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Lead extraction in children and young adults using different techniques
Embiya Dilber1, Tevfik Karagöz, Alpay Celiker
1Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Insights
Percutaneous pacemaker lead removal in children was successful in most cases, but simple traction techniques often required surgery. Newer methods are needed to improve pediatric lead extraction success rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Device Extraction
Background:
- Pacemaker lead removal in children presents unique challenges.
- Implantation duration and patient history (e.g., prior cardiac surgery) can influence extraction outcomes.
Purpose of the Study:
- To evaluate the effectiveness of different techniques for percutaneous pacemaker lead removal in pediatric patients.
- To identify factors influencing successful lead extraction in this population.
Main Methods:
- Retrospective analysis of 39 lead removals in 30 pediatric patients (aged 4-21 years) between 1999 and 2006.
- Techniques included simple traction/rotation, locking stylet with traction, and laser extraction.
- Reasons for removal varied, including lead fracture, upgrading, and infection.
Main Results:
- Overall, 74.3% (29/39) of leads were completely removed.
- Simple traction/rotation had a lower success rate, necessitating surgical removal in some cases.
- Longer duration of lead implantation was the sole significant predictor of successful removal.
Conclusions:
- Percutaneous lead removal is feasible in most pediatric cases but current techniques have limitations.
- Simple traction methods are associated with a higher rate of surgical conversion.
- Development of advanced techniques is crucial to enhance pediatric pacemaker lead extraction success.
Objective:
To describe our experience with removal of pacing lead in children using different techniques.
Patients And Methods:
Between 1999 and 2006, removal of 39 leads was attempted in 30 patients: 21 males and 9 females aged 4-21 years (mean 12 +/- 5 years). Sixteen patients had previous corrective cardiac surgery. The leads had been implanted for 46 +/- 31 months (range 1-120 months). The reasons for removal included lead fracture in 14, upgrading in 8, infection in 7, dislodgment in 5, pacing system not needed in 2, and other reasons in 3.
Results:
Of the 39 leads, 29 (74.3%) were completely removed. Twelve leads were removed with simple traction and rotation and 9 were removed using a locking stylet combined with simple traction and rotation; a laser extraction system was used in 10 cases in which 8 leads were successfully removed. Duration of implantation was the only important predictor for successful removal. Three patients necessitated surgical lead removal and had epicardial pacemaker implantation.
Conclusion:
Using currently available techniques, percutaneous pacemaker lead removal was possible in the majority of cases, although a significant number of cases were not successful. Attempted lead removal with simple traction and rotation resulted in the need for surgical removal in a significant number of patients. Newer techniques should be developed to increase the success rate.
