Contributions of advanced techniques to the success and safety of transvenous leads extraction.
OBJECTIVE
We measured the proportion of intravascular leads, which can be extracted by simple traction versus with newer techniques, and examined the overall safety and success rate of lead extractions.


METHODS
Between January 2005 and December 2007, 311 consecutive patients (mean age = 70 +/- 14 years, 79% men) underwent extractions of 250 atrial, 318 ventricular, and 22 coronary sinus leads, in the surgical facilities of two experienced medical centers, under general anesthesia, at a mean of 7.2 +/- 5.1 years (range 0.1-27.0) after lead implantation. Infection was the indication for extraction in 67.5% of cases. Complementary techniques were used when simple extraction with a locking stylet was unsuccessful.


RESULTS
Simple traction, with or without a locking stylet, allowed the complete removal in 27.0% (95% confidence interval [CI] 22.1-31.9) of patients. A mechanical sheath, laser sheath, and/or lasso catheter were used in the remaining patients. The overall extraction success rate was 89.7% (95% CI 86.3-93.1). There was one procedure-related death (0.3%; 95% CI 0.0-1.0). Among five other deaths occurring within 10 days after the procedure, four were due to septic shock. Duration of lead implantation was the strongest independent predictor of major adverse events (P = 0.002) and incomplete lead extraction (P = 0.005).


CONCLUSIONS
In contrast with simple traction, advanced techniques allowed the complete extraction of nearly 90% of leads. In experienced hands and with surgical back-up, these techniques were safe. Patients presenting with infected implanted cardiac devices suffered a high rate of major adverse despite complete extraction of the lead(s).
Marijon
Eloi
E
Département de Rythmologie, Clinique Pasteur, Toulouse, France. eloi_marijon@yahoo.fr
Boveda
Serge
S
De Guillebon
Maxime
M
Jacob
Sophie
S
Vahdat
Olivier
O
Barandon
Laurent
L
Combes
Nicolas
N
Sidobre
Laurent
L
Albenque
Jean-Paul
JP
Clémenty
Jacques
J
Bordachar
Pierre
P
D000368:Aged; D020878:Device Removal / Q000295:instrumentation / Q000379:methods* / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate