TY - JOUR
T1 - Outcomes and predictors of difficulty with coronary sinus lead removal
AU - Sheldon, Seth
AU - Friedman, Paul A.
AU - Hayes, David L.
AU - Osborn, Michael J.
AU - Cha, Yong Mei
AU - Rea, Robert F.
AU - Asirvatham, Samuel J.
N1 - Funding Information:
Conflict of interest Dr. Friedman received honoraria from St. Jude Medical, Bard, Biotronik, and Medtronic and research support from Medtronic, ST Micro Electronics, Pfizer, and Biotronik. Dr. Hayes received honoraria from Medtronic, Boston Scientific, St. Jude Medical, Sorin Medical, and Biotronik and royalty payments (up-to-date) from Wiley-Blackwell; an advisory board of Boston Scientific, St. Jude Medical, and Medtronic; and a steering committee member of Medtronic and St. Jude Medical. Dr. Cha was a recipient of research grants from St. Jude Medical and Medtronic. Dr. Asirvatham received honoraria from Medtronic, Boston Scientific, and St. Jude Medical.
PY - 2012/10
Y1 - 2012/10
N2 - 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.
AB - 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.
KW - Biventricular pacing
KW - CRT
KW - Complications
KW - Coronary sinus
KW - Laser lead extraction
KW - Lead extraction
KW - Lead removal
KW - Left ventricular lead
KW - Locking stylet
KW - Pacing lead complication
KW - Snare
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U2 - 10.1007/s10840-012-9685-2
DO - 10.1007/s10840-012-9685-2
M3 - Article
C2 - 22584767
AN - SCOPUS:84866121846
SN - 1383-875X
VL - 35
SP - 93
EP - 100
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 1
ER -