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Transvenous Lead Extraction in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Amr F Barakat1, Mohammad A Zmaili2, Khaldoun G Tarakji3

  • 1Department of Medicine, Cleveland Clinic, Cleveland, Ohio; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

JACC. Clinical Electrophysiology
|June 22, 2019
PubMed

Insights

Transvenous lead extraction (TLE) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients is safe and effective. High success rates and low complication rates were observed when using established techniques and tools in a high-volume center.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Arrhythmogenic right ventricular cardiomyopathy (ARVC) necessitates device implantation for sudden death prevention.
  • Transvenous lead extraction (TLE) in ARVC patients presents unique challenges due to potential right ventricular wall thinning and fragility.
  • Limited data exists on the safety and efficacy of TLE in the context of ARVC.

Purpose of the Study:

  • To evaluate the effectiveness and safety of transvenous lead extraction (TLE) in patients diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC).

Main Methods:

  • A retrospective analysis of consecutive ARVC patients who underwent TLE between 1996 and 2016.
  • Utilized specialized extraction tools with sheaths advanced to the right ventricle with countertraction at the lead tip.
  • Success and complication rates were assessed according to Heart Rhythm Society guidelines.

Main Results:

  • Twenty-two TLE procedures were performed on 27 leads (22 defibrillators, 5 pacemakers) in ARVC patients.
  • Indications for TLE included lead malfunction (77%) and device infection (23%).
  • Complete procedural success was achieved in all cases with no major complications, utilizing specialized tools in 91% of procedures.

Conclusions:

  • Transvenous lead extraction in ARVC patients can be performed with high success and low complication rates.
  • Adherence to guideline-established techniques and utilization of appropriate tools are crucial for safe TLE in ARVC.
  • High-volume centers can achieve excellent outcomes for TLE in this challenging patient population.
Abstract

Keywords:
arrhythmogenic right ventricular cardiomyopathyarrhythmogenic right ventricular dysplasiaimplantable cardioverter-defibrillatorlead extractionpacemaker

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