Outcomes Of Transvenous Lead Extraction Research Articles

Three-dimensional binding sites volume assessment during cardiac pacing lead extraction

Background/objectivesBinding sites are the principal cause of failed lead removal and complications, and are not directly visualized by fluoroscopy. We aimed to assess binding sites between permanent cardiac pacing leads and cardiovascular structures using CartoSound™ three-dimensional (3D) imaging technology (Biosense Webster Inc., Diamond Bar, CA) during transvenous lead extraction, and compared outcomes to standard approach. MethodsWe recruited 291 patients undergoing percutaneous lead extraction, and 3D CartoSound anatomical mapping of the superior vena cava, right atrium (RA), coronary sinus, right ventricle (RV), pacing leads, and binding sites before, during, and after lead removal was randomly performed in 46 of them (38 men; mean age 73.7±10.5years; 1.96 leads/patient; mean time-from-implant of 62.7±51.8months) using a 10-Fr 3D SoundStar™ catheter and integrated into the Carto® mapping system. ResultsCartoSound was able to detect more intracardiac binding sites compared to fluoroscopy (RA 17.4% vs. 4.3%, p=0.04; RV 43.5% vs. 21.7%, p=0.04), but was unable to assess the subclavian/innominate veins. Binding sites volume correlated positively with time-from-implant (r=0.38, p<0.05), and powered-sheath use (r=0.39, p<0.05), and negatively with procedural success (r=−0.37, p<0.05). When compared to standard approach, CartoSound use was characterized by a significantly lower mean procedure time (p=0.0001), major complications (p=0.03), and greater procedure success rates (p=0.03). ConclusionsReal-time 3D binding sites assessment is feasible and improves transvenous lead extraction outcomes. Its role as a complementary information requires extensive validation, and might be beneficial for a tailored strategy.

Rib Perforation From a Right Ventricular Pacemaker Lead

A 50-year-old man was admitted to a community hospital for high fever. Seven years earlier, he had been in a motor vehicle accident and a cervical spine injury had resulted in quadriplegia and ventilator dependence. During that hospitalization, he was noted to have long sinus pauses that were thought to be vagally mediated, and a single-chamber pacemaker was implanted to hasten his recovery, with an active fixation pacing lead placed at the right ventricular apex (Figure 1A through 1C). His bradycardia spells subsequently disappeared, and minimal pacing was needed. Figure 1. Serial chest radiographs showing the pacemaker lead position at the time of implantation (A), at initial hospital discharge (B), 7 months after implantation (C), and at the current admission (D). The position of the lead tip is designated by an arrow, and the lead tip is clearly located outside the rib cage (D). Because of spiking fevers, leukocytosis, and methicillin-resistent Staphylococcus aureus growing from blood cultures; a …