Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads

Melanie Maytin, Roger Carrillo, Pablo Baltodano, Raymond H M Schaerf, Maria G. Bongiorni, Andrea Di Cori, Antonio Curnis, Joshua M. Cooper, Charles Kennergren, Laurence M. Epstein

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background/Objective: Active fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited. Methods: We performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers. Patient and procedural characteristics, indications for extraction, use of extraction sheath (ES) assistance, and outcomes are reported. Results: Between January 2009 and February 2011, 12 patients underwent transvenous lead extraction (TLE) of Medtronic StarFix® lead (Medtronic Inc., Minneapolis, MN, USA). The cohort was 83% male with mean age 71 ± 14 years. Average implant duration was 14.2 ± 5.7 months (2.3-23.6). All leads but one were removed for infectious indications (67% systemic infection). At the time of explant, the fixation lobes were completely retracted in only one of the 12 cases and ES assistance was required for lead removal in all cases (58% laser, 25% cutting, 25% mechanical, and 25% femoral). The majority of cases required advancement of the sheath into the CS (75.0%) and often into a branch vessel (41.7%). One lead could not be removed transvenously and required surgical lead extraction. There were no major complications. Examination of the leads after extraction frequently revealed significant tissue growth into the fixation lobes. Conclusions: Although TLE of active fixation CS leads can be a safe procedure in select patients and experienced hands, powered sheaths and aggressive techniques are frequently required for successful removal despite relatively short implant durations. This raises significant concern regarding future TLE of active fixation CS leads with longer implant durations.

Original languageEnglish
Pages (from-to)641-647
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2012

Fingerprint

Coronary Sinus
Thigh
Lead
Lasers
Cohort Studies
Retrospective Studies
Hand
Growth
Infection

Keywords

  • Lead extraction
  • Lead management
  • LV pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Maytin, M., Carrillo, R., Baltodano, P., Schaerf, R. H. M., Bongiorni, M. G., Di Cori, A., ... Epstein, L. M. (2012). Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads. PACE - Pacing and Clinical Electrophysiology, 35(6), 641-647. https://doi.org/10.1111/j.1540-8159.2012.03353.x

Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads. / Maytin, Melanie; Carrillo, Roger; Baltodano, Pablo; Schaerf, Raymond H M; Bongiorni, Maria G.; Di Cori, Andrea; Curnis, Antonio; Cooper, Joshua M.; Kennergren, Charles; Epstein, Laurence M.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 35, No. 6, 01.06.2012, p. 641-647.

Research output: Contribution to journalArticle

Maytin, M, Carrillo, R, Baltodano, P, Schaerf, RHM, Bongiorni, MG, Di Cori, A, Curnis, A, Cooper, JM, Kennergren, C & Epstein, LM 2012, 'Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads', PACE - Pacing and Clinical Electrophysiology, vol. 35, no. 6, pp. 641-647. https://doi.org/10.1111/j.1540-8159.2012.03353.x
Maytin, Melanie ; Carrillo, Roger ; Baltodano, Pablo ; Schaerf, Raymond H M ; Bongiorni, Maria G. ; Di Cori, Andrea ; Curnis, Antonio ; Cooper, Joshua M. ; Kennergren, Charles ; Epstein, Laurence M. / Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads. In: PACE - Pacing and Clinical Electrophysiology. 2012 ; Vol. 35, No. 6. pp. 641-647.
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abstract = "Background/Objective: Active fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited. Methods: We performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers. Patient and procedural characteristics, indications for extraction, use of extraction sheath (ES) assistance, and outcomes are reported. Results: Between January 2009 and February 2011, 12 patients underwent transvenous lead extraction (TLE) of Medtronic StarFix{\circledR} lead (Medtronic Inc., Minneapolis, MN, USA). The cohort was 83{\%} male with mean age 71 ± 14 years. Average implant duration was 14.2 ± 5.7 months (2.3-23.6). All leads but one were removed for infectious indications (67{\%} systemic infection). At the time of explant, the fixation lobes were completely retracted in only one of the 12 cases and ES assistance was required for lead removal in all cases (58{\%} laser, 25{\%} cutting, 25{\%} mechanical, and 25{\%} femoral). The majority of cases required advancement of the sheath into the CS (75.0{\%}) and often into a branch vessel (41.7{\%}). One lead could not be removed transvenously and required surgical lead extraction. There were no major complications. Examination of the leads after extraction frequently revealed significant tissue growth into the fixation lobes. Conclusions: Although TLE of active fixation CS leads can be a safe procedure in select patients and experienced hands, powered sheaths and aggressive techniques are frequently required for successful removal despite relatively short implant durations. This raises significant concern regarding future TLE of active fixation CS leads with longer implant durations.",
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AU - Di Cori, Andrea

AU - Curnis, Antonio

AU - Cooper, Joshua M.

AU - Kennergren, Charles

AU - Epstein, Laurence M.

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