Complication Of Transvenous Lead Extraction Research Articles

Discussing the Prognosis and Complications of Transvenous Lead Extraction in Patients With Cardiac Implantable Electronic Devices (CIED): A Systematic Review.

An increase in cardiovascular implantable electronic devices (CIEDs) and undoubtedly the complications brought on by these devices coincide with an increase in cardiovascular disorders, particularly heart rhythm abnormalities. The safest procedure to extract these devices is transvenous lead extraction (TLE). Thus, this systematic review aimed to summarize the possibility of success rates and the common complications that could arise during the surgery. Full-text publications in PubMed, MEDLINE, PubMed Central (PMC), and ScienceDirect were used in this study, which was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were reviewed for this systematic review after being screened by title, abstract, full-text availability, and quality appraisal assessment. Heart and vascular tears, along with tricuspid regurgitation (TR), are common adverse events. Pulmonary embolism, hemothorax, hemopericardium, and ghost appearance in echo are less common consequences. In addition, the longer the dwelling time of the leads, the greater the chance of infection due to an increase in lead adhesions and fibrous tissue that has made the procedure unsafe as time passes. However, we concluded that TLE is a successful method across all age groups with an excellent probability of clinical and procedural successin a majority of studies.

PO-02-056 REAL-TIME VIDEO ASSISTED THORACOSCOPIC SURGERY IN HIGH-RISK TRANSVENOUS LEAD EXTRACTION

Laceration injury to the superior vena cava (SVC) remains the most feared complication of transvenous lead extraction (TLE). Early recognition is crucial to prevent catastrophic complications. Use of real time video assisted thoracoscopic surgery (VATS) during high risk TLE can potentially be useful for prompt recognition of SVC injury. We describe the use of video assisted thorascopic surgery (VATS) guidance for complex transvenous lead extractions (TLE). We conducted a retrospective analysis of all patients that underwent TLE at our institution from September 2018 to November 2022. Our TLE protocol uses a risk stratification scheme of level 1, 2 and 3 based on perceived risk. Defibrillation leads with a dwell time of >10 years or presence of 3 leads with oldest lead >10 years qualify as level 3 TLE cases. All procedures are performed with surgical back up with the use of VAT via a right thoracoscopic approach in level 3 cases. During single lung ventilation, the surgeon places a camera port to provide visualization of the SVC and right atrium for direct visualization during the laser/mechanical sheath manipulation in the great vessels. Out of 41 patients that underwent TLE during the study period, 10 patients underwent concomitant right VATS. Mean age of cohort was 61.5 + 15.2 years and 70% were males. Mean BMI and LVEF was 28.8 + 7.9 & 28.5 + 5.9 % respectively. Indications for TLE included lead malfunction (50%), infection (40%) and removal of abandoned leads in 1 patient. Mean lead dwell time was 10.4 + 5.6 years. Laser sheath was used in all cases with 2 patients requiring use of additional mechanical sheaths. One case demonstrated externalized ICD coil and extraction was abandoned. A femoral approach with snaring was done in 1 patient. All patients had adequate visualization of the SVC via VATS during TLE. Average procedure duration was 134 + 79.1 minutes. There were no immediate procedural complications. VATS port was removed and a chest drain was placed which was removed on post operative day 1 in all patients. VATS allows for direct visualization of the venous structures, provides real time information regarding impending venous injury, and is feasible with minimal impact on procedural risk and length of stay.

Cardiac tamponade as an inherent but potentially nonfatal complication of transvenous lead extraction: Experience with 1126 procedures performed using mechanical tools.

Cardiac tamponade (CT) is one of the most common and dangerous complications of transvenous lead extraction (TLE). So far, however, there has been little discussion about the problem. We analyzed the occurrence of CT in a group of 1226 patients undergoing TLE at a single reference center between June, 2015 and February, 2021. Using standard mechanical devices as first-line tools, a total of 2092 leads had been extracted. CT occurred in 18 patients (1.47%): due to injury to the wall of the right atrium in 14 patients (1.14%) and other cardiac walls in four patients (0.33%). Younger patient age at first implantation, female gender, high left ventricular ejection fraction (LVEF), lowerNew York Heart Association class, low Charlson comorbidity index, longer implant duration, and the number of previous procedures related to cardiac implantable electronic devices (CIED) are important patient-related risk factors for CT. Significant procedure-related risk factors include the number of extracted leads, extraction of atrial leads and longer dwell time of extracted leads. Intraoperative transoesophageal echocardiography (TEE) provides a lot of information about pulling on various cardiac structures and is able to detect a very early phase of bleeding to the pericardial sac. As a result of implementing best practices guidance in performing extraction procedures and close collaboration with cardiac surgeons that allowed immediate rescue intervention in our series of 18 CT cases, there were no procedure-related deaths (mortality 0%). The need for rescue surgery due to CT has no influence on clinical and procedural success. Early diagnosed (TEE monitoring) and properly managed CT does not generate any additional risk in short- and long-term follow-up after TLE.

