title: Cardiac venous left ventricular lead removal and reimplantation following device infection: a large single-center experience.
abstract: BACKGROUND
  Early series of biventricular device removal have contained mostly younger cardiac venous (CV) left ventricular leads and few have reported on rates of successful reimplantation.
  
  
  RESULTS
  We performed a retrospective analysis of all patients referred to the Cleveland Clinic between February 2, 2001 and July 27, 2011 for removal of a biventricular device with a CV pacing lead for an infectious indication. A total of 173 patients were included. The median age of the CV leads was 22.3 months (interquartile range: 5.2-46.3 months). The complete procedural success rate for all leads was 97.7%, with the remaining 2.3% clinical successes. A total of 76.9% of CV leads were removed using simple traction alone with the remaining leads requiring the use of a laser-powered sheath. A total of 3.5% of leads required intervention (manual dissection or laser-powered dissection) within the coronary sinus (CS). Major complications occurred in 1.2% of patients. Minor complications occurred in 7.5% of patients, the majority of which were hematomas requiring drainage (6.9%). CV lead reimplantation was attempted in 107 patients of which 88 (82.8%) were successful.
  
  
  CONCLUSIONS
  CV lead removal in patients with an infected biventricular device is associated with an extremely high procedural success rate and a low incidence of major complications. The use of a laser-powered sheath is necessary in roughly one-quarter of cases with a very small percentage requiring intervention within the CS. Reimplantation of CV leads is achievable in roughly 83% of patients, a figure lower than nationally quoted estimates for de novo implantations.
authors.affiliation: Heart and Vascular Institute Cleveland Clinic, Cleveland, Ohio, USA. rickarj2@ccf.org
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Tarakji
authors.forename: Edmond
authors.initials: E
authors.lastname: Cronin
authors.forename: Michael P
authors.initials: MP
authors.lastname: Brunner
authors.forename: Gregory
authors.initials: G
authors.lastname: Jackson
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.forename: Peter P
authors.initials: PP
authors.lastname: Borek
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D062906:Cardiac Catheters; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D004866:Equipment Contamination; D004867:Equipment Design; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left