title: The fate of nontargeted endocardial leads during the extraction of one or more targeted leads in pediatrics and congenital heart disease.
abstract: BACKGROUND
  Extraction of targeted endocardial leads can lead to inadvertent damage or dislodgement of nontargeted leads, though the frequency of this has not been reported in pediatrics and congenital heart disease (CHD).
  
  
  METHODS
  This is a retrospective review of lead extraction procedures from 2002 to 2010 from two pediatric and CHD centers evaluating unplanned interventions on nontargeted leads during the extraction of one or more targeted leads.
  
  
  RESULTS
  Nontargeted leads were present in the 22 lead extraction procedures performed on 20 patients with median age 15 years (interquartile range, 11.5-18.5 years): 11 (55%) with structurally normal hearts and nine (45%) with CHD. Twenty of 23 targeted leads (86%) were extracted with complete success. Of the 22 nontargeted leads, including 17 atrial leads and five ventricular leads, seven (32%) required further intervention including: five extracted due to damage, dislodgement, or change in device location; one abandoned due to damage; and one dislodged requiring a second procedure for repositioning. The remaining 15 nontargeted leads (68%) were unharmed. Nontargeted leads requiring further intervention had a shorter lead duration in situ (median 2 years, interquartile range 0.5-3.5 years) than unharmed nontargeted leads (median 6.6 years, interquartile range 4.1-9.1 years; P = 0.01). Age at extraction, CHD, implantable cardioverter defibrillator leads, atrial lead position, or primary extraction modality did not predict further intervention for nontargeted leads. Major complications occurred in one procedure (4.5%) with no deaths.
  
  
  CONCLUSIONS
  In pediatrics and CHD, nontargeted leads are frequently damaged or dislodged during the extraction of targeted leads. The risk of lead damage or dislodgement has implications for procedural planning and counseling for patients and families of pediatric and CHD patients requiring lead extraction.
authors.affiliation: Department of Pediatrics, University of Colorado Denver School of Medicine/Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: McCanta
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.forename: David Martin
authors.initials: DM
authors.lastname: Runciman
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D003120:Colorado; D020878:Device Removal / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004699:Endocardium / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis / Q000209:etiology*; D006330:Heart Defects, Congenital / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: congenital heart disease; lead extraction; pediatrics