'Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper' [Europace 2012;14:124-134. doi: 10.1093/europace/eur338]

Deharo, Jean Claude; Bongiorni, Maria Grazia; Rozkovec, A.; Bracke, Frank; Defaye, Pascal; Fernández‐Lozano, Ignacio; Golzio, Pier Giorgio; Hansky, Bert; Kennergren, Charles; Manolis, Antonis S.; Mitkowski, Przemysław; Platou, Eivind S.

doi:10.1093/europace/eus035

Cited by 39 publications

(57 citation statements)

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“…Clinical success was defined as the removal of all targeted leads and all lead material from the vascular space or retention of a small portion of the lead that does not negatively impact the outcome goals of the procedure. Any event occurring while the patient was in the operating room and all events related to the procedure occurring within 30 days were classified as intraprocedural complications or postprocedural complications, respectively …”

Section: Methodsmentioning

confidence: 99%

Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience

Mazzone

Melillo

Radinovic

et al. 2020

Journal of Arrhythmia

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Aim The aim of this study is to assess the safety and efficacy of the new bidirectional rotational mechanical sheath TightRail™ (Spectranetics) for lead extraction. Methods and results This is a bicentric prospective study that included patients who underwent a transvenous lead extraction (TLE) in two Italian centers (San Raffaele Hospital and Humanitas Gavazzeni Hospital). From November 2016 to December 2018, 26 patients underwent a TLE procedure in which the TightRail™ was used. The new TightRail Sub‐C was used in 20 (76%) patients to overcome the fibrosis between the vessel and the first rib. Median age was 69 (IQR 60.7‐79.5) years. The indication for TLE were infection (57.7%) or lead dysfunction (42.3%). A total of 57 leads (range 1‐4), 40 of which using the TightRail (range 1‐4), were extracted. Overall mean implant duration was 98.2.0 ± 66.5 months. Mean age of the lead extracted with the TightRail sheath was 99.1 ± 70.2 months and was higher compared to that of the leads extracted manually (84.4 ± 60.3 months, P = .001). The overall clinical success was 100% and complete procedural success without the use of a snare was achieved in 98.3%. There were no cases of death or major complications and only two minor complications occurred. All patients were event‐free at 6‐month follow‐up. Conclusion This initial experience using the TightRail™ suggests a high safety and efficacy profile for extractions in a wide range of lead age.

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Section: Methodsmentioning

confidence: 99%

Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience

Mazzone

Melillo

Radinovic

et al. 2020

Journal of Arrhythmia

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“…With regards to the approach to CIED removal, the percutaneous technique has emerged as the initial and preferred approach, even in patients with vegetations >10-20 mm in size [33][34][35], as long as it is performed in an experienced and recognized center with available cardiovascular surgical back-up [36]. An open surgical approach may be needed in patients with very large (>20-30 mm) lead-associated vegetations, in cases of failed, incomplete, or complicated percutaneous removal or when valve or other cardiac surgery is indicated for other reasons [35,37].…”

Section: Cied Removal and Lead Extractionmentioning

confidence: 99%

“…Prior to removal as much clinical and procedural data as possible should be garnered [31,36]. This should start with a detailed history and a complete physical examination.…”

Section: Cied Removal and Lead Extractionmentioning

confidence: 99%

“…Implantation reports providing data of device type and lead information will be helpful to assist in selection of proper extraction tools. Blood typing and crossmatch should be routinely performed [36].…”

Section: Cied Removal and Lead Extractionmentioning

confidence: 99%

“…The initial standard approach for percutaneous lead removal starts from the primary venous insertion site with use of a variety of extraction tools, including locking stylets and telescoping sheaths for traction and countertraction techniques [36]. However, occasionally extraction may need to be performed from the femoral or jugular vein with use of different set of lead grasping tools.…”

Section: Cied Removal and Lead Extractionmentioning

confidence: 99%

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Managing infected cardiovascular implantable electronic devices

Manolis¹,

Melita

2016

Continuing Cardiol Educ

Self Cite

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The number of cardiac implantable electronic device (CIED) implants is growing; unfortunately, the rate of device infections is also rising, outpacing the increase in device implantation and paralleling the complexity of current CIEDs and CIED recipients, incurring high morbidity and mortality, long hospital stays, and increased financial cost. For either pocket or lead infection, percutaneous complete removal of the infected device and lead system combined with prolonged antibiotic treatment is the standard approach to patient management. A variety of mechanical and/or laser‐assisted techniques and tools are employed with high success rates in experienced centers. Surgery is reserved for cases with very large vegetations, need for other concomitant cardiac surgery or for failed or complicated percutaneous approach. Following removal of an infected CIED, the need for reimplantation of a new device is individualized, although the timing is variable, mainly based on the absence of signs of continued infection. In general, CIED‐related infective endocarditis and the presence of comorbid conditions are associated with increased mortality. These and other important relevant issues of contemporary management of patients with infected CIEDs are herein reviewed. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4596336/Activity.aspx

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Predictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients

Isawa

Honda

Yamaya

et al. 2020

Journal of Arrhythmia

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Background Studies on femoral approach during transvenous lead extraction (TLE) are limited. Methods We retrospectively evaluated 75 patients undergoing TLE from September 2014 through November 2019 via supportive femoral approach (Femoral/Superior group; n = 22) and superior approach alone (Superior group; n = 53). Results No significant between‐group differences were observed regarding patients’ baseline characteristics except for a higher incidence of access vein occlusion in the Femoral/Superior group (59.1% vs. 31.4%; P = .037). The Femoral/Superior group exhibited significantly longer dwell times of the oldest extracted lead (median: 13.4 years; interquartile range [IQR]: 8.8‐21.2 years vs. median, 7.2 years; IQR: 3.7‐10.8 years; P < .001) and a higher incidence of passive fixation ventricular pacemaker lead (81.8% vs. 39.6%; P = .001). Multivariate logistic analysis showed that access vein occlusion (odds ratio [OR]: 4.07, 95% confidence interval [CI]: 1.08‐15.3; P < .001) and dwell time of the oldest extracted lead (per year) (OR: 1.22, 95% CI: 1.09‐1.37; P = .038) were predictors of the need for supportive femoral approach. Receiver operating characteristic curve analysis revealed that 11.8 years from implant was the cutoff for the need for supportive femoral approach (sensitivity 68.2%, specificity of 81.1%, area under the curve 0.81). Conclusions Access vein occlusion and long dwell time of the oldest extracted lead predict a high probability of the need for supportive femoral approach. Supportive femoral approach may be necessary in patients with leads that are implanted for >11.8 years and whose access veins are occluded.

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'Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper' [Europace 2012;14:124-134. doi: 10.1093/europace/eur338]

Cited by 39 publications

References 0 publications

Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience

Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience

Managing infected cardiovascular implantable electronic devices

Predictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients

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