Femoral extraction of transvenous leads and leadless pacemakers—A review of the data, tools, and procedural steps

El‐Chami, Mikhael F.; Merchant, Faisal M.

doi:10.1111/pace.13766

Cited by 3 publications

(3 citation statements)

References 20 publications

(40 reference statements)

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“…CIED leads undergoe fibrotic encapsulation over time, whose mechanism is not entirely understood but is most likely due to simultaneous activation of cellular and humoral mechanisms [5]. TLE employs several methods in order to liberate targeted leads from fibrotic tissue, which binds them to major veins, cardiac structures, or other CIED leads [6,7]. During the last decade, modern extraction tools and technical advancements improved the success rate and safety of the procedure, but TLE is still considered a high-risk intervention with serious potential complications and even death [8].…”

Section: Introductionmentioning

confidence: 99%

Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Zsigmond

Miklós

Vida

et al. 2021

J Interv Card Electrophysiol

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Purpose The use of cardiac implantable electronic devices (CIEDs) has increased significantly over the last decades. With the development of transvenous lead extraction (TLE), procedural success rates also improved; however, data regarding long-term outcomes are still limited. The aim of our study was to analyze the outcomes after TLE, including reimplantation data, all-cause and cause-specific mortality. Methods Data from consecutive patients undergoing TLE in our institution between 2012 and 2020 were retrospectively analyzed. Periprocedural, 30-day, long-term, and cause-specific mortalities were calculated. We examined the original and the revised CIED indications and survival rate of patients with or without reimplantation. Results A total of 150 patients (age 66 ± 14 years) with 308 leads (dwelling time 7.8 ± 6.3 years) underwent TLE due to pocket infection (n = 105, 70%), endocarditis (n = 35, 23%), or non-infectious indications (n = 10, 7%). All-cause mortality data were available for all patients, detailed reimplantation data in 98 cases. Procedural death rate was 2% (n = 3), 30-day mortality rate 2.6% (n = 4). During the 3.5 ± 2.4 years of follow-up, 44 patients died. Arrhythmia, as the direct cause of death, was absent. Cardiovascular cause was responsible for mortality in 25%. There was no significant survival difference between groups with or without reimplantation (p = 0.136). Conclusions Despite the high number of pocket and systemic infection and long dwelling times in our cohort, the short-and longterm mortality after TLE proved to be favorable. Moreover, survival without a new device was not worse compared to patients who underwent a reimplantation procedure. Our study underlines the importance of individual reassessment of the original CIED indication, to avoid unnecessary reimplantation.

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Section: Introductionmentioning

confidence: 99%

Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Zsigmond

Miklós

Vida

et al. 2021

J Interv Card Electrophysiol

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“…Specialized snare tools introduced via the femoral vein can be used to complete the extraction; this ‘bail-out’ approach is required in 5% of cases 3 which are often challenging cases with longer lead dwell time and a high number of leads to extract. 4 A small number of operators have utilized the femoral access as the primary route for TLE with clinical success rates of 98%. 5 These two TLE routes have also been used in ‘Tandem’.…”

Section: Introductionmentioning

confidence: 99%

Transvenous lead extraction: Experience of the Tandem approach

Akhtar,

Kontogiannis,

Elbatran

et al. 2023

Europace

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Aims Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with ‘bail-out’ support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach. Method The ‘Tandem’ procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive ‘Tandem’ procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics. Results The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar. Conclusion The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.

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“…Case reports to date have described techniques that typically involve capturing the device with a goose-neck snare via a deflectable sheath introduced through a femoral vein. 4 The needle’s eye snare is widely used during extraction of chronically implanted leads 5 ; however, its use has not hitherto been reported for the extraction of LPs. Given the likely growth in LP implantation, further work is required to develop effective techniques for device extraction.…”

Section: Introductionmentioning

confidence: 99%

The use of a needle’s eye snare to extract a leadless pacemaker in a patient with a persistent bacteremia

Mor-Welch

Butcher

Sporton

et al. 2022

HeartRhythm Case Reports

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Femoral extraction of transvenous leads and leadless pacemakers—A review of the data, tools, and procedural steps

Cited by 3 publications

References 20 publications

Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Transvenous lead extraction: Experience of the Tandem approach

The use of a needle’s eye snare to extract a leadless pacemaker in a patient with a persistent bacteremia

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