title: Re-evaluation of transvenous lead extraction with modified standard technique: a prospective study in 229 patients.
abstract: As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients (median, 66 years) who underwent lead extraction due to infection and lead malfunction were registered and followed up prospectively with respect to clinical features, reasons for lead extraction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted transvenously by using special tools from 229 patients (male, 72.1%). Vegetations ≥1 cm were detected in six patients. Locking Stylets were applied for 398 (90.5%) leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 (45.9%) leads due to lead adhesion, and the mean implant duration of the 202 leads was longer than the other 238 leads (48.9±22.6 vs. 26.6±17.8 months; P <0.01). In addition, modified isolation and snare techniques were used for 56 leads (12.7%). Minor and major procedure-related complications occurred in three (1.3%) and four (1.7%) cases respectively, including one death (0.4%). Severe lead residue occurred in one case. Complete procedural success rate was 96.1% (423/440), and clinical success rate was 98.9% (435/440). The median follow-up period was 18 (1-76) months. No infection- and procedure-related death occurred in our series. Our data demonstrated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.
authors.affiliation: Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, 266100, China.|Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Xian-Ming
authors.initials: XM
authors.lastname: Chu
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China. qd1234321@yeah.net.
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Long
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Jiang-Bo
authors.initials: JB
authors.lastname: Duan
authors.affiliation: Department of Biology, Medical College of Qingdao University, Qingdao, 266021, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China. cxm19782001@sina.com.
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents