title: Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads.
abstract: OBJECTIVE
  Active fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited.
  
  
  METHODS
  We performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers. Patient and procedural characteristics, indications for extraction, use of extraction sheath (ES) assistance, and outcomes are reported.
  
  
  RESULTS
  Between January 2009 and February 2011, 12 patients underwent transvenous lead extraction (TLE) of Medtronic StarFix® lead (Medtronic Inc., Minneapolis, MN, USA). The cohort was 83% male with mean age 71 ± 14 years. Average implant duration was 14.2 ± 5.7 months (2.3-23.6). All leads but one were removed for infectious indications (67% systemic infection). At the time of explant, the fixation lobes were completely retracted in only one of the 12 cases and ES assistance was required for lead removal in all cases (58% laser, 25% cutting, 25% mechanical, and 25% femoral). The majority of cases required advancement of the sheath into the CS (75.0%) and often into a branch vessel (41.7%). One lead could not be removed transvenously and required surgical lead extraction. There were no major complications. Examination of the leads after extraction frequently revealed significant tissue growth into the fixation lobes.
  
  
  CONCLUSIONS
  Although TLE of active fixation CS leads can be a safe procedure in select patients and experienced hands, powered sheaths and aggressive techniques are frequently required for successful removal despite relatively short implant durations. This raises significant concern regarding future TLE of active fixation CS leads with longer implant durations.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mmaytin@partners.org
authors.forename: Melanie
authors.initials: M
authors.lastname: Maytin
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
authors.forename: Pablo
authors.initials: P
authors.lastname: Baltodano
authors.forename: Raymond H M
authors.initials: RH
authors.lastname: Schaerf
authors.forename: Maria G
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Charles
authors.initials: C
authors.lastname: Kennergren
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
mesh_terms: D000368:Aged; D015331:Cohort Studies; D054326:Coronary Sinus / Q000601:surgery*; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D009205:Myocarditis / Q000209:etiology* / Q000517:prevention & control*; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome