title: Percutaneous lead and system extraction in patients with cardiac resynchronization therapy (CRT) devices and coronary sinus leads.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction is required due to the occurrence of system infection, malfunction, or upgrade. Published series of CS lead extraction are limited by small sample sizes. We present a 10-year experience of CRT device and CS lead extraction.
  
  
  METHODS
  All lead extractions between 2000 and 2010 were entered into a computer database. From these, a cohort of 71 cases involving a CRT device or CS lead was analyzed for procedural method, success, and complications.
  
  
  RESULTS
  Sixty coronary sinus leads were extracted in 71 cases (median age 71 years; 90% male) by manual traction/locking stylets (n = 54) or using a laser sheath (n = 6). Procedural success was achieved in 98% of CS leads. A total of 143 non-CS leads were extracted, with laser required in 46% of cases. The mean duration of lead implantation was 35.8 months (range 1-116 months) and 2.86 ± 1.07 leads were extracted per case. CRT extraction case load increased significantly over time. Minor complications occurred in four (5.6%) cases and major complications in one (1.4%) case. There were no intraprocedural deaths, but two deaths occurred within 30 days of extraction.
  
  
  CONCLUSIONS
  Our 10-year experience confirms that percutaneous removal of CS leads can be achieved with high procedural success. Our recorded complication rates are no higher than those of non-CS lead extraction series, and should be taken in the context of the frail nature of CRT patients. Ongoing audit of procedure success and complications will be required to further guide best practice in CS lead extraction.
authors.affiliation: Department of Cardiology Cardiothoracic Centre, St Thomas' Hospital, London, UK. stevenwilliams@nhs.net
authors.forename: Steven E
authors.initials: SE
authors.lastname: Williams
authors.forename: Aruna
authors.initials: A
authors.lastname: Arujuna
authors.forename: John
authors.initials: J
authors.lastname: Whitaker
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Shetty
authors.forename: Julian
authors.initials: J
authors.lastname: Bostock
authors.forename: Nikhil
authors.initials: N
authors.lastname: Patel
authors.forename: Margaret
authors.initials: M
authors.lastname: Mobb
authors.forename: Mike
authors.initials: M
authors.lastname: Cooklin
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.forename: Christopher
authors.initials: C
authors.lastname: Blauth
authors.forename: Cliff
authors.initials: C
authors.lastname: Bucknall
authors.forename: Shoaib
authors.initials: S
authors.lastname: Hamid
authors.forename: C Aldo
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D015331:Cohort Studies; D054326:Coronary Sinus; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome