title: Large, single-center experience in transvenous coronary sinus lead extraction: procedural outcomes and predictors for mechanical dilatation.
abstract: BACKGROUND
  The aim of this study was to evaluate procedural outcomes of coronary sinus (CS) lead extraction, focusing on predictors and need for mechanical dilatation (MD) in the event that manual traction (MT) is ineffective.
  
  
  METHODS
  The study assessed results in 145 consecutive patients (age 69 ± 10 years; 121 men)--a total of 147 CS pacing leads--who underwent transvenous CS lead removal between January 2000 and March 2010.
  
  
  RESULTS
  All leads but one (99%) (implantation time 29 ± 25 months) were successfully removed. MT was effective in 103 (70%), and MD was necessary in the remaining 44 (30%) procedures. In multivariate analyses, unipolar design (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.7; P = 0.005) and noninfective indication (OR 4.8, 95% CI 1.8-13, P = 0.002) were independent predictors for MD (P < 0.0001), with a predictive trend for prior cardiac surgery (OR 2.2, 95% CI 0.98-5.26; P = 0.06). Five (3.4%) complex procedures required a transfemoral vein approach (TFA) or repeat procedure. No deaths occurred, and there was one major complication (0.7%), cardiac tamponade, after MT. No complication predictors were identified.
  
  
  CONCLUSIONS
  CS leads were safely and effectively removed in nearly all patients, and 70% were removed with MT alone; 30% required MD. Preoperative predictors suggesting the need for MD or TFA were noninfective indication and unipolar lead design. Complications were rare, and there was no predictable pattern among MT or MD removal techniques.
authors: Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, Hospital University of Pisa, Pisa, Italy. a.dicori@virgilio.it
authors: Andrea
authors: A
authors: di Cori
authors: Maria Grazia
authors: MG
authors: Bongiorni
authors: Giulio
authors: G
authors: Zucchelli
authors: Luca
authors: L
authors: Segreti
authors: Stefano
authors: S
authors: Viani
authors: Raffaele
authors: R
authors: de Lucia
authors: Luca
authors: L
authors: Paperini
authors: Ezio
authors: E
authors: Soldati
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000379:methods / Q000401:mortality*; D054326:Coronary Sinus / Q000601:surgery*; D020878:Device Removal / Q000379:methods / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome