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Europace 2009 11(2):213-215; doi:10.1093/europace/eun374
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Leads and Lead Extraction

Extraction of chronic pacemaker and defibrillator leads from the coronary sinus: laser infrequently used but required

Shoaib Hamid1,*, Aruna Arujna1, Sitara Khan1, Andrew Ladwiniec1, Mark McPhail1, Julian Bostock1, Margaret Mobb1, Nik Patel2, Cliff Bucknall1 and Christopher A. Rinaldi1

1 St Thomas’ Hospital, London, UK; 2 Eastbourne District Hospital, Eastbourne, UK

Aims: Cardiac resynchronization therapy is an accepted treatment for heart failure but it may be necessary to explant these systems along with their leads. The evidence base for coronary sinus (CS) lead extractions is limited. We aimed to evaluate the percutaneous removal of these leads and the utility of laser extraction when necessary.

Methods and results: Of 265 patients referred for lead extraction between January 2004 and June 2008, 32 (12.1%) involved CS leads (30 males, mean age 67 years). Mean implantation time was 26.5 ± 28.7 months (range 1–116 months). Indications for extraction were pocket infection (34.4%), lead malfunction (43.8%), skin erosion (15.6%), and endocarditis (6.2%). Twenty-eight (87.5%) CS leads were removed with manual traction, with laser utilized in four cases (12.5%). No major complications of CS laceration, pericardial effusion, emergency surgery, or death occurred.

Conclusion: Our experience supports the percutaneous extraction of CS leads as a safe and effective procedure including the utility of laser when necessary.

Key Words: Cardiac resynchronization therapy, Lead extraction, Pacing complications

* Corresponding author. Tel: +44 20 71887313, Email: shoaibhamid{at}hotmail.com

Manuscript submitted 21 August 2008. Accepted after revision 8 December 2008.


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