EN-580-01 RISK PREDICTION TOOL FOR CARDIAC PERFORATION DURING TRANSVENOUS LEAD EXTRACTION: A CANADIAN LEAD EXTRACTION RISK (CLEAR) STUDY SCORE

Cardiac perforation is a potentially life-threatening complication of transvenous lead extraction. Despite procedural advances in technology and techniques, the incidence is significant at 1 to 3%. A risk prediction tool is warranted to identify patients with an elevated risk of perforation prior to lead extraction to improve surgical planning and safety.

CI-545-01 RISK PREDICTION TOOL FOR CARDIAC PERFORATION DURING TRANSVENOUS LEAD EXTRACTION: A CANADIAN LEAD EXTRACTION RISK (CLEAR) STUDY SCORE

Cardiac perforation is a potentially life-threatening complication of transvenous lead extraction. Despite procedural advances in technology and techniques, the incidence is significant at 1 to 3%. A risk prediction tool is warranted to identify patients with an elevated risk of perforation prior to lead extraction to improve surgical planning and safety.

Transvenous lead extraction in patients with persistent left superior vena cava.

Predictors of difficulty and complications of transvenous lead extraction (TLE) have been investigated in several studies; however, little is known about the venous anatomical characteristics that can have an impact on procedural outcomes. Among them, the persistent left superior vena cava (PLSVC) is a common anomaly often discovered incidentally during cardiac device implantation and could raise concerns if TLE is indicated. We report technical considerations and outcomes of TLE for two patients with leads implanted via PLSVC. Two cardiac implantable electronic device recipients with isolated PLSVC required TLE due to infective endocarditis in one case and lead failure in the other. In the first case, TLE procedure was performed in a hybrid operating room with minimally invasive video-assisted thoracoscopic monitoring due to the high procedural risk. Two active fixation 20-year-old pacing leads were removed with a relatively short fluoroscopy time. In the second case, we successfully extracted a single-coil active fixation lead without the need of a locking stylet or advanced extraction tools. There were no procedural complications or adverse events at 1-year follow-up. TLE procedures for two patients with isolated PLSVC were successfully completed with less difficulty and tools than expected based on the characteristics of the targeted leads. If indicated, TLE in the presence of a PLSVC should be considered in experienced centers.

Risk Factors Predicting Complications of Transvenous Lead Extraction.

Objective Transvenous lead extraction (TLE) is the gold standard in the management of patients with cardiac implantable electronic devices (CIED)-related complications. Knowledge of TLE risk factors is very important. Methods Clinical data from 1915 patients undergoing TLE at the Reference Center between 2006 and 2015 were analyzed. The effects of clinical and procedure-related factors on the development of major (MJC) and minor (MIC) complications and survival after TLE were evaluated. Results MJC were caused mainly by lead implant duration, presence of abandoned leads, multiple procedures preceding TLE, and any technical problem during TLE. Of clinical factors female gender and anemia increased the risk of MJC. MIC were reported in patients with the first implantation of CIED under the age of 30 and after sternotomy analysis of 30-day survival after procedure demonstrated a significant effect of clinical factors and lead dwell times, previous unsuccessful TLE, and MIC. Conclusions Efficacy and safety of TLE depend mainly on procedure-related factors. This knowledge is essential for preventing MJC and MIC. Mortality at 30 days following TLE is mainly associated with the clinical factors; however, there was also a significant effect of lead dwell time and periprocedural complications on the short-term prognosis of patients undergoing TLE.

P1664Risk factors predicting complications of transvenous lead extraction

P1664Risk factors predicting complications of transvenous lead extraction

A rare complication of transvenous lead extraction - pulmonary embolization with a broken distal lead fragment

A rare complication of transvenous lead extraction - pulmonary embolization with a broken distal lead fragment

Removal of the broken part of implantable cardioverter-defibrillator's electrode causing pulmonary embolism via femoral vein

A 66-year-old patient with idiopathic dilated cardiomyopathy underwent transvenous extraction of an implantable cardioverter-defibrillator. The distal part of the electrode was broken during manual traction through the left subclavian vein. In the present case, we showed a rare complication of transvenous lead extraction and its management.

