Transvenous extraction of pacemaker leads via femoral approach using a gooseneck snare

Abstract Background Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads. Methods We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations. Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical) or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead. Results A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37 (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in 93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p < 0.001). Conclusion Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.

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Late complications from pacemaker leads implanted via jugular vein access

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297769 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Burger ◽

SK Schmidt ◽

G Goebel ◽

W Ehrlich ◽

T Walther ◽

...

Keyword(s):

Jugular Vein ◽

Late Complications ◽

Vein Access ◽

Pacemaker Leads

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Systemic Infection Related to Endocarditis on Pacemaker Leads

Circulation ◽

10.1161/01.cir.95.8.2098 ◽

1997 ◽

Vol 95 (8) ◽

pp. 2098-2107 ◽

Cited By ~ 371

Author(s):

Didier Klug ◽

Dominique Lacroix ◽

Christine Savoye ◽

Luc Goullard ◽

Daniel Grandmougin ◽

...

Keyword(s):

Systemic Infection ◽

Pacemaker Leads

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Ratchet mechanism selectively causing idiopathic macrodislodgement of an active-fixation coronary sinus lead: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa466 ◽

2020 ◽

Author(s):

Pier Giorgio Golzio ◽

Arianna Bissolino ◽

Raffaele Ceci ◽

Simone Frea

Keyword(s):

Coronary Sinus ◽

Pulse Generator ◽

Thoracic Inlet ◽

Ratchet Mechanism ◽

Active Fixation ◽

First Case ◽

Time In Literature ◽

Pacemaker Leads ◽

Coronary Sinus Lead ◽

Arm Motion

Abstract Background ‘Idiopathic’ lead macrodislodgement may be due to Twiddler’s syndrome depending on active twisting of pulse generator within subcutaneous pocket. All leads are involved, at any time from implantation, and frequently damaged. In the past few years, a reel syndrome was also observed: retraction of pacemaker leads into pocket without patient manipulation, owing to lead circling the generator. In other cases, a ‘ratchet’ mechanism has been postulated. Reel and ratchet mechanisms require loose anchoring, occur generally briefly after implantation, with non-damaged leads. We report the first case of an active-fixation coronary sinus lead selective macrodislodgement involving such ratchet mechanism. Case summary A 65-year-old man underwent biventricular defibrillator device implantation, with active-fixation coronary sinus lead. Eight months later, he complained of muscle contractions over device pocket. At fluoroscopy, coronary sinus lead was found near to pocket, outside of thoracic inlet. Atrial and ventricular leads were in normal position. After opening pocket, a short tract of coronary sinus lead appeared anteriorly dislocated to generator, while greater length of lead body twisted a reel behind. The distal part of lead was found outside venous entry at careful dissection. Atrial and ventricular leads were firmly anchored. Discussion Our case is a selective ‘Idiopathic’ lead macrodislodgement, possibly due to a ratchet mechanism between the lead and the suture sleeve, induced by normal arm motion; such mechanism incredibly, and for first time in literature involves a coronary sinus active-fixation lead. Conclusion Careful attention should always be paid to secure anchoring even of active-fixation coronary sinus leads.

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