Lead Removal Without Extraction Tools: A Single-Center Experience.

Neiberg De Alcantara Lima,Stela Maria Vitorino Sampaio,Carol Cavalcante De Vasconcelos Lima,Natalia Soares De Menezes,Gisele Schinaider Cunha,Evilásio Leobino Da Silva Junior

doi:10.21470/1678-9741-2018-0275

Neiberg De Alcantara Lima, Stela Maria Vitorino Sampaio + Show 4 more

Open Access

https://doi.org/10.21470/1678-9741-2018-0275

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Abstract

IntroductionIndications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure’s outcome but have economic implications.ObjectiveThe aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices.MethodsThis retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes.ResultsThe median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases.ConclusionThis article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Highlights

Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls
The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices
This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique

Summary

Introduction

Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. With a global trend towards the in-creasingly technological tools, meant to improve the procedure’s outcome but have economic implications. The rising number of comorbidities per patient as well as the use of cardiac resynchronization therapy (CRT) devices, which require more leads to be implanted, contribute to the increasing need for lead extractions as a result of infections, failed leads and device recalls[3]. It uses methods that vary from simple local traction to the use of powered laser sheaths, with a global trend towards the increasingly technological tools, meant to improve the procedure’s outcomes[6].

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