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Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads
George H Crossley1, Robert A Sorrentino2, Derek V Exner3
1Vanderbilt University, Nashville, Tennessee.
Heart Rhythm
|February 2, 2016
Summary
Extracting the Medtronic StarFix (model 4195) left ventricular lead is challenging but achievable. Experienced operators in high-volume centers can successfully remove these leads with low complication rates.
Area of Science:
- Cardiology
- Medical Device Technology
- Electrophysiology
Background:
- The Medtronic StarFix (model 4195) is an active fixation left ventricular lead with deployable lobes for coronary sinus (CS) stability.
- Concerns exist regarding the extractability of the StarFix lead despite its proven CS stability.
Purpose of the Study:
- To compare the safety and efficacy of extracting the Medtronic StarFix (model 4195) lead versus other Medtronic CS leads.
- To evaluate lead extraction success and complication rates in a prospective cohort study.
Main Methods:
- Prospective enrollment of patients undergoing CS lead extraction for standard indications.
- Primary outcomes: lead removal success rates and complication rates.
- One-month follow-up post-procedure.
Main Results:
- Overall left ventricular lead extraction success rate was 97.6% (n=205).
- Successful extraction of StarFix leads (model 4195) was 92.5% (37/40), compared to 98.8% for non-4195 leads (165/167).
- All 10 StarFix leads implanted <6 months were removed without incident; 2/3 failures involved non-standard techniques.
Conclusions:
- CS lead extraction success rates are high with similar complication rates across models.
- StarFix lead extraction is more challenging but feasible in experienced, high-volume centers.
- Extraction of the StarFix lead by experienced operators is recommended.
