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Intravascular lead extraction using locking stylets, sheaths, and other techniques
N E Fearnot1, H J Smith, L B Goode
1Hillenbrand Biomedical Engineering Center, Purdue University, West Lafayette, Indiana 47907.
Pacing and Clinical Electrophysiology : PACE
|December 1, 1990
Summary
Transvenous lead extraction is effective for removing chronic pacemaker leads, even in complex cases. Proper training and surgical backup ensure patient safety and successful outcomes, potentially avoiding open-heart surgery.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Interventional Cardiology
Background:
- Septicemia and infection are common reasons for chronic pacemaker lead extraction.
- Pacemaker lead extraction is a complex procedure with potential complications.
- Various lead types, insulation materials, and fixation methods exist, influencing extraction difficulty.
Purpose of the Study:
- To evaluate the efficacy and safety of transvenous lead extraction in a large patient cohort.
- To identify factors influencing procedural success and complications.
- To assess the necessity of open-heart surgery for lead removal.
Main Methods:
- A retrospective analysis of 228 chronic pacemaker lead extractions across 34 institutions.
- Leads were accessed via implantation veins (subclavian, cephalic, jugular) or femoral approach.
- Data collected included patient demographics, lead characteristics, indications for extraction, procedural techniques, and complications.
Main Results:
- Successful complete extraction was achieved in 194 out of 228 leads (85%).
- Indications for extraction included infection (48%), prophylaxis/replacement (40%), and others (12%).
- Serious procedural complications were rare (e.g., torn atrium, hemothorax, myocardial avulsion).
Conclusions:
- Intravascular lead extraction is a viable and beneficial technique for managing chronic pacemaker leads.
- Adequate intensive training and availability of open-heart surgical backup are crucial for safe and effective procedures.
- This technique can potentially obviate the need for open-heart surgery for lead extraction.