title: [Percutaneous extraction of pacemaker and defibrillator leads].
abstract: OBJECTIVE
  There is an increasing need for endocardial pacing and defibrillators leads to be removed. However, the procedure can be complex and it is not risk-free. We reviewed our experience between April 1989 and June 2006 with the percutaneous extraction of leads.
  
  
  METHODS
  In total, 314 electrodes were extracted from 187 patients. The leads had been implanted over an average period of 69.16 months (range 0.11-234.6 months, median 60.25 months). Some 115 were atrial leads, 196 were ventricular, and three were in the coronary veins; of these, 78 had been abandoned in the vascular bed.
  
  
  RESULTS
  Indications for removal were infection (26.1%), dysfunction (22.9%), erosion (25%), endocarditis (20.7%), and bacteremia (2.7%). Overall, 58.8% of patients were referred from other departments. In 96.8%, the electrodes were completely removed. Simple traction was used in 23.4%, and countertraction techniques (with and without radiofrequency current support) were used in 60.7%. For abandoned leads, a biopsy clamp was used in combination with countertraction (4.3%) or a femoral approach with a snare (10.1%). A sternotomy was required in three of the 10 patients with remaining electrode fragments. The complication rate was 4.6% (with major complications in 2.5%). Complications were associated with age < 60 years (odds ratio [OR]=5.38, 95% confidence interval [CI] 1.07-27.23), the presence of endocarditis (OR=4.97: 95%CI, 1.04-23.70), and right side implantation (OR=17.09; 95% CI, 2.15-135.70).
  
  
  CONCLUSIONS
  In the majority of cases, pacing and defibrillator leads can be removed without difficulty using modern extraction techniques. However, because there is a risk of complications during extraction, even though it is low, the procedure should be carried out in specialized centers with surgical facilities.
authors.affiliation: Servicio de Cirugía Cardiaca de Adultos, Hospital Ramón y Cajal, Madrid, Spain. centellato@telefonica.net
authors.forename: Tomasa
authors.initials: T
authors.lastname: Centella
authors.forename: Enrique
authors.initials: E
authors.lastname: Oliva
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Andrade
authors.forename: Pilar
authors.initials: P
authors.lastname: Martín-Dávila
authors.forename: Javier
authors.initials: J
authors.lastname: Cobo
authors.forename: José L
authors.initials: JL
authors.lastname: Moya
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Madrid
authors.forename: Antonio
authors.initials: A
authors.lastname: Epeldegui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome