Usefulness of mechanical transvenous dilation and location of areas of adherence in patients undergoing coronary sinus lead extraction

Abstract

Few data have been currently reported on the outcome of coronary sinus (CS) lead removal, particularly using mechanical dilation (MD). We aimed to evaluate feasibility, safety, and effectiveness of CS lead extraction, focusing on MD usefulness, in the event that lead traction (LT) was ineffective. We studied 37 consecutive patients (30 males, mean age 68.1, range 52-80), who underwent left ventricle (LV) pacing lead removal; the indication for extraction was local infection in 16 patients (43.3%), sepsis in 11 patients (29.7%), and lead malfunction in 10 patients (27%). The procedure was first attempted by LT, followed, if unsuccessful, by MD using polypropylene sheaths. All CS leads (time from implant 19.5 +/- 16.5, range 2-84 months) were successfully removed; LT was effective (LT group) in 27 patients (73%) and ineffective in 10 patients (27%), for whom MD was necessary (MD group). There were no major complications. The areas of adherence were in the CS in only one patient. No differences were noted in the data analysed between LT and MD groups; in particular, time from implant was similar in the two groups (MD vs. LT group: 17 +/- 8.9 vs. 20.4 +/- 18.6 months; P = ns). Our study suggests that CS leads, after medium-term implantation, can be effectively and safely removed using MD with polypropylene sheaths, in the case of unsuccessful LT. No pre-operative elements predictive of LT failure could be identified. Areas of adherence were rarely located in the CS or its tributaries.