Usefulness of mechanical transvenous dilation and location of areas of adherence in patients undergoing coronary sinus lead extraction.

AIMS: Few data have been currently reported on the outcome of coronary sinus (CS) lead removal, particularly using mechanical dilation (MD). We aimed to evaluate feasibility, safety, and effectiveness of CS lead extraction, focusing on MD usefulness, in the event that lead traction (LT) was ineffective. METHODS AND RESULTS: We studied 37 consecutive patients (30 males, mean age 68.1, range 52-80), who underwent left ventricle (LV) pacing lead removal; the indication for extraction was local infection in 16 patients (43.3%), sepsis in 11 patients (29.7%), and lead malfunction in 10 patients (27%). The procedure was first attempted by LT, followed, if unsuccessful, by MD using polypropylene sheaths. All CS leads (time from implant 19.5 +/- 16.5, range 2-84 months) were successfully removed; LT was effective (LT group) in 27 patients (73%) and ineffective in 10 patients (27%), for whom MD was necessary (MD group). There were no major complications. The areas of adherence were in the CS in only one patient. No differences were noted in the data analysed between LT and MD groups; in particular, time from implant was similar in the two groups (MD vs. LT group: 17 +/- 8.9 vs. 20.4 +/- 18.6 months; P = ns). CONCLUSION: Our study suggests that CS leads, after medium-term implantation, can be effectively and safely removed using MD with polypropylene sheaths, in the case of unsuccessful LT. No pre-operative elements predictive of LT failure could be identified. Areas of adherence were rarely located in the CS or its tributaries.     

Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis

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Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead.

A 74-year-old patient was referred for a rapidly increasing pacing threshold 9 months after DDD pacemaker implantation because of symptomatic total atrioventricular (AV) block. She had a history of hypertension, diabetes with micro-angiopathy and a recent transient ischaemic attack. The paced electrocardiogram on admission had a right bundle branch block pattern and 3-dimensional transoesophageal echocardiography demonstrated passage of the lead through an atrial septal defect with a left ventricular position in addition to moderate atherosclerosis of the ascending aorta. No thrombus could be detected on the lead. Percutaneous extraction is usually not recommended because of the risk of mobilization of thrombus material. However, the risk of stroke during removal using cardiopulmonary bypass in this patient was considerably increased because of the presence of multiple independent risk factors. Therefore, percutaneous extraction using a locking device was selected and performed without complications: follow-up was uneventful.     

Management and long-term outcomes associated with recalled implantable cardioverter-defibrillator leads: A multicenter experience

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Arrhythmia device lead extraction: factors that necessitate laser assistance

BACKGROUND:

The removal of pacemaker and implantable cardioverter defibrillator (ICD) leads has become a common procedure. The need for laser use has considerable implications regarding cost and expertise. It is not an option at all centres and introduces an element of risk to the procedure. Anticipation of the need for laser assistance may be of benefit to procedure planning.

METHODS:

Data on all patients undergoing lead extraction at London Health Sciences Centre (London, Ontario) between July 2001 and October 2006 were reviewed. Variables were assessed for independent association with the need for laser assistance. A prediction rule for laser use was created based on the multivariate model.

RESULTS:

From July 2001 to October 2006, 154 patients underwent lead extraction, with laser assistance required in 106 patients (68.8%). One hundred seven patients (69.5%) had pacemakers and the remainder had ICDs. The mean (± SD) device age was 7.6±5.7 years, with 1.9±0.9 leads requiring extraction. Clinical success was achieved in 152 patients (98.7%). Multivariate analysis revealed that laser use was less likely among men (OR 0.24, 95% CI 0.069 to 0.84; P=0.026) and among septic patients (OR 0.25, 95% CI 0.072 to 0.84; P=0.025), and more likely with ICDs than pacemakers (OR 4.40, 95% CI 1.50 to 12.91; P=0.0069) and with each additional year of device age (OR 1.46 per year, 95% CI 1.26 to 1.70; P<0.0001).

