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Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques
Xian-Ming Chu1, Xue-Bin Li, Ping Zhang
1Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China.
Insights
This study demonstrates a modified technique for percutaneous coronary sinus (CS) lead extraction, achieving high success rates. The cost-effective method is particularly beneficial for developing countries lacking specialized equipment.
Area of Science:
- Cardiology
- Medical Device Extraction
- Interventional Cardiology
Background:
- Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are necessary for systemic infection, malfunction, or device upgrades.
- Research on CS lead extraction is limited, especially in developing nations due to high costs and lack of specialized tools.
- This study evaluates modified conventional techniques for percutaneous CS lead extraction.
Purpose of the Study:
- To assess the feasibility and effectiveness of modified conventional techniques for percutaneous coronary sinus (CS) lead extraction.
- To provide a practical solution for CS lead removal in resource-limited settings.
Main Methods:
- Prospective analysis of 24 patients undergoing CS lead extraction from January 2007 to June 2011.
- Utilized modified conventional techniques including locking stylets, manual traction, mechanical dilatation, and snare techniques.
- Analyzed clinical characteristics, extraction techniques, and procedural outcomes.
Main Results:
- Achieved 95.8% complete procedural success and 100.0% clinical success in 24 CS leads.
- Infection was the primary indication for extraction (66.7%).
- Modified techniques, including locking stylets and manual traction, were successful in 66.6% of cases; mechanical dilatation and snare techniques were used for challenging extractions.
Conclusions:
- Modified percutaneous extraction of CS leads is practical and effective.
- This approach offers a viable alternative in developing countries where expensive powered sheaths are unavailable.
- The technique demonstrates high success rates for CS lead removal, addressing a gap in specialized procedures.
Background:
Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques.
Methods:
Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 (12.0%) involved CS leads (24 CS leads). We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction.
Results:
Complete procedural success was achieved in 23 patients (95.8%), and the clinical success in 24 patients (100.0%). The leading indication for CS lead extraction was infection (66.7%). Mean implant duration was (29.5 ± 20.2) months (range, 3 - 78 months). Sixteen CS leads (66.6%) were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads (16.7%), which had longer implant duration than other leads ((62.5 ± 12.3) vs. (22.9 ± 14.1) months, P < 0.05). Another 4 CS (16.7%) leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes (range, 3 - 61 minutes) per CS lead, which had significant correlation with implant duration (r = 0.8, P < 0.001). Sixteen patients (66.6%) were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months (range, 8 - 61 months), three patients died due to sudden cardiac death (26 months), heart failure (45 and 57 months, respectively).
Conclusion:
The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.
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