title: Comparison of standard and modified transvenous techniques for complex pacemaker lead extractions in the context of cardiac implantable electronic device-related infections: a 10-year experience.
abstract: OBJECTIVE
  Complete lead extraction of cardiac implantable electronic devices (CIED) for device-related infections remains a complex procedure for chronically implantated leads. We present data from a single-centre registry of consecutive patients with extractions over 10 years.
  
  
  RESULTS
  Patients were identified from the centre's electronic database with CIED-related infections who underwent lead extraction using either the standard technique and equipment or a modified innovative transvenous lead technique extraction using an ablation catheter. Of 151 patients with CIED-related infections, not responding to simple manual traction to effect lead extraction, average age 65 ± 8 years (range 45-82), 64% being male, 75 underwent standard (S) extraction, and 76 underwent modified (M) extraction. Procedural, lead extraction, and fluoroscopy exposure times with S and M methods, respectively, were 65 ± 14 vs. 52 ± 6 min (P < 0.01), 56 ± 12 vs. 36 ± 8 min (P < 0.001), and 48 ± 12 vs. 31 ± 7 min (P < 0.001). Retrieval rates were numerically lower with the standard technique at 92 vs. 96% but did not achieve significance, with respective complication rates of 6.7 and 5.3%.
  
  
  CONCLUSIONS
  In our single-centre study, a modified extraction technique to retrieve leads for infections of CIEDs using a steerable ablation catheter has improved procedural parameters over the standard technique, without compromising clinical lead extraction success rates. This may be a promising approach for a future, prospective trial.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urmuqi, Xinjiang 830011, China.
authors.forename: XianHui
authors.initials: X
authors.lastname: Zhou
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: Jian
authors.initials: J
authors.lastname: Ma
authors.forename: Ameet
authors.initials: A
authors.lastname: Bakhai
authors.forename: JinXin
authors.initials: J
authors.lastname: Li
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: YaoDong
authors.initials: Y
authors.lastname: Li
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: YanYi
authors.initials: Y
authors.lastname: Zhang
authors.forename: GuoJun
authors.initials: G
authors.lastname: Xu
authors.forename: JiangHua
authors.initials: J
authors.lastname: Zhang
authors.forename: BaoPeng
authors.initials: B
authors.lastname: Tang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac implantable electronic devices; Femoral approach; Lead extraction; Pacemaker