0382: Transvenous extraction of pacing and defibrillator leads: a highvolume single centre experience

Following the exponential growth of cardiac device implantation, there is an increase of lead extraction indications. In the meantime, the tools, the indications, and the outcomes of those procedures continue to progress. The purpose of this study was to examine contemporary indications, outcomes, and complications of transvenousleadextraction in a large series of patients at a high-volume lead extraction center. We performed a retrospective cohort study of consecutive patients undergoing leadextraction at a single, high-volume center.Our extraction strategy consists in manual traction, locking stylet traction, laser use followed by inferior approach in case of failure. Patient and lead characteristics and the indications, outcomes, and need for laser assistance were analyzed From January 2002 to December 2013, a total of 751 chronic endovascular leads were removed from 391patients.The mean age was years 68 (range 13- 98). Seventy-five percent of patients were males. Median implantation duration was 5,5 years. Indications for extraction were systemic infection (33,3%), pocket infection (25,1%), mechanical lead failure (32,7%), and upgrade of device system (6,1%)due to thrombosis of veinous access. Extraction was successful in 97,7% of patients with complete removal. Laser assistance for extraction wasrecquired in 259 patients (66,2%), completed with an inferior approach in 38 patients(9,7%). Complications were death in 2 patients (0,5%), bleeding in 21 patients (5,4%), pericardial tamponade in 8 patients (2%). In univariate analysis, laser-assisted lead extraction was required more frequently for leads that were implanted more 36 months than others (p<0,001), as well as for passive leads compared to active leads (p=0,04). Lead extraction can be safely and succefully performed in the majority of patients, with limited life-threatening complications.

Incidence, management, and outcomes of the arteriovenous fistula complicating transvenous lead extraction

An arteriovenous (AV) fistula is an infrequently reported complication of transvenous lead extraction (TLE), but may be under-recognized. To determine the incidence, management, and outcomes of the AV fistula complicating TLE. All TLE procedures from July 2001 to December 2012 were reviewed. Of 2471 patients who underwent TLE, the AV fistula occurred in 8 (0.3%; 6 pacemaker and 2 implantable cardioverter-defibrillator) procedures. Patients who developed an AV fistula had longer lead implant duration (11.8 [interquartile range 7.7] vs 5.2 [interquartile range 7.0] years) and were more likely to have required a powered sheath (8 of 8 [100%] vs 1392 of 2463 [56.5%]) compared to those who did not. Other procedural and demographic details did not discriminate. All patients had a continuous bruit along the anterior chest wall. Catheter angiography was more sensitive (100%) than computed tomography (75%) or ultrasound (25%) for confirming the diagnosis and identifying the vessels involved. One fistula closed spontaneously, while others were closed with covered stents (4) or surgical glue (1). One attempt at closure failed, and one was diagnosed postmortem. Mortality related to the AV fistula was 3 of 8 (37.5%). Patients who died all had structural heart disease. In the 5 patients with normal hearts, the AV fistula was well tolerated for up to 2 years. An AV fistula is an infrequent, though possibly under-recognized, complication of TLE. It requires a high index of suspicion for early diagnosis, may present late, and may be associated with significant morbidity and mortality in patients with structural heart disease.

Large, single-center, single-operator experience with transvenous lead extraction: Outcomes and changing indications

Lead extraction is increasingly necessary given the exponential growth in cardiac device implantation. Meanwhile, the tools, indications, and outcomes of this procedure continue to change. The purpose of this study was to examine contemporary indications, outcomes, and complications of transvenous lead extraction in a large series of patients at a high-volume lead extraction center. We performed a retrospective cohort study of consecutive patients undergoing lead extraction at a single, high-volume center. Patient and lead characteristics and the indications, outcomes, and need for laser assistance were analyzed. From January 2000 to March 2007, a total of 975 chronic endovascular leads were removed from 498 patients. Median implant duration was 5.7 years (range 0.5-32.7 years). Indications were infection (60.3%), mechanical lead failure (29.3%), and upgrade of device system (8.8%). Over the study period, lead malfunction decreased relative to other indications. Laser assistance for extraction was more likely with leads implanted longer than 3.4 years compared to less than 3.4 years (odds ratio 6.15, 95% confidence interval 3.35-11.28) and with implantable cardioverter-defibrillator leads compared to pacemaker leads (odds ratio 3.44, 95% confidence interval 1.84-6.43). Overall, 97.5% of the leads were completely removed. Major complications occurred in 2 (0.4%) patients. Only one patient required cardiac surgery. No deaths occurred. In a high-volume center, lead extraction has a high success rate and low complication rate. Infection was the most common indication overall. Lead failure has decreased in relative proportion. Implantable cardioverter-defibrillator leads and longer lead implant time are associated with a requirement for laser lead extraction.