title: Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads.
abstract: The Medtronic model 4195 (StarFix) left ventricular lead is an active fixation lead that provides additional support within the coronary sinus (CS) via deployable lobes. While this lead has been shown to have excellent stability within the CS, concerns about its extractability have been raised.
  
  
  
  The aim of this study was to compare the safety and efficacy of the extraction of the model 4195 lead vs other Medtronic CS leads in a prospective cohort study.
  
  
  
  Patients undergoing extraction of this and other CS leads for standard indications were prospectively enrolled and studied. The primary outcomes of interest were the removal success rates and associated complication rates. Patients were followed for a month postprocedure.
  
  
  
  The overall left ventricular lead extraction success rate was 97.6% (n = 205). Among 40 patients with chronic model 4195 leads, there were 37 successful extractions (92.5%) as compared to 98.8% for the 165 non-4195 leads. However, in 2 of the 3 StarFix lead extraction failures, standard extraction techniques were not used. All 10 of the model 4195 leads that had been implanted for less than 6 months were extracted without incident.
  
  
  
  In this largest study of CS lead extractions published to date, the overall success rate of the extraction of chronically implanted CS leads is high and the complication rate is similar in these lead models. The extraction of the model 4195 lead is clearly more challenging, but it can be accomplished in high-volume extraction centers with experienced operators. It is recommended that the model 4195 lead be extracted by experienced operators.
authors.affiliation: Vanderbilt University, Nashville, Tennessee. Electronic address: george.crossley@vanderbilt.edu.
authors.forename: George H
authors.initials: GH
authors.lastname: Crossley
authors.affiliation: Medical College of Georgia, Georgia Regents University, Augusta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorrentino
authors.affiliation: Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Derek V
authors.initials: DV
authors.lastname: Exner
authors.affiliation: Bryan Heart, Lincoln, Nebraska.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Merliss
authors.affiliation: Long Beach Memorial, Long Beach, California.
authors.forename: Serge M
authors.initials: SM
authors.lastname: Tobias
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: Ralph
authors.initials: R
authors.lastname: Augostini
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Providence Saint Joseph Medical Center, Burbank, California.
authors.forename: Raymond
authors.initials: R
authors.lastname: Schaerf
authors.affiliation: Medtronic Inc., Minneapolis, Minnesota.
authors.forename: Shelby
authors.initials: S
authors.lastname: Li
authors.affiliation: Medtronic Inc., Minneapolis, Minnesota.
authors.forename: Clayton T
authors.initials: CT
authors.lastname: Miller
authors.affiliation: HealthEast Heart Care, St. Paul, Minnesota.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Adler
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices / Q000145:classification*; D015331:Cohort Studies; D054326:Coronary Sinus / Q000601:surgery; D020878:Device Removal / Q000009:adverse effects / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010138:Pacemaker, Artificial / Q000145:classification*; D011446:Prospective Studies
keywords: Cardiac resynchronization therapy; LV leads; Lead extraction