Predictors and outcomes of lead extraction requiring a bailout femoral approach: Data from 2 high-volume centers

El‐Chami, Mikhael F.; Merchant, Faisal M.; Waheed, Anam; Khattak, Furqan; El-Khalil, Jad; Patel, Anamika; Sayegh, Michael N.; Desai, Yaanik; León, Angel R.; Saba, Samir

doi:10.1016/j.hrthm.2017.01.029

Cited by 16 publications

(23 citation statements)

References 17 publications

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“…These marked differences between our bailout transfemoral lead extraction cohort and that described by El‐Chami most likely explains the higher procedural major complication and mortality rates in our cohort (10/104, 9.6% vs 0/50, 0%) . Whilst El‐Chami et al did not perform regression analysis to assess independent predictors of bailout transfemoral extraction, they did conclude from analysis of their outcomes similar findings to the present study that longer lead dwells times and greater number of leads extracted were significantly higher in the bailout femoral group compared to their nonfemoral group . Additionally, they found that infection indication was significantly higher in the bailout femoral group …”

Section: Discussionsupporting

confidence: 52%

“…El-Chami et al previously collated two registries to assess predictors and outcomes of the bailout femoral approach. 16 A total of 50/1080 (4.6%) patients required a bailout transfemoral lead extraction in their study compared to 104/1038 (10.0%) in the present study. 16 Patients undergoing bailout transfemoral extraction in our cohort had longer lead dwell times (11.8 ± 9.6 vs 9.5 ± 6.0 years), more leads extracted per procedure (2.8 ± 1.3 vs 2.0 ± 1.0) and a distinctly lower clinical failure rate (3.8% vs 24%) compared to their combined cohort.…”

Section: Predictors Of Bailout Transfemoral Lead Extractioncontrasting

confidence: 51%

“…Similarly, in ELECTRa a femoral approach was associated with a higher incidence of procedure related major complications including mortality (OR 3.6) without an increase in all‐cause mortality, as in the present study. El‐Chami et al previously collated two registries to assess predictors and outcomes of the bailout femoral approach . A total of 50/1080 (4.6%) patients required a bailout transfemoral lead extraction in their study compared to 104/1038 (10.0%) in the present study .…”

Section: Discussionmentioning

confidence: 52%

“…Patients undergoing bailout transfemoral extraction in our cohort had longer lead dwell times (11.8 ± 9.6 vs 9.5 ± 6.0 years), more leads extracted per procedure (2.8 ± 1.3 vs 2.0 ± 1.0) and a distinctly lower clinical failure rate (3.8% vs 24%) compared to their combined cohort . These marked differences between our bailout transfemoral lead extraction cohort and that described by El‐Chami most likely explains the higher procedural major complication and mortality rates in our cohort (10/104, 9.6% vs 0/50, 0%) . Whilst El‐Chami et al did not perform regression analysis to assess independent predictors of bailout transfemoral extraction, they did conclude from analysis of their outcomes similar findings to the present study that longer lead dwells times and greater number of leads extracted were significantly higher in the bailout femoral group compared to their nonfemoral group .…”

Section: Discussionmentioning

confidence: 63%

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Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

Gould

Sidhu

Porter

et al. 2019

Pacing Clinical Electrophis

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Background Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P < .001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P < .001), 30‐day procedure related major complications (including deaths) (8.5% vs 1.1%, P < .001) and emergency thoracotomy rates (4.2% vs 0.7%, P = .007). All‐cause 30‐day mortality rates were similar between groups (3.4% vs 2.0%, P = .315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion Femoral approach TLE is associated with increased risk of 30‐day procedure related major complications but not 30‐day all‐cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high‐volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

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Section: Discussionsupporting

confidence: 52%

Section: Predictors Of Bailout Transfemoral Lead Extractioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 63%

See 2 more Smart Citations

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

Gould

Sidhu

Porter

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…[6][7][8][9][10] While FLE is used by some operators as a primary method for LE, 11 it is often used as a bailout after failure of the traditional approach for LE; hence it selects for more challenging and difficult procedures, such as in patients with leads of longer dwell time or multiple leads. 12 For example, FLE is required in up to 18% of patients with abandoned leads 13 and in 9.5% of young adults, a population that tends to have higher degrees of lead fibrosis and may pose greater extraction complexity. 5 Familiarity with femoral extraction is essential for a comprehensive skill set in lead management.…”

Section: Introductionmentioning

confidence: 99%

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

El‐Chami

Merchant

2019

Pacing Clinical Electrophis

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Extraction of transvenous leads via the femoral route might be needed when extraction via the implant vein fails or when retained lead fragments exist. The skill set required for this procedure is unique as it relies on the ability to snare and the use of a variety of shelf tools. In this era of leadless pacing, this skill set might be called upon more frequently. In this article, we review the data, tools, and procedural steps of femoral lead extraction and retrieval/extraction of leadless pacemakers.

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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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Predictors and outcomes of lead extraction requiring a bailout femoral approach: Data from 2 high-volume centers

Cited by 16 publications

References 17 publications

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

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

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

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