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Updated: Jun 26, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Extraction of chronic pacemaker and defibrillator leads from the coronary sinus: laser infrequently used but required
Shoaib Hamid1, Aruna Arujuna, Aruna Arujna
1St Thomas' Hospital, London, UK. shoaibhamid@hotmail.com
Insights
Percutaneous extraction of coronary sinus (CS) leads is a safe and effective procedure for managing cardiac resynchronization therapy systems. Laser extraction is useful when needed, with no major complications reported in this study.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Extraction
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure treatment.
- Explantation of CRT systems, including coronary sinus (CS) leads, may be required.
- Limited evidence exists for the safety and efficacy of CS lead extraction.
Purpose of the Study:
- To evaluate the safety and effectiveness of percutaneous CS lead extraction.
- To assess the role of laser extraction in difficult cases.
- To analyze outcomes and complications associated with CS lead removal.
Main Methods:
- Retrospective review of 32 patients undergoing CS lead extraction from January 2004 to June 2008.
- Analysis of indications for extraction, implantation duration, and extraction techniques.
- Documentation of procedural success and complications.
Main Results:
- 32 CS leads were extracted from 265 patients (12.1%).
- Indications included lead malfunction (43.8%) and pocket infection (34.4%).
- 87.5% of leads were removed with manual traction; laser was used in 12.5% with no major complications.
Conclusions:
- Percutaneous extraction of CS leads is a safe and effective procedure.
- Laser extraction is a valuable tool when necessary for CS lead removal.
- The study supports routine use of percutaneous extraction for CS leads.
Aims:
Cardiac resynchronization therapy is an accepted treatment for heart failure but it may be necessary to explant these systems along with their leads. The evidence base for coronary sinus (CS) lead extractions is limited. We aimed to evaluate the percutaneous removal of these leads and the utility of laser extraction when necessary.
Methods And Results:
Of 265 patients referred for lead extraction between January 2004 and June 2008, 32 (12.1%) involved CS leads (30 males, mean age 67 years). Mean implantation time was 26.5 +/- 28.7 months (range 1-116 months). Indications for extraction were pocket infection (34.4%), lead malfunction (43.8%), skin erosion (15.6%), and endocarditis (6.2%). Twenty-eight (87.5%) CS leads were removed with manual traction, with laser utilized in four cases (12.5%). No major complications of CS laceration, pericardial effusion, emergency surgery, or death occurred.
Conclusion:
Our experience supports the percutaneous extraction of CS leads as a safe and effective procedure including the utility of laser when necessary.
