Coronary Venous Lead Extraction.

Edmond Cronin

doi:10.19102/icrm.2017.080604

Abstract

The increasing number of cardiac resynchronization therapy devices implanted, coupled with the increasing incidence of cardiac implantable electronic device infection, has led to a greater need for extraction of coronary venous pacing leads. The objectives of this study were to review the indications, techniques and published results of coronary venous lead extraction. In this study, we searched PubMed using the search terms “lead extraction,” “coronary sinus,” “coronary venous,” “pacing,” and “cardiac resynchronization therapy” for relevant papers. The reference lists of relevant articles were also searched, and personal experience was drawn upon. Published success rates and complications were found to be similar to those reported for non-coronary venous leads in experienced centers. However, reimplantation success differs and can be limited by vessel occlusion postextraction. The available active fixation coronary sinus lead (Attain Starfix™; Medtronic, MN, USA) is a particularly complex lead to extract, whereas limited data on the newer active fixation leads (Attain Stability™, Medtronic, MN, USA) suggest that they are less challenging to remove. The study concluded that coronary venous lead extraction presents unique challenges, especially reimplantation, that require special consideration and planning to overcome.

Highlights

Expanded indications for cardiac resynchronization therapy (CRT), both with and without an implantable cardioverterdefibrillator (ICD), have led to increasing numbers of implants.[1,2] This, coupled with an increasing incidence of cardiac implantable electronic device (CIED) infection, has led to a more frequent need of transvenous lead extraction (TLE) of coronary venous leads
The coronary venous system includes the coronary sinus (CS) and its branches and has a highly variable anatomy,[3] leading to lead courses that can vary considerably. This is in contrast to relatively uniform right atrial and right ventricular lead courses
Patients with coronary venous leads are generally regarded as being sicker and more medically complex than those with single- or dual-chamber ICDs or pacemakers

Summary

Introduction

Expanded indications for cardiac resynchronization therapy (CRT), both with and without an implantable cardioverterdefibrillator (ICD), have led to increasing numbers of implants.[1,2] This, coupled with an increasing incidence of cardiac implantable electronic device (CIED) infection, has led to a more frequent need of transvenous lead extraction (TLE) of coronary venous leads. The coronary venous system includes the coronary sinus (CS) and its branches and has a highly variable anatomy,[3] leading to lead courses that can vary considerably. This is in contrast to relatively uniform right atrial and right ventricular lead courses. These patients involves both careful periprocedural patient management and a thorough knowledge of anatomy and techniques

Methods

Findings

Conclusions