The GermAn Laser Lead Extraction RegistrY: GALLERY

Pecha, Simon; Bürger, H. C.; Chung, Da‐Un; Möller, V.; Madej, T.; Maali, Alaa; Osswald, Brigitte; Simone, Raffaele De; Monsefi, Nadeja; Ziaukas, V.; Erler, Stefan; Elfarra, H.; Perthel, M.; Wehbe, Mahmoud Sleiman; Ghaffari, N.; Sandhaus, T.; Busk, Henning; Schmitto, Jan D.; Bärsch, Volker; Easo, Jerry; Albert, Marc; Treede, Hendrik; Nägele, Herbert; Zenker, Dieter; Hegazy, Yasser G.; Ahmadi, Donja; Geßler, Nele; Ehrlich, W.; Romano, Gabriele; Knaut, Michael; Reichenspurner, Hermann; Willems, Stephan; Butter, Christian; Hakmi, Samer

doi:10.1093/europace/euac056

Cited by 23 publications

(34 citation statements)

References 22 publications

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“…17 Additionally, as proved by The GermAn Laser Lead Extraction RegistrY: GALLERY a lead dwell time ≥10 years was identified as an independent risk factor for procedural failure during laser lead extraction. 18 As observed by Nir Levi et al in lead fixation mechanism impacts outcome of TLE: data from the European Lead Extraction ConTRolled Registry: older age of ICD leads, a higher percentage of passive-fixation leads, and dual-coil ICD leads contributed to longer fluoroscopy time during extraction of ICD leads in group A compared with group B (3.3 min vs. 1.4 min, P < 0.001). 19 Additionally, in our study with 23 Sprint Fidelis leads, we observed complete procedural success in all cases with no major complications or procedure-related deaths regardless of the method of extraction.…”

Section: Discussionmentioning

confidence: 70%

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Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

et al. 2023

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Aims To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems. Methods and results Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B. Conclusion The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

et al. 2023

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“…In addition, we have shown a treatment algorithm for patients with device endocarditis requiring lead removal, pacemaker dependency and atrial fibrillation. Systemic device related infection represents a rare but serious complication of device therapy, associated with significant morbidity and mortality (10). In systemic device related infection, extraction of all lead material is recommended as a class I indication (11).…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive epicardial left-ventricular lead implantation and simultaneous left atrial appendage closure

Petersen

Alassar²,

Yıldırım³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAtrial fibrillation (AF) is common in patients with heart failure resulting in a high prevalence of AF in patients receiving Cardiac Resynchronization Therapy (CRT) implantation. In patients, unsuitable for transvenous left ventricular (LV)-lead implantation, epicardial LV-lead implantation represents a valuable alternative. Epicardial LV-lead placement can be achieved totally thoracoscopical or via minimally invasive left lateral thoracotomy. In patients with atrial fibrillation, concomitant left atrial appendage (LAA) clipping is feasible via the same access. Therefore, the aim of our study was the analysis of safety and efficacy of epicardial LV lead implantation and concomitant LAA clipping via minimally invasive left-lateral thoracotomy.MethodsBetween December 2019 and March 2022, 8 patients received minimally invasive left atrial LV-lead implantation with concomitant LAA closure using the AtriClip. Transesophageal echocardiography (TEE) was performed to intraoperatively guide and control LAA closure.ResultsMean patients age was 64 ± 11.2 years, 67% were male patients. Minimally invasive left-lateral thoracotomy was used in 6 patients while a totally thoracoscopic approach was performed in 2 cases. Epicardial lead implantation was successfully performed in all patients with good pacing threshold (mean 0.8 ± 0.2 V) and sensing values (10.1 ± 2.3 mV). Posterolateral position of the LV lead was achieved in all patients. Furthermore, successful LAA closure was confirmed during TEE in all patients. No procedure-related complications occurred in any of the patients. Two patients additionally received simultaneous laser lead extraction during the same procedure. Complete lead extraction was achieved in both patients. All patients were extubated in the OR and had an uneventful postoperative course.ConclusionOur study highlights a novel treatment approach for patients with atrial fibrillation and the necessity of epicardial LV leads. Placement of a posterolateral LV lead position with concomitant occlusion of the left atrial appendage via a minimally-invasive left-lateral thoracotomy or even a totally thoracoscopic approach is safe and feasible with superior cosmetic result and complete occlusion of the left atrial appendage.

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“…2 Major TLE procedural complications, including death, occur in 1%-2% of cases, and superior vena cava (SVC) tears have been reported in up to 1.8%. 1,3 Some authors suggest that risk factors for SVC tears are:…”

Section: Introductionmentioning

confidence: 99%

“…female sex, ICD leads and they may be more common with the use of laser sheaths. 3,4 Laceration of the SVC is the most lethal complication during TLE with a mortality as high as 50%. 5,6 Since rapid surgical intervention is required, a heart team approach is essential to handle this rare but potentially lethal complication.…”

Section: Introductionmentioning

confidence: 99%

Superior vena cava tear during transvenous lead extraction: Medical management in hemodynamically stable patients

Domain

Strubé

Jacques

et al. 2023

Pacing Clinical Electrophis

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Introduction Superior vena cava (SVC) tear is the most lethal complication during transvenous lead extraction (TLE) with a mortality rate as high as 50%. Treatment involves aggressive attempts to maintain cardiac output and immediate sternotomy to localize and repair the vascular tear. Occlusion balloons have been developed to provisionally occlude the lacerated SVC and to provide hemodynamic stability allowing time for surgery. In case of mediastinal hematoma without hemodynamic instability, the strategy remains unclear. Methods and Results We describe two cases of SVC tear during TLE. The first case was a 60‐year‐old man who presented with a right ventricular single‐chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28‐year‐old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual‐chamber defibrillator (ICD). Conclusion Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.

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The GermAn Laser Lead Extraction RegistrY: GALLERY

Cited by 23 publications

References 22 publications

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

Minimally invasive epicardial left-ventricular lead implantation and simultaneous left atrial appendage closure

Superior vena cava tear during transvenous lead extraction: Medical management in hemodynamically stable patients

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