The challenges of transvenous lead extraction

Maytin, Melanie; Epstein, Laurence M.

doi:10.1136/hrt.2009.189910

Cited by 51 publications

(38 citation statements)

References 24 publications

(23 reference statements)

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“…and with ICD lead failure or infections. When lead failures or infections occur, transvenous lead extraction may be necessary with reimplantation of a new system; this procedure is highly challenging with major complication rates of about 1% and a mortality risk of 0.3% also in experienced centers [3,4]. Subcutaneous ICD lead has no requirement for a stylet to aid placement; thus, it has no lumen, and it is not subjected to continuous movement and mechanical stress from cardiac structure.…”

Section: Discussionmentioning

confidence: 99%

“…When lead failures or infections occur, transvenous lead extraction may be necessary with reimplantation of a new system. This procedure is highly challenging with major complication rates of about 1% and a mortality risk of 0.3% also in experienced centers [3,4]. An entirely subcutaneous ICD system (S-ICD, Cameron Health, Inc., San Clemente, CA, USA) was recently approved by the European Community and marketed in European countries; this system avoids the need for the placement of electrodes within the heart and can provide clinical advantages, especially among some subgroups of patients.…”

Section: Introductionmentioning

confidence: 99%

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Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art

Maria

Bonetti

Patrizi

et al. 2011

J Interv Card Electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art

Maria

Bonetti

Patrizi

et al. 2011

J Interv Card Electrophysiol

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“…This is referred to as the 'rail effect'. 2 In order for a lead to serve as an adequate rail it is important for the operator to have control over the complete length of a targeted lead from the proximal end to the distal tip of the lead. There are different locking stylets available to support lead control and the rail effect of a targeted lead.…”

Section: Introductionmentioning

confidence: 99%

Compression coil provides increased lead control in extraction procedures

Starck¹,

Stepuk²,

Holubec³

et al. 2014

Europace

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AIMS: We investigated a new lead extraction tool (Compression Coil; One-Tie, Cook Medical) in an experimental traction force study. METHODS AND RESULTS: On 13 pacemaker leads (Setrox JS53, Biotronik) traction force testing was performed under different configurations. The leads were assigned to three groups: (i) traction force testing without central locking stylet support (n = 5), (ii) traction force testing with the use of a locking stylet (Liberator, Cook Medical) and a proximal ligation suture (n = 4), (iii) traction force testing with the use of a locking stylet and a compression coil (n = 4). The following parameters were obtained for all groups: stress-strain curves, maximal forces, elastic modulus, post-testing lead length and lead elongation. In Groups 2 and 3 retraction of the locking stylet within the lead was measured [lead tip-locking stylet distance (LTLSD)]. Maximal forces for the three groups were: (i) 28.3 ± 0.3 N; (ii) 30.6 ± 3.0 N; (iii) 31.6 ± 2.9 N (1 vs. 2, P = 0.13; 1 vs. 3, P = 0.04; 2 vs. 3, P = 0.65). Elastic modulus was (i) 22.8 ± 0.1 MPa; (ii) 2830.8 ± 351.1 MPa; (iii) 2447.0 ± 510.5 MPa (1 vs. 2, P < 0.01; 1 vs. 3, P < 0.01; 2 vs. 3, P = 0.26). Mean LTLSD in Group 2 was 19.8 ± 3.2 cm and was 13.8 ± 1.7 cm in Group 3 (P = 0.02). The ratio of LTLSD/post-testing lead length was 0.37 ± 0.03 for Group 2 and 0.24 ± 0.03 for Group 3 (P < 0.01). CONCLUSION: The application of a compression coil leads to an increased lead control expressed by less retraction of the locking stylet within the lead. This enables improved central support of extraction sheaths in the case of challenging extraction procedures. AimsWe investigated a new lead extraction tool (Compression Coil; One-Tie, Cook Medical) in an experimental traction force study. Methods and resultsOn 13 pacemaker leads (Setrox JS53, Biotronik) traction force testing was performed under different configurations. The leads were assigned to three groups: (i) traction force testing without central locking stylet support (n ¼ 5), (ii) traction force testing with the use of a locking stylet (Liberator, Cook Medical) and a proximal ligation suture (n ¼ 4), (iii) traction force testing with the use of a locking stylet and a compression coil (n ¼ 4). The following parameters were obtained for all groups: stress-strain curves, maximal forces, elastic modulus, post-testing lead length and lead elongation. In Groups 2 and 3 retraction of the locking stylet within the lead was measured [lead tip-locking stylet distance (LTLSD)]. Maximal forces for the three groups were: (i) 28.3 + 0.3 N; (ii) 30.6 + 3.0 N; (iii) 31.6 + 2.9 N (1 vs. 2, P ¼ 0.13; 1 vs. 3, P ¼ 0.04; 2 vs. 3, P ¼ 0.65). Elastic modulus was (i) 22.8 + 0.1 MPa; (ii) 2830.8 + 351.1 MPa; (iii) 2447.0 + 510.5 MPa (1 vs. 2, P , 0.01; 1 vs. 3, P , 0.01; 2 vs. 3, P ¼ 0.26). Mean LTLSD in Group 2 was 19.8 + 3.2 cm and was 13.8 + 1.7 cm in Group 3 (P ¼ 0.02). The ratio of LTLSD/post-testing lead length was 0.37 + 0.03 for Group 2 and 0.24 + 0.03 for Group 3 (P , 0.01). ConclusionThe app...

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“…The exponential increase in TLE has similarly been described by a number of experts and highvolume centers. 1,[5][6][7][8] The patients were mostly male and white, mirroring the overall device population. More than 61% of extractions were performed for noninfectious indications.…”

Section: Article See P 2363mentioning

confidence: 99%