Nonthoracotomy Implantable Defibrillator Lead Extraction:

Abstract

Extraction of pacemaker leads has been demonstrated to be successful and safe in experienced hands using current tools. Whether application of such techniques and tools yield similar results among patients undergoing extraction of nonthoracotomy implantable defibrillator leads is unknown. This report describes a retrospective analysis of indications, techniques used, and outcome of patients who had a single ventricular nonthoracotomy implantable defibrillator lead extracted at The Cleveland Clinic Foundation. Results were compared to a matched population of patients undergoing extraction of ventricular pacemaker leads from a national registry and to the experience with pacemaker lead extraction at The Cleveland Clinic Foundation. Successful complete extraction of ventricular nonthoracotomy implantable defibrillator leads, in the absence of major complications, was achieved in 96.9% of attempts to extract leads from 161 patients. Clinical success was achieved in 98.1% of patients. Failure occurred in three patients. Two patients had major complications, including one death. The most common indication for extraction was infection (46.6%), followed by lead failure (34.2%). Procedure (140.8 vs 171.2 minutes, P<0.01) and fluoroscopy (9.9 vs 11.0 minutes, P<0.01) times compared favorably with those obtained from the pacemaker lead extraction database. Use of LASER did not influence the safety of the procedure or fluoroscopy times. Extraction of ventricular nonthoracotomy implantable defibrillator leads using currently available tools is a complex but effective procedure. In experienced hands, excellent success rates should be achieved with a low incidence of complications.

Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction

“…Still, it is vital that these injuries be avoided. As indicated by the MAUDE data and multiple studies, 19,24,25 the innominate vein–superior vena cava–high right atrium is a region of great risk for fatal extraction injuries. Local tissue factors, such as calcification and infection, or the presence of other leads may confound the best available techniques, and operators must know when to stop the extraction and use a different approach such as another tool, surgery, or simply abandoning the lead.…”

“…A single-centre's retrospective study reported one fatality during laser-assisted extraction of 91 ICD leads; this death was caused by a superior vena cava–right atrial tear despite immediate thoracotomy. 25 …”

The Growing Mismatch Between Patient Longevity and the Service Life of Implantable Cardioverter-Defibrillators

“…More than one-half of all pacemaker and ICD infections occur after replacement procedures (15). An ICD infection often requires complex lead extraction that is associated with significant morbidity and mortality (16). Thus, pulse generator replacement is not desirable except in patients whose clinical circumstances warrant the risks and costs of upgrading to a new model.…”

Lead Extraction in Pediatric and Congenital Heart Disease Patients

“…Several large series have investigated the different lead extraction techniques and their safety and efficacy in adult patients without CHD. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, data on lead extraction in pediatric and CHD patients remain limited. [15][16][17][18] …”