CONCLUSIONS:

Laser assistance was required in 68.8% of cases, with clinical success in 98.7% of patients. Laser use was less likely among septic patients and men, and more likely with ICD leads and increasing time since lead implant. It was not possible to derive an accurate prediction rule for cases that would not need laser assistance. Therefore, it is prudent to ensure that a laser and appropriate infrastructure is available for lead extractions, and that the patient is aware of the possible need for laser assistance, along with the risks entailed.     

Single-step transvenous extraction of a passive fixation lead with delayed perforation of the right ventricle

Delayed pacemaker lead perforation is a very rare complicationand most of the published reports involve active fixation leads.The authors report an uneventful transvenous extraction of apassive fixation lead, which had a delayed perforation of theright ventricle, disclosed two months after pacemaker implantation.     

Extraction chirurgicale fatale de sondes de défibrillateur cardiaque triple chambre dans un contexte d’endocardite à Staphylococcus epidermidis méthicilline-résistant. À propos d’un cas et revue de la littérature

A 82-year-old man equipped with a cardiac resynchronisation therapy defibrillator for dilated cardiomyopathy with normal coronary arteries, in complete atrioventricular block, develops six months after a change of the generator-pocket a severe endocarditis due to a methicillin-resistant Staphylococcus epidermidis with a large lead vegetation. After 4 days of adapted antimicrobial therapy, a surgical device removal is realised with unfortunately a fatal end during extraction. This observation points out the severity of cardiovascular device infections in old and weak population, as well as the difficulty of treatment choices because of both infectious and rhythmic constraints. The lead extraction is a strong recommendation but the modality and timing of extraction are not consensual, especially in cardioverter defibrillator-dependent patients. Surgical removal remains an alternative to percutaneous lead extraction but with a higher operative risk.     

起搏电极导线引起心脏穿孔的处理策略研究

目的探讨起搏电极导线引起心脏穿孔的处理策略。方法研究入选2007年1月至2017年12月就诊于北京大学人民医院并明确诊断心脏穿孔的患者46例。回顾性分析患者的基本情况、穿孔电极类型、临床表现、胸片、超声心动图、CT、程控参数以及处理方法等。总结心脏穿孔的最佳处理策略。结果46例患者发生了心脏穿孔,急性心脏穿孔者23例(50.0%),发生于术后1~29(14±8)d,慢性心脏穿孔者23例(50.0%),发生于术后35~2555(1147±812)d。临床表现中以胸痛、肌肉跳动最常见,分别为18例(39.1%)、8例(17.4%)。程控参数中以起搏阈值升高为主,为42例(91.3%)。29例(63.0%)患者的胸片提示电极顶端紧贴或穿出心脏影外缘,20例(43.5%)患者的超声心动图提示心脏穿孔。6例接受胸部CT检查的患者均发现了心脏穿孔。本研究中由内科经静脉拔除电极导线者34例,成功拔除者32例(94.1%),2例患者因考虑术后心脏压塞风险较大,故保留原电极导线;外科参与电极导线拔除者12例,且全部(100%)成功拔除穿孔电极导线,44例心脏穿孔患者拔除穿孔电极导线后均未出现心包积液以及心脏压塞。结论心脏穿孔常以胸痛、膈肌刺激为主要临床表现,可通过程控、影像学检查明确诊断。在血流动力学稳定且无周围器官损伤的情况下,采用经静脉拔除穿孔电极的手术方式是安全可靠的。     

经下腔静脉途径反推力牵引法拔除永久性起搏电极导线

采用经下腔静脉途径 ,对 11例起搏器术后顽固性感染和 2例电极导线断裂患者的电极导线进行血管内反推力牵引拔除术。需拔除电极导线共 17根 (心房和心室电极导线分别为 5和 12根 ) ,其中 15根因起搏器囊袋感染和破溃需拔除的电极导线置入时间为 11.5± 3.5 (8～ 2 0 )年 ,经上腔静脉途径拔除失败。结果 :经下腔静脉途径完全拔除电极导线 15根、不完全拔除 1根、失败 1根 ,无严重并发症。表明对置入年限长久和断裂电极导线 ,经下腔静脉途径的拔除成功率高 ,应作为首选拔除途径