Outcomes and predictors of difficulty with coronary sinus lead removal

Seth Sheldon, Paul A. Friedman, David L. Hayes, Michael J. Osborn, Yong Mei Cha, Robert F. Rea, Samuel J. Asirvatham

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

With increasing coronary sinus (CS) pacemaker leads for cardiac resynchronization therapy, the need to remove these leads has risen. The purpose of this study is to describe a single center's experience with CS lead removal and to attempt to identify predictors of difficulty with lead removal and complications. We reviewed all percutaneous endocardial CS lead removals performed at our institution through February 2010. Successful removal with traction alone was considered simple while complex extractions required traction devices and/or laser sheaths. Between December 1996 and February 2010, 125 CS leads were percutaneously removed ≥1 week post-implantation from 115 patients. One attempt at CS lead extraction was unsuccessful. The average duration since implantation for the CS leads was 1.54 years (±.75 years, range 8 days to 8.24 years). The majority of the leads were removed by simple traction (n=;114, 91.2 %). The remainder were removed by femoral approach with snare (n=;3, 2.4 %), locking stylet (n=;2, 1.6 %), or locking stylet and laser sheath (n=;6, 4.8 %). Half of CS leads in place greater than 4 years required complex extraction (n=;7/14, 50 %). CS complications (n=;11 patients, 8.8 %) included CS or tributary thrombosis (n=;7/102, 6.9 %) and CS dissection (n=;4/102, 3.9 %). Major non-CS complications (n=;2 patients, 1.6 %) included a cardiac tear requiring pericardiocentesis and thoracotomy (n=;1, 0.8 %) and subclavian vein tear requiring surgical repair (n=;1, 0.8 %). Minor non-CS complications (n=;9 patients, 7.2 %) included a pneumothorax (n=;1, 0.8 %), hematoma (n=;2, 1.6 %), subclavian vein thrombosis (n=;3, x%), and blood transfusion (n=;5, 4.0 %). A longer duration since implantation and larger lead diameter were associated with complex versus simple removal (p<.0001 and p=;.0009 respectively). Percutaneous CS lead removal is successful by simple traction alone in the vast majority of cases. CS leads in place greater than 4 years, however, often require complex extraction. Specific extraction techniques can be implemented when simple traction is unsuccessful without an appreciable increase in complications.

Original languageEnglish (US)
Pages (from-to)93-100
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Volume35
Issue number1
DOIs
StatePublished - Oct 1 2012

Keywords

  • Biventricular pacing
  • CRT
  • Complications
  • Coronary sinus
  • Laser lead extraction
  • Lead extraction
  • Lead removal
  • Left ventricular lead
  • Locking stylet
  • Pacing lead complication
  • Snare

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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