Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Surgical Techniques

Background:

• Early lead replacement for pacemakers (PM) and implantable cardioverter defibrillators (ICD) poses challenges.
• Subclavian vein puncture for lead replacement risks complications like pneumothorax and hematothorax.
• The Byrd-sheath offers a venous puncture-avoiding alternative for lead replacement.

Purpose of the Study:

• To evaluate the safety and efficacy of the Byrd-sheath technique for early lead replacement.
• To assess the feasibility of lead exchange within 14 days of initial implantation.
• To determine if this method avoids complications associated with subclavian vein puncture.

Main Methods:

• A retrospective analysis of 55 patients undergoing early lead exchange using the Byrd-sheath from January 2010 to December 2017.
• The technique involved cutting the malfunctioning lead, stabilizing it with a stylet, and passing it through the Byrd-sheath into the subclavian vein.
• After lead removal, the Byrd-sheath was replaced with a peel-away sheath for new lead insertion.

Main Results:

• Successful explantation of 23 defibrillation leads and 34 pacing leads (16 RA, 17 RV, 1 LV).
• Subclavian vein access was uneventful with minimal blood loss.
• Negligible radiation exposure and fluoroscopy time were recorded.

Conclusions:

• The Byrd-sheath technique is a safe and successful method for early lead replacement.
• It provides reliable subclavian vein access within two weeks of initial implantation.
• This approach effectively avoids the risks of repeat subclavian vein puncture.