title: Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction.
abstract: OBJECTIVE
  The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction.
  
  
  METHODS
  The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups.
  
  
  RESULTS
  The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B.
  
  
  CONCLUSIONS
  Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Uk
authors.initials: U
authors.lastname: Jo
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: You-Mi
authors.initials: YM
authors.lastname: Hwang
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Hyung-Oh
authors.initials: HO
authors.lastname: Choi
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Woo-Seok
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang-Hee
authors.initials: CH
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.affiliation: Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
keywords: Defibrillators, implantable; Device removal; Pacemaker, artificial