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Safety and effectiveness of coronary sinus leads extraction - single high-volume centre experience
Andrzej W Kutarski1, Wojciech Jacheć2, Łukasz Tułecki3
1Cardiology Department, Medical University of Lublin, Lublin, Poland.
Insights
Transvenous lead extraction (TLE) of coronary sinus (CS) leads is safe and effective, with complication rates comparable to other lead types. Advanced techniques may be needed for difficult CS lead removal.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Extraction
Background:
- Transvenous lead extraction (TLE) of coronary sinus (CS) leads is perceived as high-risk.
- Limited data exists on the safety and efficacy of CS lead TLE.
Purpose of the Study:
- To evaluate the safety and efficacy of CS lead extraction.
- To compare CS lead TLE outcomes with non-CS lead TLE.
Main Methods:
- Analysis of 408 CS lead extractions by a single operator across two centers.
- Comparison with a control group of 2465 non-CS lead TLE procedures.
Main Results:
- Clinical success rates were similar (97.9% vs. 98.0%) between CS and control groups.
- Major complication rates were comparable (2.1% vs. 1.8%).
- Lead destination and tip location affected procedural success but not complications.
Conclusions:
- TLE of CS leads is achievable with high success and acceptable complication rates.
- Over half of CS leads require mechanical sheaths for removal.
- CS lead extraction does not increase the need for cardiosurgery or procedure-related death.
Introduction:
Transvenous leads extraction (TLE) of permanently implanted coronary sinus (CS) leads is widely believed to present greater risks than the removal of other leads.
Aim:
To assess the safety and efficacy of CS leads extraction based on large research material obtained by one operator performing procedures in two TLE centres.
Material And Methods:
We extracted 408 CS leads from 389 patients, and the results were compared to a control group of 2465 patients who underwent non-CS lead TLE procedures.
Results:
There were no significant differences in the clinical success rate (97.9% vs. 98.0%) or the major complication rate (2.1% vs. 1.8%) between the CS and control group. CS lead destination (LV/LA pacing) and tip location (CS ostium/mid CS /CS tributaries) influenced the procedural and radiological success rates and procedural complexity but not the complications. CS lead extraction did not affect the necessity for a cardiosurgical intervention or presence of procedure-related death.
Conclusions:
TLE of CS leads can be achieved with a high procedural success rate. The major complication rate is not higher than that seen in non-CS lead extraction patients. More than half of CS leads cannot be removed by simple traction and the use of mechanical sheaths may be necessary. The detachment of CS leads from connective tissue scars in the venous and atrial areas up to the CS ostium is generally sufficient for further removal of the lead using simple traction.
