Safety and feasibility of coronary sinus left ventricular leads extraction: a preliminary report.
BACKGROUND
transvenous positioning of the left ventricular (LV) lead in a branch of the coronary sinus (CS) is generally the preferred implantation technique in biventricular pacing. Very few data are reported about removal of LV pacing leads positioned in a CS branch. Aim of the study was to describe our experience with percutaneous extraction of LV pacing leads in order to evaluate feasibility and safety of this procedure.


METHODS
we enrolled 392 patients who underwent a biventricular pacing implant. The indication for catheter removal was considered in case of definite diagnosis of infection and in some cases of lead dislodgement or diaphragmatic stimulation. LV lead extraction was first attempted by manual traction; in case of failure a locking stylet or locking stylet plus radiofrequency could be used.


RESULTS
twelve of 392 patients implanted needed LV lead removal. The leads had been in place for 13.9 +/- 11.7 months. Extraction was indicated in 5 of them for LV lead dislodgement or diaphragmatic stimulation, and in 7 patients for lead infection. In all cases manual traction succeeded to remove the LV lead. In 7 cases of infection, the right atrial and ventricular leads were removed. The mean total procedure time was 69 +/- 22 min. No complications were observed.


CONCLUSIONS
our study suggests that CS leads could be easily and safely removed without any complication, also when placed in a CS branch, at least for relatively young catheters.
De Martino
Giuseppe
G
Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. giusepdemartino@libero.it
Orazi
Serafino
S
Bisignani
Giovanni
G
Toscano
Salvatore
S
Messano
Loredana
L
Parisi
Quintino
Q
Santamaria
Matteo
M
Pelargonio
Gemma
G
Dello Russo
Antonio
A
Bellocci
Fulvio
F
Zecchi
Paolo
P
Crea
Filippo
F
D015331:Cohort Studies; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010690:Phlebography; D018570:Risk Assessment; D013997:Time Factors