In-Hospital and Midterm Outcomes of Lead Extraction: A Single-Center Clinical Study
-
Fahimeh Valizadeh-shiran
,
Negin Sadat Hosseini Mohammadi
,
Kiarash Tavakoli
,
Arash Jalali
,
Seyed Hossein Ahmadi Tafti
,
Ahmad Yaminisharif
Abstract
Background: The rate of lead extraction has steadily increased alongside the extensive use of cardiovascular implantable electronic devices. Data on the complications and safety of this challenging procedure are limited. We investigated in-hospital and midterm outcomes following lead extraction.
Methods: Data were retrieved from 51 patients who underwent pacemaker/defibrillator lead extraction procedures at Tehran Heart Center between 2016 and 2021. The procedural success rate, patients’ demographic characteristics, and in-hospital and midterm procedure-related complications were investigated.
Results: Fifty-one patients were enrolled, including 44 men (86.3%). A total of 109 leads were extracted, with a 90.2% complete procedural success rate. In-hospital death occurred in 4 patients (7.8%): 1 patient (1.9%) died from pneumonia, 1 (1.9%) from septic shock, and 2 (3.9%) from septic shock besides heparin‐induced thrombocytopenia. Adverse events in 3 patients (5.8%) were directly related to the procedure: 1 patient (1.9%) suffered lung laceration and hemorrhage, 1 (1.9%) sustained subclavian injury, and 1 (1.9%) developed tamponade. Neither reinfection nor rehospitalization was observed during follow-up.
Conclusion: Lead extraction can be considered a highly successful procedure with a low rate of death-related events and complications.
1. Jacheć W, Polewczyk A, Polewczyk M, Tomasik A, Janion M, Kutarski A. Risk Factors Predicting Complications of Transvenous Lead Extraction. Biomed Res Int 2018;2018:8796704.
2. Maisel WH, Moynahan M, Zuckerman BD, Gross TP, Tovar OH, Tillman DB, Schultz DB. Pacemaker and ICD generator malfunctions: analysis of Food and Drug Administration annual reports. JAMA 2006;295:1901-1906.
3. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2013;127:e283-352.
4. Wazni O, Epstein LM, Carrillo RG, Love C, Adler SW, Riggio DW, Karim SS, Bashir J, Greenspon AJ, DiMarco JP, Cooper JM, Onufer JR, Ellenbogen KA, Kutalek SP, Dentry-Mabry S, Ervin CM, Wilkoff BL. Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 2010;55:579-586.
5. Maytin M, Epstein LM. The challenges of transvenous lead extraction. Heart 2011;97:425-434.
6. Buiten MS, van der Heijden AC, Schalij MJ, van Erven L. How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods. Europace 2015;17:689-700.
7. Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, Epstein LM, Friedman RA, Kennergren CE, Mitkowski P, Schaerf RH, Wazni OM; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009;6:1085-1104.
8. Camboni D, Wollmann CG, Löher A, Gradaus R, Scheld HH, Schmid C. Explantation of implantable defibrillator leads using open heart surgery or percutaneous techniques. Ann Thorac Surg 2008;85:50-55.
9. Atallah J, Erickson CC, Cecchin F, Dubin AM, Law IH, Cohen MI, Lapage MJ, Cannon BC, Chun TU, Freedenberg V, Gierdalski M, Berul CI; Pediatric and Congenital Electrophysiology Society (PACES). Multi-institutional study of implantable defibrillator lead performance in children and young adults: results of the Pediatric Lead Extractability and Survival Evaluation (PLEASE) study. Circulation 2013;127:2393-2402.
10. Kennergren C, Bjurman C, Wiklund R, Gäbel J. A single-centre experience of over one thousand lead extractions. Europace 2009;11:612-617.
11. Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 1990;13(12 Pt 2):1871-1875.
12. Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 1990;13(12 Pt 2):1871-1875.
13. Swerdlow CD, Koneru JN, Gunderson B, Kroll MW, Ploux S, Ellenbogen KA. Impedance in the Diagnosis of Lead Malfunction. Circ Arrhythm Electrophysiol 2020;13:e008092.
14. Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha YM, Clancy J, Deharo JC, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017;14:e503-e551.
15. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-1549.
16. Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000;23(4 Pt 1):544-551.
17. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Jenkins SM, Baddour LM. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 2008;83:46-53.
18. Epstein LM, Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Hayes DL, Reiser C. Initial experience with larger laser sheaths for the removal of transvenous pacemaker and implantable defibrillator leads. Circulation 1999;100:516-525.
19. Chua JD, Wilkoff BL, Lee I, Juratli N, Longworth DL, Gordon SM. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000;133:604-608.
20. Kazemisaeed A, Moezzi A, Shafiee A, Ghazanchai F. Unusual treatment of pacemaker pocket infection: a case report. J Tehran Heart Cent 2010;5:202-204.
21. Lima NA, Cunha GS, Menezes NS, Silva ELD Junior, Lima CCV, Sampaio SMV. Lead Removal Without Extraction Tools: A Single-Center Experience. Braz J Cardiovasc Surg 2019;34:458-463.
22. Neuzil P, Taborsky M, Rezek Z, Vopalka R, Sediva L, Niederle P, Reddy V. Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. Europace 2007;9:98-104.
23. Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol 1999;33:1671-1676.
24. Roux JF, Pagé P, Dubuc M, Thibault B, Guerra PG, Macle L, Roy D, Talajic M, Khairy P. Laser lead extraction: predictors of success and complications. Pacing Clin Electrophysiol 2007;30:214-220.
25. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Turk KT, Reeves R, Young R, Crevey B, Kutalek SP, Freedman R, Friedman R, Trantham J, Watts M, Schutzman J, Oren J, Wilson J, Gold F, Fearnot NE, Van Zandt HJ. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 1999;22:1348-1357.
26. Kutarski A, Czajkowski M, Pietura R, Obszanski B, Polewczyk A, Jachec W, Polewczyk M, Mlynarczyk K, Grabowski M, Opolski G. Effectiveness, safety, and long-term outcomes of non-powered mechanical sheaths for transvenous lead extraction. Europace 2018;20:1324-1333.
27. Yaminisharif A, Ahmadi Tafti SH, Hosseinsabet A, Shafiee A. Repositioning a Displaced Right Ventricular Pacing Lead via Percutaneous Approach in Three Patients. J Innov Card Rhythm Manag 2022;13:5057-5060.
28. Puri R, Psaltis PJ, Nelson AJ, Sanders P, Young GD. Povidone-iodine Irrigation - A Possible Alternative To Lead Extraction. Indian Pacing Electrophysiol J 2011;11:115-119.
29. Sharif AY, Davoodi G, Saeed AK, Sadeghian S. New technique: repositioning of dislodged atrial pacing lead with a specially designed urological basket. Europace 2007;9:105-107.
2. Maisel WH, Moynahan M, Zuckerman BD, Gross TP, Tovar OH, Tillman DB, Schultz DB. Pacemaker and ICD generator malfunctions: analysis of Food and Drug Administration annual reports. JAMA 2006;295:1901-1906.
3. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2013;127:e283-352.
4. Wazni O, Epstein LM, Carrillo RG, Love C, Adler SW, Riggio DW, Karim SS, Bashir J, Greenspon AJ, DiMarco JP, Cooper JM, Onufer JR, Ellenbogen KA, Kutalek SP, Dentry-Mabry S, Ervin CM, Wilkoff BL. Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 2010;55:579-586.
5. Maytin M, Epstein LM. The challenges of transvenous lead extraction. Heart 2011;97:425-434.
6. Buiten MS, van der Heijden AC, Schalij MJ, van Erven L. How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods. Europace 2015;17:689-700.
7. Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, Epstein LM, Friedman RA, Kennergren CE, Mitkowski P, Schaerf RH, Wazni OM; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009;6:1085-1104.
8. Camboni D, Wollmann CG, Löher A, Gradaus R, Scheld HH, Schmid C. Explantation of implantable defibrillator leads using open heart surgery or percutaneous techniques. Ann Thorac Surg 2008;85:50-55.
