title: Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute.
abstract: Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix or Encore leads (46%), or other causes (2%). Patients were 64+/-17 years of age (range 5-96); 59% were men, 41% women. Leads were implanted 47+/-41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P<0.0001), less experienced physicians (P<0.0001), ventricular leads (P<0.005), noninfected patients (P<0.0005), and younger patients (P<0.0001). Major complications were reported for 1.4% of patients (<1% at centers with >300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P<0.005) and with less experienced physicians (P<0.005); risk of major complications was higher for women (P<0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.
authors.affiliation: University of Miami School of Medicine, Florida, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Byrd
authors.forename: B L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: C J
authors.initials: CJ
authors.lastname: Love
authors.forename: T D
authors.initials: TD
authors.lastname: Sellers
authors.forename: K T
authors.initials: KT
authors.lastname: Turk
authors.forename: R
authors.initials: R
authors.lastname: Reeves
authors.forename: R
authors.initials: R
authors.lastname: Young
authors.forename: B
authors.initials: B
authors.lastname: Crevey
authors.forename: S P
authors.initials: SP
authors.lastname: Kutalek
authors.forename: R
authors.initials: R
authors.lastname: Freedman
authors.forename: R
authors.initials: R
authors.lastname: Friedman
authors.forename: J
authors.initials: J
authors.lastname: Trantham
authors.forename: M
authors.initials: M
authors.lastname: Watts
authors.forename: J
authors.initials: J
authors.lastname: Schutzman
authors.forename: J
authors.initials: J
authors.lastname: Oren
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.forename: F
authors.initials: F
authors.lastname: Gold
authors.forename: N E
authors.initials: NE
authors.lastname: Fearnot
authors.forename: H J
authors.initials: HJ
authors.lastname: Van Zandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D012307:Risk Factors