Lead Extraction and Re-Extractions - Inherent Parts of Permanent Pacing in Children and Young Adults

Abstract

Children require often replacement of leads even several times. Repeated extraction in this group nay be challenging. We report the case of a 22-year-old man with the first pacemaker implanted in the first year of life, after Transvenous Lead Extraction procedure (TLE) and implantation of a dual-chamber pacemaker in the age of 12 years, who was admitted to the reference center for repeated TLE and to replace the entire pacing system. The presence of complete venous occlusion, lead strain and strong lead-to-lead adherence with calcified connecting tissue scar effected TLE complicity and needed utility of numerous tools and atypical technique and tricks among of them simultaneous extraction of strongly connected each one leads together via one tool showed to be crucial.

Incomplete Lead Removal During the Extraction Procedure: Predisposing Factors and Impact on Long-Term Survival in Infectious and Non-Infectious Cases: Analysis of 3741 Procedures

“…We used a stepwise approach starting with non-powered mechanical telescoping polypropylene sheaths (Byrd Dilator Sheaths, Cook Medical Inc., Bloomington, IN, USA) of all sizes and lengths. The second-line tools were powered mechanical sheath systems (Evolution Mechanical Dilator Sheaths, Cook Medical, Bloomington, IN, USA; Tigh-tRail Mechanical Rotating Dilator Sheaths, Phillips, Colorado Springs, CO, USA) or metal sheaths if the obstacle was near the venous entry site and subclavian region as previously described [13][14][15][16]19].…”

“…Standard stylets or locking stylets (Liberator Locking Stylets, Cook Medical Inc., Bloomington, IN, USA) were used, the latter ones for extraction of the oldest leads. Screwout and simple traction were very rarely used because preserved or re-established venous access was important for implantation of a new or temporary pacing lead [13][14][15][16]19].…”

“…The lasso or basket catheter served as an extension of the fractured lead, and the extraction procedure was continued until the lead was removed. If the distal fragments were unable to be taken out, the procedure was deemed as either a partial radiographic success or having a lack of radiographic success; thus, procedural success was dependent on lead remnant length and infection presence [13][14][15][16]19,26]. This was our working hypothesis that needed to be verified.…”

“…The goal of TLE is to remove all targeted leads in their entirety with a minimal risk of major complications [1][2][3]. Fracture of the lead during the removal procedure is not a rare complication (a few percent) [4][5][6][7][8][9][10][11], but only several papers [12][13][14] and case reports have addressed the strategy of lead fracture management [15][16][17][18][19]. Furthermore, little attention has been paid to the predictive role of incomplete lead extraction [20][21][22].…”

Unexpected Procedure Difficulties Increasing the Complexity of Transvenous Lead Extraction: The Single Centre Experience with 3721 Procedures

“…As a consequence, the duration of extraction and fluoroscopy use was longer than usual [9][10][11][12][13][14][15][16][17]. However, the occurrence and significance of unforeseen obstacles/procedure difficulties such as blockages in the lead implant vein/subclavian region [19][20][21], polypropylene dilator collapse/fracture [21,22], lead-to-lead adhesion [23][24][25][26][27], lead fracture during extraction [25][26][27][28][29][30][31][32][33][34], the use of an alternative venous approach [16,21,[24][25][26][27][28][29][30][31][32]34], the loss of a broken lead fragment [34][35][36][37][38][39], or the dislodgement of functional lead have been described in case reports, but never in...…”