Abstract
BackgroundImplantation of coronary sinus (CS) leads may be a difficult procedure due to different vein anatomies and a possible lead dislodgement. The mode of CS lead fixation has changed and developed in recent years.ObjectivesWe compared the removal procedures of active and passive fixation leads.MethodsBetween January 2009 and January 2014, 22 patients at our centre underwent CS lead removal, 6 active and 16 passive fixation leads were attempted using simple traction or lead locking devices with or without laser extraction sheaths. Data on procedural variables and success rates were collected and retrospectively analyzed.ResultsThe mean patient age was 67.2 ± 9.8 years, and 90.9% were male. The indication for lead removal was infection in all cases. All active fixation leads were Medtronic® Attain StarFix™ Model 4195 (Medtronic Inc., Minneapolis, MN, USA). The mean time from implantation for the active and passive fixation leads was 9.9 ± 11.7 months (range 1.0–30.1) and 48.7 ± 33.6 months (range 5.7–106.4), respectively (p = 0.012). Only 3 of 6 StarFix leads were successfully removed (50%) compared to 16 of 16 (100%) of the passive fixation CS leads (p = 0.013). No death or complications occurred during the 30-day follow-up.ConclusionAccording to our experience, removal of the Starfix active fixation CS leads had a higher procedural failure rate compared to passive.
Highlights
The number of implanted cardiac resynchronization-therapy devices (CRT) has increased over time, so has the need of coronary sinus (CS) lead removal [1] [2] [3] [4]
No death or complications occurred during the 30-day follow-up
We report our findings on CS lead removal, with the aim to evaluate procedural success related to the mode of CS lead fixation, which has been changing and developing in recent years [6]
Summary
The number of implanted cardiac resynchronization-therapy devices (CRT) has increased over time, so has the need of CS lead removal [1] [2] [3] [4]. The removal of such leads, indicated by infection or lead dysfunction, can be very complicated, due to the fragile structure of the CS and the possible laceration of the thin vein wall, as supported by animal data [5]. We report our findings on CS lead removal, with the aim to evaluate procedural success related to the mode of CS lead fixation, which has been changing and developing in recent years [6].
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