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

Abstract

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.

Transvenous lead extraction in children with bidirectional rotational dissection sheaths

“…Clinical success was achieved in 97% of patients. This compares well with the results from previous studies with clinical success rates of 80%-98% in children or mixed cohorts and approximately 98% in large registries of adult patients reported in recent years (8,11,(14)(15)(16)(17).…”

“…Indications for lead extractions for adult patients have been recommended by current consensus statements (12,13). In children, however, data on transvenous lead extractions is limited to a small number of observational studies (14)(15)(16)(17)(18)(19)(20). Accordingly, due to the limited evidence, current consensus statements for CIED therapy in children have largely adopted recommendations on lead extractions from the experience in adult patients but emphasize important knowledge gaps (21).…”

“…Accordingly, due to the limited evidence, current consensus statements for CIED therapy in children have largely adopted recommendations on lead extractions from the experience in adult patients but emphasize important knowledge gaps (21). Comparable to adults, the use of various advanced extraction tools has been reported including radiofrequency, laser and mechanical powered sheaths (14,16,17,18,22). However, in particular data on the use of new generation mechanical rotational sheaths is limited to small numbers of pediatric patients (17,23,24).…”

“…Comparable to adults, the use of various advanced extraction tools has been reported including radiofrequency, laser and mechanical powered sheaths (14,16,17,18,22). However, in particular data on the use of new generation mechanical rotational sheaths is limited to small numbers of pediatric patients (17,23,24).…”

“…Procedural complexity of lead extraction and the need for advanced extraction techniques are associated with increasing lead age among other factors (16,19). The incidence of major complications of lead extractions in children is fortunately very low with reported rates of 0%-4% and exceptionally rare procedure related mortality (14)(15)(16)(17)(18)(19). With these considerations, it has become our institutional policy to attempt transvenous lead extraction in children whenever lead revision is required.…”