The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease

McCanta, Anthony C.; Tanel, Ronn E.; Gralla, Jane; Runciman, D.M.I.; Collins, Kathryn K.

doi:10.1111/pace.12282

Cited by 15 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8-12,21-26 Even an adequate amount of slack does not help avoid strain on the lead (as previously thought), and lead adhesion to cardiac structures makes the extraction procedure more difficult (Figures 1-3). [8][9][10][11][12][21][22][23][24][25][26] Although not confirmed in the present study, differences in the type of pacing systems possibly affect the level of difficulty and complexity of the procedure. Implant duration before TLE is considered the most significant risk factor for major complications and procedure difficulty.…”

Section: Discussioncontrasting

confidence: 68%

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―

Kutarski

Miszczak-Knecht

Brzezinska

et al. 2023

Circ J

View full text Add to dashboard Cite

Background: Cardiac implantable electronic devices (CIED) are very rare in the pediatric population. In children with CIED, transvenous lead extraction (TLE) is often necessary. The course and effects of TLE in children are different than in adults. Thus, this study determined the differences and specific characteristics of TLE in children vs. adults. Methods and Results:A post hoc analysis of TLE data in 63 children (age ≤18 years) and 2,659 adults (age ≥40 years) was performed. The 2 groups were compared with respect to risk factors, procedure complexity, and effectiveness. In children, the predominant pacing mode was a single chamber ventricular system and lead dysfunction was the main indication for lead extraction. The mean implant duration before TLE was longer in children (P=0.03), but the dwell time of the oldest extracted lead did not differ significantly between adults and children. The duration (P=0.006) and mean extraction time per lead (P<0.001) were longer in children, with more technical difficulties during TLE in the pediatric group (P<0.001). Major complications were more common, albeit not significantly, in children. Complete radiographic and procedural success were significantly lower in children (P<0.001).Conclusions: TLE in children is frequently more complex, time consuming, and arduous, and procedural success is more often lower. This is related to the formation of strong fibrous tissue surrounding the leads in pediatric patients.

show abstract

Section: Discussioncontrasting

confidence: 68%

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―

Kutarski

Miszczak-Knecht

Brzezinska

et al. 2023

Circ J

View full text Add to dashboard Cite

show abstract

“…Children and juveniles with leads implanted in childhood form a specific group of patients from the viewpoint of lead management and lead extraction in particular. Based on previous reports, the importance of rapid lead-induced tissue scarring and calcification has been emphasized 1 – 7 . The formation of this fibrous capsule in combination with somatic growth is a common source of mechanical lead damage and more difficult extraction in children than in adults 5 – 10 .…”

Section: Introductionmentioning

confidence: 99%

Disparities in transvenous lead extraction in young adults

Kutarski

Jacheć

Tułecki

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Adults with cardiac implantable electronic devices (CIEDs) implanted at an early age constitute a specific group of patients undergoing transvenous lead extraction (TLE). The aim of this study is to assess safety and effectiveness of TLE in young adults. A comparative analysis of two groups of patients undergoing transvenous lead extraction was performed: 126 adults who were 19–29 years old at their first CIED implantation (early adulthood) and 2659 adults who were > 40 years of age at first CIED implantation and < 80 years of age at the time of TLE (middle-age/older adulthood). CIED-dependent risk factors were more common in young adults, especially longer implant duration (169.7 vs. 94.0 months). Moreover younger age of patients at first implantation, regardless of the dwell lead time, is a factor contributing to the greater development of connective tissue proliferation on the leads (OR 2.587; p < 0.001) and adhesions of the leads with the heart structures (OR 3.322; p < 0.001), which translates into worse TLE results in this group of patients. The complexity of procedures and major complications were more common in younger group (7.1 vs. 2.0%; p < 0.001), including hemopericardium (4.8 vs 1.3; p = 0.006) and TLE-induced tricuspid valve damage (3.2 vs.0.3%; p < 0.001). Among middle-aged/older adults, there were 7 periprocedural deaths: 6 related to the TLE procedure and one associated with indications for lead removal. No fatal complications of TLE were reported in young adults despite the above-mentioned differences (periprocedural mortality rate was comparable in study groups 0.3% vs 0.0%; p = 0.739). Predictors of TLE-associated major complications and procedure complexity were more likely in young adults compared with patients aged > 40 to < 80 years. In younger aged patients prolonged extraction duration and higher procedure complexity were combined with a greater need for second line tools. Both major and minor complications were more frequent in young adults, with hemopericardium and tricuspid valve damage being predominant.

show abstract

“…Previous reports indicated that the dislodgement of nontargeted leads during TLE procedures was a risk factor for major complications . The latest report indicated that a rate of dislodgement of nontargeted leads was 1.2% during the procedure .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience

Higuchi

Shoda

Saito

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background A challenging decision exists as whether to abandon or remove noninfectious superfluous leads during lead revisions or cardiac implantable electronic device (CIED) upgrades. There is insufficient data in the Asian population to guide decision making. Methods This study investigated the safety and efficacy of transvenous lead extractions (TLEs) in a high‐volume Japanese center. Among a total of 341 patients who underwent lead revisions or CIED upgrades between 2008 and 2018, 53 patients (16%) who underwent TLEs to remove the superfluous leads were analyzed. Results Indications for TLE were vascular issues (60%), recalled leads (21%), growth of the body size (6%), abandoned leads in young patients (6%), switch to a subcutaneous implanted cardiac defibrillator (4%), need for an MRI conditional CIED (2%), and risks of vascular injury (2%). The population included 29 patients (55%) with nonfunctional leads and 24 (45%) with functional abandoned leads. A total of 74 target leads (mean 1.4 leads/person, median lead age 6.7 years) were extracted with a complete removal achieved in 98%. All coexisting leads, intended for continued use, were not damaged. All new leads (mean 1.4 leads/person) that had been simultaneously implanted during the TLE procedures were successfully implanted. There was one minor complication (2%) involving a pericardial effusion but it did not affect the hemodynamics. Conclusions In this Japanese single center experience, the removal of noninfectious superfluous leads with TLEs seemed to be a safe and effective therapeutic option.

show abstract

The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease

Cited by 15 publications

References 15 publications

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―

Disparities in transvenous lead extraction in young adults

Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience

Contact Info

Product

Resources

About

The Fate of Nontargeted Endocardial Leads during the Extraction of One or More Targeted Leads in Pediatrics and Congenital Heart Disease

Cited by 15 publications

References 15 publications

Transvenous Lead Extraction in Pediatric Patients ― Is It the Same Procedure in Children as in Adults? ―

Transvenous Lead Extraction in Pediatric Patients ― Is It the Same Procedure in Children as in Adults? ―

Disparities in transvenous lead extraction in young adults

Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: A single‐center experience

Contact Info

Product

Resources

About

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―

Transvenous Lead Extraction in Pediatric Patients　― Is It the Same Procedure in Children as in Adults? ―