title: Removal of active-fixation coronary sinus leads using a mechanical rotation extraction device.
abstract: BACKGROUND
  Active fixation coronary sinus (CS) leads are widely used in cardiac resynchronization therapy (CRT). Due to their low dislodgement rates they are an attractive option for implanters. However, extraction of active fixation leads is a complex procedure that bears potential fatal risks for patients.
  
  
  METHODS
  We analyzed all patients undergoing StarFix® (Medtronic Inc., Minneapolis, MN, USA) extraction because of severe infection at our institution. Indication for extraction was severe device infection. Procedural outcomes as well as patient characteristics are reported. For removal of the leads a 9-Fr Evolution® (Cook Intravascular Inc., Leechburg, PA, USA) mechanical rotation extraction sheath was used.
  
  
  RESULTS
  Between 2011 and 2014, six patients underwent extraction of StarFix® leads. One patient was female, whereas the others were males (mean age 64 ± 12 years). Implant duration was 46.5 ± 8.2 months before removal. All leads could be successfully extracted totally with the Evolution®. In one patient (16.6%) pericardial tamponade occurred immediately requiring surgical intervention. After establishment of cardiopulmonary bypass a 5-mm sharp cut in the lateral vein of the CS could be identified. It was fixed and the patient survived. On all leads, significant tissue growth between the fixation lobes could be observed.
  
  
  CONCLUSIONS
  As illustrated by our cases, Attain StarFix® leads implanted years ago can be extracted with the help of a mechanical extraction sheath. However, this procedure bears potential risks and should only be performed with a cardiac surgery standby. If clinicians evaluate the implantation of Attain StarFix® leads in patients who are young or at high risk for device infection, they should be aware of these findings.
authors.affiliation: Department of Internal Medicine 1 - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kypta
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.forename: Karim
authors.initials: K
authors.lastname: Saleh
authors.forename: Simon
authors.initials: S
authors.lastname: Hönig
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kammler
authors.forename: Clemens
authors.initials: C
authors.lastname: Steinwender
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000503:physiopathology / Q000601:surgery*; D020878:Device Removal / Q000295:instrumentation*; D004452:Echocardiography; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000628:therapy*; D012399:Rotation
keywords: active fixation leads; device infection; lead extraction; resynchronization therapy