Europace Advance Access originally published online on March 27, 2009
Europace 2009 11(5):612-617; doi:10.1093/europace/eup054
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Leads and Lead Extraction
A single-centre experience of over one thousand lead extractions
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
Aims: The aim of the study was to present a single-centre experience of pacemaker and implantable cardioverter defibrillator (ICD) lead extraction using different methods, mainly laser-assisted extraction.
Methods and results: Data from 1032 leads and 647 procedures were gathered. A step-by-step approach using different techniques while performing an ongoing risk–benefit analysis was used. The most common indications were local infection, systemic infection, non-functional lead, elective lead replacement, and J-wire fracture. Mean implantation time for all leads was 69 months and for laser-extracted leads 91 months. Laser technique was used to extract 60% of the leads, 29% were manually extracted, 6% extracted with mechanical tools, 4% were surgically removed, and 0.6% extracted by a femoral approach. Failure rate was 0.7%, and major complication rate was 0.9%. No extraction-related mortality occurred. Median time for laser extraction was 2 min. Long implantation time was not a risk factor for failure or for complication.
Conclusion: Pacing and ICD leads can safely, successfully, and effectively be extracted. Leads can often be extracted by a superior transvenous approach; however, open-chest and femoral extractions are still required. Laser-assisted lead extraction proved to be a useful technique to extract leads that could not be removed by manual traction. The results indicate that the paradigm of abandoning redundant leads, instead of removing them, may have to be reconsidered.
Key Words: Lead extraction, Laser, Infection, Non-functional leads, Recalled leads, Risk factors
* Corresponding author. Tel: +46 31 342 1000, Fax: +46 31 417 991, Email: charles.kennergren{at}vgregion.se
Present address. CardioNord AB, Stockholm, Sweden.
Manuscript submitted 4 November 2008. Accepted after revision 2 February 2009.
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Related articles in Europace:
- Yes we can! But should we? Lead extraction for superfluous pacemaker and implanted cardioverter-defibrillator leads
- Frank A. Bracke
Europace 2009 11: 546-547.[FREE Full Text]
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  F. A. Bracke Yes we can! But should we? Lead extraction for superfluous pacemaker and implanted cardioverter-defibrillator leads Europace, May 1, 2009; 11(5): 546 - 547. [Full Text] [PDF]
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