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Published on: December 11, 2017
Coronary sinus lead extraction in the era of cardiac resynchronization therapy: single center experience
Babak Kasravi1, Serge Tobias, Mary J Barnes
1Memorial Heart Institute, Long Beach Memorial Medical Center, Long Beach, California 90806, USA.
Insights
Coronary sinus (CS) lead extraction for cardiac resynchronization therapy is increasingly common. This study found that CS lead extraction using nonsurgical techniques is safe and effective, with no major complications observed.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) utilizes coronary sinus (CS) leads.
- Increasing CRT use necessitates safe CS lead extraction protocols.
- Safety data for CS lead extraction remains limited.
Purpose of the Study:
- To evaluate the safety and success of nonsurgical CS lead extraction.
- To report complications associated with CS lead removal.
Main Methods:
- Retrospective review of pacemaker lead extractions from January 2002 to February 2004.
- Analysis of 14 patients with biventricular devices requiring CS lead extraction.
- Documentation of extraction techniques, duration of lead implantation, and complications.
Main Results:
- All 14 CS leads were successfully extracted using nonsurgical methods.
- Leads implanted for longer durations (>27 months) required femoral vein approach due to fibrous attachment.
- No major complications such as CS laceration, hypotension, or pericardial effusion occurred.
Conclusions:
- Nonsurgical extraction of CS leads is a safe and effective procedure.
- The technique is associated with relative ease and minimal complications.
- Further studies with larger cohorts are warranted to confirm these findings.
Abstract:
As the number of coronary sinus (CS) lead implantations for cardiac resynchronization therapy increases so will the need for extraction of these leads. The safety of extraction of leads from the branches of the CS has not been reported. We reviewed our database of patients undergoing pacemaker lead extraction from January 2002 through February 2004 at our institution. Of 149 patients referred for lead extraction, 14 (9%) had a biventricular device. The indications for lead extraction were infection, lead malfunction, and exit block. The duration of CS lead implants ranged between 2 and 43 months (mean 17 months). All 14 CS leads were removed successfully using nonsurgical lead extraction techniques. Three leads that were in place the longest (> or =27 months) were removed via the femoral vein approach due to fibrous attachment of the CS lead body to the other pacemaker leads. The leads were structurally intact and without any significant fibrosis of their tips upon visual inspection. There were no major complications of CS laceration, hypotension, pericardial effusion, or excessive blood loss associated with any of the extraction procedures. CS leads were removed safely, successfully and with relative ease based on our experience in this small cohort of patients.
