Difficulty and potential risks of single-lead atrioventricular synchronous pacing leads in transvenous lead...

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Lead extraction is a critical procedure in managing cardiac implantable electronic device complications.
• The excimer laser sheath has emerged as a valuable tool for complex lead extractions.
• Factors influencing the success of laser sheath lead extraction require further elucidation.

Purpose of the Study:

• To investigate the key factors impacting the success rate of cardiac lead extraction using an excimer laser sheath.
• To identify predictors of procedural failure in excimer laser sheath-assisted lead extraction.

Main Methods:

• A retrospective analysis of 372 lead extractions performed between January 2011 and December 2016.
• Patients underwent lead extraction using an excimer laser sheath, with data collected on demographics, lead characteristics, and procedural outcomes.
• Statistical analysis was employed to compare characteristics between successful and failed extraction groups.

Main Results:

• The overall clinical success rate for lead extraction was 96%.
• Procedural failure was significantly associated with the use of a single-lead atrioventricular synchronous (VDD) pacing lead (odds ratio 30.9) and longer time since lead implantation (odds ratio 1.1).
• Longer fluoroscopy times were also observed in cases of procedural failure.

Conclusions:

• The use of a VDD-pacing lead is a significant predictor of unsuccessful lead extraction.
• Increased time since lead implantation is also a critical factor associated with extraction failure.
• Operators should exercise heightened caution and employ specific strategies when performing lead extraction with VDD-pacing leads.