title: Implantable defibrillator lead extraction with optimized standard extraction techniques.
abstract: BACKGROUND
  Implantable cardioverter-defibrillator (ICD) leads might not be extracted especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate transvenous extraction of ICD leads using optimized standard techniques.
  
  
  METHODS
  We prospectively analyzed clinical characteristics, optimized extraction techniques and the feasibility of extraction for 40 patients (33 males; mean age 47.9 ± 16.1 years) with 42 ICD leads.
  
  
  RESULTS
  Complete procedural success rate was 95.2% (40/42), and the clinical success rate was 97.6% (41/42). One ICD lead required cardiothoracic surgery. Minor complications occurred in three cases (7.5%), and no major complications or death occurred. Locking stylets were used to extract most leads (34, 81.0%) and almost half of the leads (20, 47.6%) required mechanical dilatation to free fibrotic adhesions; these leads had been implanted for a longer period of time than the others (43.7 ± 18.2 vs. 18.4 ± 13.4 months, P < 0.05). Three-quarters of the leads (30, 71.4%) were extracted with locking stylets plus manual traction (12, 28.6%), or mechanical dilatation with counter-traction (18, 42.8%) by the superior vena cava approach and one-quarter of the leads (11, 26.2%) were removed by optimized snare techniques using the femoral vein approach. Median extraction time was 20 min (range 2-68 min) per lead. Linear regression analysis showed that the extraction time was significantly correlated with implant duration (r = 0.70, P < 0.001). Median follow-up was 14.5 months (range 1-58 months), no infection, or procedure-related death occurred in our series.
  
  
  CONCLUSIONS
  Our optimized procedure for transvenous extraction of ICD leads provides a practical and low-cost method for standard procedures.
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China ; Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China.
authors.forename: Xian-Ming
authors.initials: XM
authors.lastname: Chu
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Li
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Yi
authors.initials: Y
authors.lastname: An
authors.forename: Jiang-Bo
authors.initials: JB
authors.lastname: Duan
authors.forename: Long
authors.initials: L
authors.lastname: Wang
authors.forename: Ding
authors.initials: D
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Guo
keywords: Complications; Extraction; Implantable cardioverter-defibrillator; Infection; Lead