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Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825
Andrzej Kutarski1, Wojciech Jacheć2, Marek Czajkowski3
1Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland.
Journal of Clinical Medicine
|April 27, 2024
Summary
Lead break (LB) during transvenous lead extraction (TLE) occurs in 6.04% of procedures. This predictable difficulty increases complexity and complication risks, necessitating strategic planning and training.
Area of Science:
- Cardiology
- Medical Device Technology
- Surgical Procedures
Background:
- Lead break (LB) during transvenous lead extraction (TLE) is an underreported complication.
- Existing literature lacks detailed descriptions of LB incidence and characteristics.
Purpose of the Study:
- To investigate the incidence, risk factors, and implications of lead break during transvenous lead extraction.
- To analyze the impact of lead break on procedure complexity and patient outcomes.
Main Methods:
- Retrospective analysis of 3825 consecutive transvenous lead extractions performed using mechanical sheaths.
- Categorization of lead break events based on fragment length and characteristics.
- Identification of risk factors and predictive scores (LECOM, LED) associated with lead break.
Main Results:
- Lead break occurred in 6.04% of transvenous lead extractions.
- Specific incidences included LB with long fragments (2.48%), short fragments (1.20%), tip fracture (1.78%), and free-floating fragments (0.57%).
- Risk factors included long lead dwell time, higher LV ejection fraction, multiple prior CIED procedures, and passive fixation lead extraction; LB increased procedure complexity and major complication rates (9.96% vs. 1.53%).
Conclusions:
- Lead break is a significant complication during TLE, occurring in 6.04% of cases.
- Predictable lead break increases procedural complexity and the risk of major complications.
- Incorporating awareness and management of lead break into TLE strategies and training is crucial.
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