Related Experiment Videos
The Dotter retriever and pigtail catheter: efficacy in extraction of chronic transvenous pacemaker leads
R E Espinosa1, D L Hayes, R E Vlietstra
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
The Dotter retriever and pigtail catheter effectively dislodge chronic pacemaker leads that resist simple traction. These tools offer a safe and successful method for lead extraction, proving valuable alongside newer technologies.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Percutaneous extraction of chronic pacemaker leads is challenging.
- Established techniques exist, but their efficacy varies.
Purpose of the Study:
- To evaluate the effectiveness of the Dotter retriever and pigtail catheter for chronic pacemaker lead removal.
- To assess the success rates of these tools in dislodging and extracting leads.
Main Methods:
- Retrospective review of 59 endocardial pacemaker lead removals in 42 patients.
- Utilized Dotter retriever and pigtail catheter for leads resistant to simple traction.
- Analyzed lead implantation duration and extraction success rates.
Main Results:
- Simple traction alone removed 32 leads; 5 were abandoned.
- Dotter retriever or pigtail catheter successfully dislodged 9 of 12 leads (75%) initially resistant to traction.
- No complications were reported with the Dotter retriever or pigtail catheter use.
Conclusions:
- The Dotter retriever and pigtail catheter demonstrate moderate efficacy in dislodging chronic endocardial leads.
- These tools are highly successful for complete lead extraction once mobilized.
- This proven technique remains valuable despite advancements in lead extraction technology.
Abstract:
Several techniques exist for percutaneous extraction of chronic pacemaker leads. To establish the efficacy of the Dotter retriever and pigtail catheter, we reviewed the removal of 59 endocardial pacemaker leads in 42 patients (mean age 71 years). The mean duration of lead implantation was 44 months (range 1-169 months). Thirty-two leads were withdrawn with simple traction alone, and five leads were abandoned when traction failed. The remaining 22 leads were manipulated with a Dotter retriever or pigtail catheter, or both. Twelve leads were dislodged from the endocardium with simple traction (10) or with traction transmitted through an entwining pigtail catheter (2), but they could not be fully withdrawn. Eleven of these leads (92%) were then successfully extracted with the Dotter retriever. Seven of the remaining 10 leads were successfully dislodged and removed by the Dotter retriever. Overall, 9 of 12 leads (75%) that could not be dislodged from the endocardium with simple traction were removed with a Dotter retriever or pigtail catheter, or both. Three patients in whom no catheter method worked required thoracotomy for removal of infected leads. No complications resulted from use of the Dotter retriever or pigtail catheter. We conclude that the Dotter retriever and pigtail catheter have moderate efficacy for dislodging chronic endocardial leads. Once mobilized, however, the leads can be withdrawn with great success with the Dotter retriever. Newer technology should not result in the abandonment of this proven technique.