Coronary Sinus Lead Removal: A Comparison between Active and Passive Fixation Leads.
Implantation of coronary sinus (CS) leads may be a difficult procedure due to different vein anatomies and a possible lead dislodgement. The mode of CS lead fixation has changed and developed in recent years.



We compared the removal procedures of active and passive fixation leads.



Between January 2009 and January 2014, 22 patients at our centre underwent CS lead removal, 6 active and 16 passive fixation leads were attempted using simple traction or lead locking devices with or without laser extraction sheaths. Data on procedural variables and success rates were collected and retrospectively analyzed.



The mean patient age was 67.2 ± 9.8 years, and 90.9% were male. The indication for lead removal was infection in all cases. All active fixation leads were Medtronic® Attain StarFix™ Model 4195 (Medtronic Inc., Minneapolis, MN, USA). The mean time from implantation for the active and passive fixation leads was 9.9 ± 11.7 months (range 1.0-30.1) and 48.7 ± 33.6 months (range 5.7-106.4), respectively (p = 0.012). Only 3 of 6 StarFix leads were successfully removed (50%) compared to 16 of 16 (100%) of the passive fixation CS leads (p = 0.013). No death or complications occurred during the 30-day follow-up.



According to our experience, removal of the Starfix active fixation CS leads had a higher procedural failure rate compared to passive.
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Simon
S
Pecha
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Charles
C
Kennergren
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Yalin
Y
Yildirim
Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Nils
N
Gosau
Department of Cardiology, St. Adolf-Stift Hospital Reinbek, Reinbek, Germany.
Ali
A
Aydin
Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Stephan
S
Willems
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Hendrik
H
Treede
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Hermann
H
Reichenspurner
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Samer
S
Hakmi
D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000601:surgery*; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome