Safety and efficacy of internal transjugular approach for transvenous extraction of implantable cardioverter defibrillator leads.
OBJECTIVE
We report our 15 years experience of a mechanical single-sheath technique with a multiple venous entry-site approach. We evaluated the effectiveness and safety of this technique in implantable defibrillator (ICD) lead extraction and investigated the potential association between clinical and lead-related factors and procedural complexity.


RESULTS
The proposed technique consists of an initial attempt at manual traction, followed by mechanical dilatation performed through the venous entry-site and, if necessary, by crossover to the internal transjugular approach. The study cohort comprised 545 consecutive patients referred to our institution for transvenous lead extraction from January 1997 to December 2012. Initial manual traction resulted in the effective removal of 6% of leads. Mechanical dilatation increased the success rate to 89% when performed through the venous entry-site, and to 99% when subsequently attempted via the internal jugular vein. No major complications were associated with lead extraction. Dwell-time, a passive fixation mechanism and dual-coil lead design were independently associated with the need for mechanical dilatation. However, dwell-time was the only variable associated with crossover to the internal transjugular approach. Specifically, a dwell-time of 20 months best predicted the need for venous entry-site mechanical dilatation, while a value of 55 months predicted crossover to the internal transjugular approach.


CONCLUSIONS
Mechanical transvenous extraction of ICD leads is a complex but safe and effective procedure. A longer lead dwell-time is associated with the need for mechanical dilatation and for crossover to the internal transjugular approach; this should be considered when planning the removal procedure. Moreover, passive lead fixation and dual-coil lead design predict a more challenging extraction procedure.
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy m.g.bongiorni@med.unipi.it.
Maria Grazia
MG
Bongiorni
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Luca
L
Segreti
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Andrea
A
Di Cori
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Giulio
G
Zucchelli
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Stefano
S
Viani
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Luca
L
Paperini
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Raffaele
R
De Lucia
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Adriano
A
Boem
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Dianora
D
Levorato
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Ezio
E
Soldati
D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000379:methods* / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007601:Jugular Veins; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
Extraction; Implantable defibrillator; Internal jugular vein; Lead