Related Experiment Videos
Coronary sinus lead extraction
G Frank O Tyers1, Jacquie Clark, Yan Wang
1Vancouver General Hospital Pacemaker Clinic, Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
Insights
Coronary sinus lead extraction (CS-LE) is complex but safe and effective. This study shows complete removal of CS leads with no serious complications, even for leads in place for many years.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Coronary sinus (CS) leads are associated with higher complication rates during implantation and extraction compared to other lead types.
- Extraction of CS leads poses increased risks, necessitating evaluation of safety and efficacy.
Purpose of the Study:
- To review the experience with non-thoracotomy lead extraction (LE) of coronary sinus leads.
- To evaluate the prevalence, safety, and efficacy of CS lead extraction.
Main Methods:
- Review of a detailed database of lead extractions performed since 1981.
- Analysis of 14 patients referred for CS-LE, including leads intentionally and inadvertently placed.
- Utilized various extraction techniques, from simple traction to advanced methods like intraluminal locking stylets and powered sheaths.
Main Results:
- Complete removal of all CS leads was achieved in all patients.
- CS-LE procedures were performed efficiently, with a mean duration of 13 minutes (1.8 minutes fluoroscopy).
- No serious complications occurred during the procedures, and the mean hospital stay was 4 days.
Conclusions:
- Non-thoracotomy lead extraction of coronary sinus leads is a safe and effective procedure.
- Successful complete lead removal can be achieved regardless of lead placement duration, from months to over 27 years.
- The findings support CS-LE as a viable option for managing CS leads when removal is indicated.
Abstract:
Complications are reported more frequently with the implantation of coronary sinus (CS) than other types of leads, and attempts to extract CS leads may also be associated with increased risks. The authors have performed nonthoracotomy lead extraction (LE) since 1981 and maintained a detailed database. By November 2001, 796 leads had been removed from 401 patients. We undertook review of our CS-LE experience to evaluate prevalence, safety, and efficacy. Of 14 patients referred for CS-LE, 7 were treated in the last year. In six the lead had been placed in the CS intentionally, and in eight inadvertently. One recent patient treated with biventricular pacing was septic and died before LE was undertaken. In nine men and four women (mean age 66 years) had one each CS lead and a total of 34 LEs (2.6/patient). Four CS leads had been in place for < 6 months (mean 1.5 month), whereas nine had been in place for between 6 months and 27 years. Several LE methods were used, from simple traction to the use of intraluminal locking stylets and powered sheaths. Complete removal of all leads was achieved in all patients. CS-LE required a mean of 13 minutes, including 1.8 minutes of fluoroscopy. There were no serious complications during the procedures, and the mean hospital stay was 4 days.