495 ventricular, 9 atrial, 16 superior vena cava leads) were submitted to TLR at our Institution. Among these not infected malfunctioning ventricular leads were 122 (mean implant period 48+35 months, range 1-159), implanted in 112 patients (89 men, mean age 53+18 years, range 8-83). System features included almost left side implanted systems (94%) with passive fixation (75%) and dual coil (74%) leads. Indications to removal were inappropriate shocks in 46 patients (41%), while the remaining lead malfunctions were detected during routine follow. We performed mechanical dilation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and an Internal Trans-Jugular Approach (ITA) through the internal jugular vein was employed in case of failure of standard approach. Results:Removal was feasible with a complete success in all the approached leads (100%). Simple manual traction was effective in 12 leads (10 %), mechanical dilatation using the venous entry site was performed in 102 (83 %), the ITA was required to remove the remaining 8 leads (7 %). No major complications were observed. Comparing the easy ("traction" group) with the complex approach ("tansjugular" group), all baseline patients and lead features resulted comparable (p=NS) with the only exception for the lead implantation time that was statistically longer in the second group (9+13 vs 67+32 months, p<0.05). Conclusions:Our results suggest that in high volume centers, TLR of malfunctioning ICD leads using mechanical dilatation is effective and safe. According to these results the indication to removal could be extended to all of malfunctioning ICD leads.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
