Shockwave Intravascular Lithotripsy Facilitated Transvenous Lead Extraction
Christopher A Latanich1, John A Anderson1
1Heart and Vascular Institute, Department of Medicine, Essentia Health, Duluth, Minnesota, USA.
JACC. Clinical Electrophysiology
|June 6, 2023
Summary
Shockwave intravascular lithotripsy (IVL) pretreatment significantly reduces extraction time for complex transvenous lead extraction (TLE) procedures. This innovative approach minimizes procedural risks by fracturing dense calcifications around pacemaker and defibrillator leads.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
- Electrophysiology
Background:
- Dense calcifications around long-dwelling transvenous leads complicate lead extraction procedures.
- Shockwave intravascular lithotripsy (IVL) utilizes sonic waves to fracture calcified tissue near the catheter.
Purpose of the Study:
- To evaluate the effectiveness of Shockwave IVL as a pretreatment method for transvenous lead extraction (TLE) in patients with long-dwelling pacemaker and defibrillator leads.
- To assess the impact of IVL on procedural time and complexity during TLE.
Main Methods:
- Retrospective analysis of TLE procedures performed between October 2019 and April 2023.
- IVL pretreatment involved using 7- and 8-mm balloons with up to 300 pulses delivered retrogradely to fracture lead calcifications.
- Comparison of procedural times between patients who received IVL pretreatment and those who did not.
Main Results:
- Among 65 eligible patients, 14 received IVL pretreatment; lead dwell time averaged 10.7 years.
- No significant differences in patient demographics or lead types between IVL and conventional groups.
- IVL pretreatment led to a significant reduction of 25 minutes in active lead extraction time (P=0.007).
Conclusions:
- Shockwave IVL serves as a novel adjunctive therapy for extracting high-risk, complex transvenous leads.
- This pretreatment method significantly decreases the duration of the highest-risk phase of lead extraction procedures.
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