A large single-center clinical trial of transvenous lead extraction

Abstract

Objective Transveneous lead extraction is the basic therapy in the management of cardiovascular implantable electrical device(CIED)infection.In this report, we presented our initial experience in transvenous lead extraction and the method of tools-choosing. Methods From January 2007 to March 2014, the study was divided into two periods: period one(January 2007-Maych 2013), period two(June 2013-December 2014).1 032 leads in 501 patients were removed.The indications for extraction were based on the recommendations of the heart rhythm society.The success rate, complication, lead types and special tools, etc were compared. Results During the period one(Jan 2007-May 2013), 509 leads in 252 patients were removed, in which atrial lead 189(37.1%), right ventricular lead 272(53.4%), left ventricular lead 24(4.7%), defibrillator coil 24(4.7%). Implantation duration was 27(0.3-360.0)months, Success rate 98.9%, major complication in 6 cases, 2 death(1.7%). During the period two(June 2013-December 2014), 523 leads in 249 patients were extracted, in which atrial leads 201(38.4%), right ventricular leads 240(45.9%), left ventricular leads 35(6.7%), defibrillator coils 47(9.0%). Implantation duration was 38(0.4-490.0)months.Success rate was 100%, major complication in 1 case, 0 deaths.In period two, 77 leads were extracted by Evolution mechanical dilator sheath(Cook Medical), major complication 1 case(1.3%). Four hundreds leads were extracted by Needle's Eye Snare(Cook Medical), major complication in 1 case(0.25%). Conclusion The transvenoues lead extraction is effective in management of CIED infection.It companied the risk of major complication.The reasonable tools-choosing will increase the safety and efficacy.Needle Eye Snare could be the primary choice in lead extraction. Key words: Cardiovascular implantable electrical device; Pacemaker; Infection; Lead extraction