title: Major predictors of fibrous adherences in transvenous implantable cardioverter-defibrillator lead extraction.
abstract: BACKGROUND
  Percutaneous removal of implantable cardioverter-defibrillator (ICD) leads is a difficult procedure because of the consequence of massive fibrous tissue growth along the lead.
  
  
  OBJECTIVE
  The purpose of this study was to describe the occurrence and location of fibrous adherences in ICD lead extraction and to identify potential predictors among patient and lead characteristics.
  
  
  METHODS
  We studied 637 consecutive patients who underwent transvenous extraction of 678 ICD leads from 1997 to 2013.
  
  
  RESULTS
  Procedural success rate was 99%, without major complications. Areas of adherence were found in the subclavian vein (78%), innominate vein (65%), superior vena cava (66%), and heart (73%). Dwell-time, passive fixation, and dual-coil lead design were independently associated with adherences. Dual-coil lead design was associated with adherences in the innominate vein and superior vena cava, whereas coil treatment (eg, expandable polytetrafluoroethylene-coated or medical adhesive back-filled strategies) prevented adherences. Passive fixation mechanism was associated with adherences in the heart.
  
  
  CONCLUSIONS
  ICD leads, after long dwell-time, are affected by fibrous adherences uniformly distributed along the lead course. Lead features represent major predictors of the phenomenon. Careful lead selection is recommended at the time of implantation to prevent adherences. In addition, lead-related risk stratification is mandatory before a transvenous extraction procedure.
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy. Electronic address: lucasegreti@gmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Segreti
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Soldati
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Zucchelli
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Viani
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Paperini
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Lucia
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coluccia
authors.affiliation: Boston Scientific Italy, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods* / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005355:Fibrosis / Q000473:pathology*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D007601:Jugular Veins; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D000267:Tissue Adhesions; D016896:Treatment Outcome
keywords: Adherence; Implantable cardioverter-defibrillator; Internal jugular vein; Lead; extraction