9. Atallah J, Erickson CC, Cecchin F, Dubin AM, Law IH, Cohen MI, Lapage MJ, Cannon BC, Chun TU, Freedenberg V, Gierdalski M, Berul CI; Pediatric and Congenital Electrophysiology Society (PACES). Multi-institutional study of implantable defibrillator lead performance in children and young adults: results of the Pediatric Lead Extractability and Survival Evaluation (PLEASE) study. Circulation 2013;127:2393-2402.
10. Kennergren C, Bjurman C, Wiklund R, Gäbel J. A single-centre experience of over one thousand lead extractions. Europace 2009;11:612-617.
11. Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 1990;13(12 Pt 2):1871-1875.
12. Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 1990;13(12 Pt 2):1871-1875.
13. Swerdlow CD, Koneru JN, Gunderson B, Kroll MW, Ploux S, Ellenbogen KA. Impedance in the Diagnosis of Lead Malfunction. Circ Arrhythm Electrophysiol 2020;13:e008092.
14. Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha YM, Clancy J, Deharo JC, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017;14:e503-e551.
15. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-1549.
16. Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000;23(4 Pt 1):544-551.
17. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Jenkins SM, Baddour LM. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 2008;83:46-53.
18. Epstein LM, Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Hayes DL, Reiser C. Initial experience with larger laser sheaths for the removal of transvenous pacemaker and implantable defibrillator leads. Circulation 1999;100:516-525.
19. Chua JD, Wilkoff BL, Lee I, Juratli N, Longworth DL, Gordon SM. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000;133:604-608.
20. Kazemisaeed A, Moezzi A, Shafiee A, Ghazanchai F. Unusual treatment of pacemaker pocket infection: a case report. J Tehran Heart Cent 2010;5:202-204.
21. Lima NA, Cunha GS, Menezes NS, Silva ELD Junior, Lima CCV, Sampaio SMV. Lead Removal Without Extraction Tools: A Single-Center Experience. Braz J Cardiovasc Surg 2019;34:458-463.
22. Neuzil P, Taborsky M, Rezek Z, Vopalka R, Sediva L, Niederle P, Reddy V. Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. Europace 2007;9:98-104.
23. Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol 1999;33:1671-1676.
24. Roux JF, Pagé P, Dubuc M, Thibault B, Guerra PG, Macle L, Roy D, Talajic M, Khairy P. Laser lead extraction: predictors of success and complications. Pacing Clin Electrophysiol 2007;30:214-220.
25. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Turk KT, Reeves R, Young R, Crevey B, Kutalek SP, Freedman R, Friedman R, Trantham J, Watts M, Schutzman J, Oren J, Wilson J, Gold F, Fearnot NE, Van Zandt HJ. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 1999;22:1348-1357.
26. Kutarski A, Czajkowski M, Pietura R, Obszanski B, Polewczyk A, Jachec W, Polewczyk M, Mlynarczyk K, Grabowski M, Opolski G. Effectiveness, safety, and long-term outcomes of non-powered mechanical sheaths for transvenous lead extraction. Europace 2018;20:1324-1333.
27. Yaminisharif A, Ahmadi Tafti SH, Hosseinsabet A, Shafiee A. Repositioning a Displaced Right Ventricular Pacing Lead via Percutaneous Approach in Three Patients. J Innov Card Rhythm Manag 2022;13:5057-5060.
28. Puri R, Psaltis PJ, Nelson AJ, Sanders P, Young GD. Povidone-iodine Irrigation - A Possible Alternative To Lead Extraction. Indian Pacing Electrophysiol J 2011;11:115-119.
29. Sharif AY, Davoodi G, Saeed AK, Sadeghian S. New technique: repositioning of dislodged atrial pacing lead with a specially designed urological basket. Europace 2007;9:105-107.
| Files | ||
| Issue | Vol 19 No 1 (2024): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v19i1.15533 | |
| Keywords | ||
| Lead Implantable cardioverter-defibrillators Cardiac resynchronization therapy Cardiac resynchronization therapy devices | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Valizadeh-shiran F, Hosseini Mohammadi NS, Tavakoli K, Jalali A, Ahmadi Tafti SH, Yaminisharif A. In-Hospital and Midterm Outcomes of Lead Extraction: A Single-Center Clinical Study. J Tehran Heart Cent. 2024;19(1):25-30.
