Coronary Sinus Lead Extraction in the Era of Cardiac Resynchronization Therapy:

Abstract

As the number of coronary sinus (CS) lead implantations for cardiac resynchronization therapy increases so will the need for extraction of these leads. The safety of extraction of leads from the branches of the CS has not been reported. We reviewed our database of patients undergoing pacemaker lead extraction from January 2002 through February 2004 at our institution. Of 149 patients referred for lead extraction, 14 (9%) had a biventricular device. The indications for lead extraction were infection, lead malfunction, and exit block. The duration of CS lead implants ranged between 2 and 43 months (mean 17 months). All 14 CS leads were removed successfully using nonsurgical lead extraction techniques. Three leads that were in place the longest (> or =27 months) were removed via the femoral vein approach due to fibrous attachment of the CS lead body to the other pacemaker leads. The leads were structurally intact and without any significant fibrosis of their tips upon visual inspection. There were no major complications of CS laceration, hypotension, pericardial effusion, or excessive blood loss associated with any of the extraction procedures. CS leads were removed safely, successfully and with relative ease based on our experience in this small cohort of patients.

Percutaneous Lead and System Extraction in Patients with Cardiac Resynchronization Therapy (CRT) Devices and Coronary Sinus Leads

“…Previous series of CS lead removal are also heterogeneous in the explantation technique used after manual traction. For example, Tyres et al 3 used powered sheaths, Kasravi et al 4 used femoral snares, Bongiorni et al 7 used mechanical dilatation, and Burke et al 6 used the laser sheath. Regardless, all of these studies, and the present study, achieved a high procedural success rate (98–100%) for CS lead extraction, indicating that CS lead extraction is technically feasible.…”

Pacemaker and Defibrillator Lead Extraction: Predictors of Mortality during Follow-Up

“…The latter will also lead to an increasing requirement for coronary sinus lead extraction. Experience in removal of these leads is being published 16–19 . The CS leads that were part of CRT devices were all removed with gentle traction.…”

Postmortem Anatomy of the Coronary Sinus Pacing Lead

“…The extraction in the one patient, however, was smooth and without any complications. Similarly, Kasravi et al 4 report on CS lead extraction in 14 patients. A total of 13 leads were extracted from the CS and its tributaries smoothly without difficulty.…”

“…Electrodes with fixation tines at the end (Easytrak, Easytrak 2, Guidant) do not seem to represent any serious problem during the removal either. In fact, 2 out of 14 extracted leads in aforementioned patients cohort 4 were tined leads. Another serious problem might be the inability to insert a locking stylet into the lead during extraction due to intraluminal thrombotic occlusion, 4 which may be desirable for tensile strength and support during gradual traction.…”